Pharmacological Interventions to Improve Muscle Mass, Muscle Strength and Physical Performance in Older People: An Umbrella Review of Systematic Reviews and Meta-analyses

Anton De Spiegeleer, David Beckwée, Ivan Bautmans, Mirko Petrovic, the Sarcopenia Guidelines Development group of the Belgian Society of Gerontology and Geriatrics (BSGG)

Sarcopenia, defined as the pathological decline in muscle mass, muscle strength and physical performance with aging, has become one of the geriatric giants because of its increasing prevalence and devastating health effects. The Belgian Society of Gerontology and Geriatrics (BSGG) is currently developing evidence-based guidelines for the prevention and therapy of sarcopenia for use in broad clinical practice. This systematic review summarizes the results of the Working Group on Pharmacology. Our objective was to provide an evidence-based overview of the possible pharmacological interventions for sarcopenia with a focus on interventions that have already been studied in systematic reviews or meta-analyses. We conducted a systematic umbrella review. Using the electronic databases PubMed and Web of Science, we identified systematic reviews and meta-analyses that assessed the effect of pharmacological interventions on criteria for sarcopenia in subjects aged ≥ 65 years. Study selection, quality assessment and data extraction were performed by two independent reviewers. We identified seven systematic reviews or meta-analyses, encompassing ten pharmacological interventions: vitamin D, combined estrogen-progesterone, dehydroepiandrosterone, growth hormone, growth hormone-releasing hormone, combined testosterone-growth hormone, insulin-like growth factor-1, pioglitazone, testosterone and angiotensin-converting enzyme inhibitors. Importantly, very few systematic reviews or meta-analyses clearly mentioned baseline sarcopenia status. Therefore, our recommendations are generalised to older people, without specifying whether the muscle effect is more effective in healthy, pre-sarcopenic or sarcopenic older people. Vitamin D had a significant effect on muscle strength and physical performance, especially in women with low baseline values (< 25 nmol/l). Adverse events were rare. Testosterone had a strong effect on muscle mass and a modest to minimal effect on muscle strength and physical performance, respectively, when supplementing men with low serum levels (< 200-300 ng/dl). The adverse events were rare and mild. Insufficient evidence was available to recommend other pharmacological interventions. Only vitamin D, especially in older women, and testosterone in older men with clinical muscle weakness and low testosterone serum levels can be justified in daily clinical practice to improve muscle mass, muscle strength and/or physical performance.