高齢者の性ホルモンとサルコペニア

高齢者の性ホルモンとサルコペニアのレビュー論文を紹介します。

Maggio, Marcello; Lauretani, Fulvio; Ceda, Gian Paolo. Sex hormones and sarcopenia in older persons. Current Opinion in Clinical Nutrition & Metabolic Care: January 2013 - Volume 16 - Issue 1 - p 3–13

性ホルモンの中でもテストステロンとデヒドロエピアンドロステロン（DHEAS）について、サルコペニア治療として投与した場合のレビュー論文です。テストステロンとDHEASの投与で筋肉量は増加しますが、筋力や身体機能の改善は明らかではありません。さらなる研究が必要という結論です。

テストステロンでは高齢男性で筋力増強も得られるというメタ解析がありますが、副作用の問題が大きく日常診療でルーチンに使用するものではないと考えます。特にサルコペニアが顕著な場合には、リハ・筋トレと併用して副作用をモニタリングしながら、同化ホルモンを使用してもよいとは思いますが。

Abstract

Purpose of review: Sarcopenia is a geriatric syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength with a risk of adverse outcomes such as physical disability, poor quality of life, and death. Sarcopenia is a multifactorial process involving the decline of androgens, including dehydroepiandrosterone sulphate (DHEAS) and testosterone. The aim of this review is to highlight the effects of DHEAS and testosterone treatment to counteract sarcopenia, especially in older men.

Recent findings: DHEAS and, more importantly, testosterone treatment are associated with increased muscle mass, whereas the effects on muscle function and physical performance are less clear. The results of recent randomized placebo controlled trials with DHEAS in older men and women and testosterone in men with mobility limitation are discussed. The novel current and future scenarios to attenuate the detrimental effects and to optimize the efficacy of sex hormone treatment are also addressed.

Summary: DHEAS and testosterone are important options in the armamentarium of sarcopenia treatment in older men. Future studies are needed to address new approaches by using selective compounds, targeting the correct form and dosage, tailoring the correct patient to treat, and taking into account the multifactorial origin and the new definition of sarcopenia.