Sarcopenia: What is it and What Does it Have to Do With My Joints?

Sarcopenia may sound like a mythical place, but it is far from somewhere we may want to go. The term sarcopenia, is derived from ancient Greek with sarx, meaning “flesh” and penia, “poverty”.  While the exact link between sarcopenia and joints has been difficult to identify, the connection is real.

What is sarcopenia?

So exactly what is sarcopenia? Sarcopenia is a type of muscle loss, called atrophy, which has been associated with aging and immobility. Sarcopenia is a progressive and generalized skeletal muscle disorder that is associated with an increased likelihood of adverse outcomes including falls, fractures, physical disability, and mortality.1 Frailty is also associated with sarcopenia and falls, and both are predictors of negative health outcomes such as falls, disability, hospitalization, and death.2

Loss of muscle mass occurs with aging, mainly due to loss of motor neurons and reduced muscle fiber number and size. Muscle function decreases as loss progresses and is not able to be compensated for by remaining motor neurons.  This results in cellular changes in muscle cells and the loss of cellular coordinated cell function.3

Sarcopenia results in a progressive and generalized loss of skeletal muscle mass and strength. It may lead to outcomes such as physical disability and poor quality of life. According to the European Working Group on Sarcopenia in Older People (EWGSOP), sarcopenia is now considered a muscle disease (muscle failure), with low muscle strength the principal determinant of disease.1  

Sarcopenia has a strong correlation with falls and fractures in older adults according to a meta-analysis of research studies. 4   It is also correlated with all types of falls in older adults with fragility hip fractures. 5 One study looked at associations of accelerometer-determined time (an instrument measuring acceleration and velocity over time) and sedentary behavior, light physical activity, and moderate-to-vigorous physical activity with sarcopenia and the incidence of falls over 12 months. Only higher amounts of accelerometer-determined time (vigorous physical activity) were consistently associated with a decreased likelihood of sarcopenia and its components, regardless of the length of bouts or amounts of sedentary behavior.6

What does sarcopenia have to do with your joints?

The ability of our joints to move in a specific direction is determined by the shape of the joint surface and the surrounding muscles or ligaments. Lack of muscle strength or tone may be due to disease, poor nutrition, injury, certain medications, lack of use, or other environmental factors.

Joint, muscle diseases, or neurological diseases can impact our mobility. Sarcopenia is a factor in various joint diseases. Both sarcopenia and many joint diseases stem from inflammation. Inflammatory joint diseases as well as diet and lifestyle affect the health and interplay of muscles and joints as well as the risk of sarcopenia.

Osteoarthritis (OA) has been compared to organ failure of the synovial joint. Muscles play a major role in joint function. Muscle loss (atrophy) and the lack of ability to rebuild muscle can impair joint function. In OA, muscle weakness contributes to pain and disability. People with osteoarthritis undergoing joint replacement are at high risk of sarcopenia.7  In a large study, sarcopenia, alone, was not the sole risk factor for OA. Obesity also was a strong factor.8

It has been suggested that muscle wasting directly affects the stability of joints, and the loss of mobility leads to the gradual degeneration of joint cartilage.9 People with osteoarthritis undergoing joint replacement are at high risk of sarcopenia.7 Unfortunately, most of the research has yet to identify the molecular processes behind this although it has been suggested that there is communication between muscle cells and the synovial cells, cartilage, and bone in which messaging and chemical signals from muscle cells promote OA.9

Sarcopenia and osteoporosis are both common In Rheumatoid Arthritis (RA). Sarcopenia may be a risk factor for osteoporosis occurrence in individuals with RA.10 A study showed that RA patients have a higher prevalence of sarcopenia. 11  In  RA, the cause of muscle loss is due to chronic inflammation, decreased physical activity, chronic pain, and increased energy expenditure during rest.12 In RA patients, associated factors for sarcopenia include advanced age, body mass index (low weight, normal weight), elevated levels of an inflammatory marker called c-reactive protein (CRP), and decreased bone mass.13

Ankylosing spondylitis (AS) is a type of arthritis that affects the spine. It involves mainly the hip and the spinal skeleton, causing inflammation, stiffness, and pain. Individuals with AS are at risk of developing early sarcopenia.14

Sarcopenia is related to joint conditions
Joint conditions are related to sarcopenia

How to prevent sarcopenia:

Overall physical activity, sedentary time, cardiorespiratory fitness, and strength have been associated with the development of sarcopenia in older adults. Physically active adults, who maintain higher levels of cardiorespiratory fitness, upper and lower body strength, and avoid being sedentary may have significantly lower risks of developing sarcopenia. Preventing or managing sarcopenia requires both diet and lifestyle interventions. Here are some tips to prevent and address sarcopenia:

  • Optimize diet and nutrition– Nutrient intake is the most important anabolic stimulus for skeletal muscle.15  Nutritional status and a healthy diet are key to maintaining muscle strength, but alone it is insufficient. Both nutrition and exercise can work together to help prevent sarcopenia.
  • Optimize vitamin D levels-Low vitamin D is associated with many conditions including osteoporosis, osteomalacia, sarcopenia, and myalgia.16 Supplementation of vitamin D is often needed to optimize vitamin D levels.
  • Reduce sugar intake-High sugar and carb diets are associated with insulin resistance and the development of diabetes. People with type 2 DM have a high risk of sarcopenia. Increased nutrition counseling in outpatients was associated with less sarcopenia.17
  • Exercise regularly and reduce sedentary behaviors– Circuit exercise training over 12 weeks was found to improve muscle mass and strength, body composition, balance, and pulmonary function in women with sarcopenia. 18 Resistance exercises are also important as they increase myofibrillar muscle protein synthesis in both young and older individuals.15
  • Get quality sleep-Develop and maintain healthy sleep patterns. Excessive daytime sleepiness is associated with the number of falls in older individuals.19
  • Consider supplements- Collagen supplementation may be beneficial to help address sarcopenia and joint pain. One study demonstrated that supplementation with Type II collagen reduced pain decreased stiffness and improved joint mobility. 20 Another study, combined aerobic and resistance exercise training and amino acid, 5% leucine supplementation, indicating that this may help to maintain skeletal muscle protein synthesis and reduce loss of muscular strength.21
  • Seek the right resources and support – Achieving your health goals may take a variety of practitioners to help address physical, diet, and lifestyle factors that can influence the risk of or mitigate sarcopenia. Functional practitioners can help look at underlying factors such as nutrition, digestive issues, detoxification issues, toxin exposure, hormones, infection, energy imbalances, and neurological factors that may be contributing to the disease.
Physical Therapists and functional practitioners can help manage sarcopenia.


The research on sarcopenia supports the need to continue research, prevention, and management of sarcopenia to prevent falls, fractures, and decreasing mobility and strength due to aging and disease. Maintaining our muscle mass and strength is key to our well-being as we age and manage joint disease. Getting adequate support and coaching to address diet and lifestyle factors can help reduce the risk of sarcopenia.


1.          Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: Revised European consensus on definition and diagnosis. Age Ageing. 2019;48(1). doi:10.1093/ageing/afy169

2.          Marques A, Queirós C. Frailty, Sarcopenia and Falls. In: ; 2018. doi:10.1007/978-3-319-76681-2_2

3.          Larsson L, Degens H, Li M, et al. Sarcopenia: Aging-Related Loss of Muscle Mass and Function. Physiol Rev. 2019;99(1):427-511. doi:10.1152/physrev.00061.2017

4.          Yeung SSY, Reijnierse EM, Pham VK, et al. Sarcopenia and its association with falls and fractures in older adults: A systematic review and meta-analysis. J Cachexia Sarcopenia Muscle. 2019;10(3). doi:10.1002/jcsm.12411

5.          Lim SK, Beom J, Lee SY, et al. Association between sarcopenia and fall characteristics in older adults with fragility hip fracture. Injury. 2020;51(11). doi:10.1016/j.injury.2020.08.031

6.          Scott D, Johansson J, Gandham A, Ebeling PR, Nordstrom P, Nordstrom A. Associations of accelerometer-determined physical activity and sedentary behavior with sarcopenia and incident falls over 12 months in community-dwelling Swedish older adults: “Physical activity, sarcopenia, and falls. J Sport Health Sci. 2021;10(5). doi:10.1016/j.jshs.2020.01.006

7.          Lovett M, Negm A, Ioannidis G, et al. Identifying patients with osteoarthritis at risk of sarcopenia using the SARC-F. Canadian Geriatrics Journal. 2021;24(1). doi:10.5770/CGJ.24.479

8.          Misra D, Fielding RA, Felson DT, et al. Risk of Knee Osteoarthritis With Obesity, Sarcopenic Obesity, and Sarcopenia. Arthritis & Rheumatology. 2019;71(2):232-237. doi:10.1002/art.40692

9.          Shorter E, Sannicandro AJ, Poulet B, Goljanek-Whysall K. Skeletal Muscle Wasting and Its Relationship With Osteoarthritis: a Mini-Review of Mechanisms and Current Interventions. Curr Rheumatol Rep. 2019;21(8):40. doi:10.1007/s11926-019-0839-4

10.        Lian L, Wang JX, Xu YC, Zong HX, Teng YZ, Xu SQ. Sarcopenia May Be a Risk Factor for Osteoporosis in Chinese Patients with Rheumatoid Arthritis. Int J Gen Med. 2022;15. doi:10.2147/IJGM.S349435

11.        Giles JT, Ling SM, Ferrucci L, et al. Abnormal body composition phenotypes in older rheumatoid arthritis patients: Association with disease characteristics and pharmacotherapies. Arthritis Rheum. 2008;59(6):807-815. doi:10.1002/art.23719

12.        Espinoza G, Maldonado G, Narvaez J, Guerrero R, Citera G, Rios C. Beyond rheumatoid arthritis evaluation: What are we missing? Open Access Rheumatol. 2021;13. doi:10.2147/OARRR.S298393

13.        Mochizuki T, Yano K, Ikari K, Okazaki K. Sarcopenia-associated factors in Japanese patients with rheumatoid arthritis: A cross-sectional study. Geriatr Gerontol Int. 2019;19(9). doi:10.1111/ggi.13747

14.        Younis MM, Mayouf Albedri KZ. Prevalence of sarcopenia in adult patients with ankylosing spondylitis. Rheumatology (Bulgaria). 2021;29(2). doi:10.35465/29.2.2021.pp3-10

15.        MAKANAE Y, FUJITA S. Role of Exercise and Nutrition in the Prevention of Sarcopenia. J Nutr Sci Vitaminol (Tokyo). 2015;61(Supplement):S125-S127. doi:10.3177/jnsv.61.S125

16.        Kupisz-Urbańska M, Płudowski P, Marcinowska-Suchowierska E. Vitamin d deficiency in older patients—problems of sarcopenia, drug interactions, management in deficiency. Nutrients. 2021;13(4). doi:10.3390/nu13041247

17.        Chan LC, Yang YC, Lin HC, Wahlqvist ML, Hung YJ, Lee MS. Nutrition counseling is associated with less sarcopenia in diabetes: A cross-sectional and retrospective cohort study. Nutrition. 2021;91-92. doi:10.1016/j.nut.2021.111269

18.        Jung WS, Kim YY, Park HY. Circuit Training Improvements in Korean Women with Sarcopenia. Percept Mot Skills. 2019;126(5). doi:10.1177/0031512519860637

19.        Soysal P, Smith L, Tan SG, Capar E, Veronese N, Yang L. Excessive daytime sleepiness is associated with an increased frequency of falls and sarcopenia. Exp Gerontol. 2021;150. doi:10.1016/j.exger.2021.111364

20.        Lima RB de, Amaral CL, Minatti J. Collagen peptides combined with type II in joint pain of the elderly. Revista Científica Multidisciplinar Núcleo do Conhecimento. Published online 2020. doi:10.32749/

21.        Xia Z, Cholewa JM, Zhao Y, et al. A potential strategy for counteracting age-related sarcopenia: preliminary evidence of combined exercise training and leucine supplementation. Food Funct. 2017;8(12):4528-4538. doi:10.1039/C7FO01181D

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