Sarcopenia Finally Obtains an ICD Code

A recent commentary celebrates the granting of an International Classification of Disease (ICD) code to sarcopenia, an important step in the lengthy formal definition of a disease. Sarcopenia is the characteristic age-related decline of muscle mass and strength - though many would say that it only counts as sarcopenia if that decline is significantly greater than normal, and that "normal aging" should not be treated. Hopefully those voices will decline in the years ahead. The carving up of degenerative aging into named conditions is a long, slow, and messy process. It is driven by regulation rather than any sort of common sense goal, as regulators refuse to approve treatments for aspects of aging that are not formally defined as a disease. Thus there is far less funding and interest in those fields, and consequently slow progress. Turning reality into a regulatory definition requires lobbying, extensive debate, and a great deal of money that would be better spent on other things. In the case of sarcopenia, it has taken more than decade of work to get to the point at which the formal definitions of disease start to crystallize into bureaucratic acceptance. So much wasted time.

Sarcopenia has come a long way since Irwin Rosenberg first suggested the term to apply to age-related muscle mass. In 2010, the European Working Group on Sarcopenia defined sarcopenia as low muscle mass together with low muscle function (strength or performance). Subsequently, other international groups developed similar definitions for sarcopenia focusing on walking speed or distance walked in 6 min or grip strength in persons with lean muscle mass. A number of studies have confirmed the validity of these definitions. Based on the available literature, it would appear that sarcopenia is present in 5 to 10% of persons 65 years of age or older. This high quality research approach to sarcopenia has led to the recognition of sarcopenia as a disease entity with the awarding of an ICD-10-CM (M62.84) code in September, 2016. This is an important step similar to the much earlier recognition of osteoporosis as a disease state. This will lead to an accelerated interest in physicians making the diagnosis of sarcopenia and for pharmaceutical companies to accelerate the interest in developing drugs to treat sarcopenia. This research will be helped by there already being a number of biomarkers available for sarcopenia. This should also drive an increase in diagnostic tool availability for recognizing sarcopenia.

Sarcopenia is the most important cause of frailty in older persons. In addition, there is a close association between sarcopenia and bone loss and hip fracture - osteosarcopenia. Sarcopenia has also been found to be a major reason for poor outcomes in persons with diabetes mellitus. SARC-F is a simple screening test for sarcopenia. It prospectively identifies decreased walking speed, activities of daily living disability, hospitalization, and mortality. It has been shown to correlate well with the available international definitions for sarcopenia. There are numerous causes of sarcopenia including anorexia, inflammation, hypogonadism, lack of activity, hypovitaminosis D, motoneuron loss, insulin resistance, poor blood flow to muscle, mitochondrial dysfunction, and genetic causes. The established treatment for sarcopenia is resistance exercise. It appears that sarcopenia is always responsive to resistance exercise. Supplementation with leucine enriched, essential amino acid can also enhance muscle rejuvenation. Vitamin D declines with ageing, and supplementation enhances muscle function when deficient. Testosterone is the drug with the strongest record for increasing muscle mass and improving function. Anamorelin improves muscle mass but not strength. A number of other drugs are under development focusing mainly on myostatin and activin-2 receptor inhibitors. Selective androgen receptor molecules (SARMs) have also shown positive effects. Overall, the availability of an ICD-10 code for those of us who work in the area of muscle wasting disease is a very exciting time. Over the next few years, we can expect major advances in the treatment of older persons with sarcopenia.

Link: http://onlinelibrary.wiley.com/doi/10.1002/jcsm.12147/full

Comments

At last! Great news!

Posted by: Antonio at November 30th, 2016 9:13 AM

Hello!
Which is the best way to give 1000€ to SENS Foundation? Just give them trough the web, or trouhgh a microcampaign, or what?
Thanks!

Posted by: Josep at November 30th, 2016 9:58 AM

@Josep: Thanks for the intent! Any method will get the money there and get your donation matched: check by mail, PayPal or credit card via their SENS Research Foundation website, etc.

If you want to get a tax deduction on your donation, then what you need to do depends on which European country you are resident in. Typically it involves donating via an intermediary organization that is a registered charity in your country. You should contact Jerri Barrett at the SENS Research Foundation for details on that front. Her email is on the SRF donation page under the stock donation section: http://www.sens.org/donate

Posted by: Reason at November 30th, 2016 10:20 AM

If regulators refuse to approve treatments for aspects of aging that are not formally defined as a disease, how is it that aging is designated as the condition treated in this Niagen study?

https://clinicaltrials.gov/ct2/show/NCT02921659

Posted by: NY2LA at November 30th, 2016 10:45 AM

The angle we are taking with ICD11 to get aging formally accepted as a disease is through much lobbying and supporting data but also consider that the ICD practically suggests aging is a disease already.

The WHO ICD 10, in "General symptoms and signs" section, already recognizes "Senility" (R54) as a disease (state). This state is defined as "Age-related physical debility" in the ICD-10-CM (the US version of ICD); it includes signs such as frailty, old age, senility, senile atrophy, senile asthenia, senile debility, etc.

However, the pathological processes of ageing begin in early adulthood, which should be reflected in the ICD. Senility is actually an end state, so the conceptual framework of the international healthcare system should be to recognize ageing as a syndromic complex of pathological processes that start in youth anddevelop gradually.

US legislation defines a disease as "a damage to an organ, part, structure, or systemof the body such that it does not function properly (e.g., cardiovascular disease), or a state of health leading to such dysfunctioning (e.g., hypertension); except that diseases resulting from essential nutrient deficiencies (e.g., scurvy, pellagra) are not included in this definition." (21CFR 101.93(g)(1)).

According to the Federal Law of the Russian Federation 323-FZ from November 21, 2011, a disease is "impairment of body functions, working capacity, ability to adapt to the changes in environment and internal environment with simultaneous changes in protective, compensating and adapting body reactions and mechanisms, which emerge due to pathogenicfactor exposure ".

Ageing damages the body and impairs its functioning and protective, compensating and adapting reactions and mechanisms. Keeping in mind the modern broad definition of a pathogenic factor, ageing meets the definitionof a diseaseby both American and Russian laws.

Ageing is a complex system phenomenon, a set of syndromes which still need to be researched thoroughly. Incomplete understanding of its causal mechanisms makes it harder to recognize ageing as a disease. Yet, biomedical research allows presently for the establishment of signs, symptoms, causal agents, mechanisms and interventions for many ageing-related pathological changes and processes, which can be already identified as diseases.

Posted by: Steve Hill at November 30th, 2016 10:58 AM

@NY2LA: Because there is slow change in that position. See also the metformin study. They're now accepting trials, but that's not the same as approving for use, or generally opening the doors to everyone versus just the more connected researchers and just the more boring, staid trials. Change is a gradual crumbling of the old to reveal the new.

Posted by: Reason at November 30th, 2016 11:02 AM

@Josep:

There is no current "microcampaign" for SENS, so you can just donate through the web. Donating bitcoins is the cheapest method (basically, it's free) if you already have the bitcoins. If you need to exchange money for bitcoins, there is some added cost, depending on the method of exchange used.

Posted by: Antonio at November 30th, 2016 11:37 AM

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