臨床整形外科54巻3号

2019年03月発行

誌上シンポジウム サルコペニアと整形外科

サルコペニアに対する栄養，薬物，運動療法

著者： 宮城正行¹

所属機関： ¹北里大学医学部整形外科学

ページ範囲：P.265 - P.269

文献概要

　高齢化率21％を超えた超高齢社会を迎えた本邦において，厚生労働省が掲げる「健康日本21」の中心課題である健康寿命の延伸が急務となっており，われわれ整形外科医が担う役割は大きい．近年注目を集める，筋肉量が低下し，筋力または身体機能が低下した状態であるサルコペニアは，疫学や関与する因子に関する研究は進んでいるが，いまだ有効な治療，予防法については確立されていない．本稿では，治療，予防法として期待される栄養，薬物，運動療法について，ビタミンD，マイオスタチン，高強度筋力トレーニングというキーワードを中心に詳述する．

参考文献

1) Rosenberg IH. Sarcopenia:origins and clinical relevance. J Nutr 1997;127(5 supple):990S-991S.

2) Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al. Sarcopenia:European consensus on definition and diagnosis:Report of the European Working Group on Sarcopenia in Older People. Age Ageing 2010;39(4):412-23.

3) Hida T, Ishiguro N, Shimokata H, et al. High prevalence of sarcopenia and reduced leg muscle mass in Japanese patients immediately after a hip fracture. Geriatr Gerontol Int 2013;13(2):413-20.

4) Fujimoto K, Inage K, Eguchi Y, et al. Use of Bioelectrical impedance analysis for the measurement of appendicular skeletal muscle mass/whole fat mass and its relevance in assessing osteoporosis among patients with low back pain:A comparative analysis using dual x-ray absorptiometry. Asian Spine J 2018;12(5):839-45.

5) Bischoff-Ferrari HA, Dawson-Hughes B, Staehelin HB, et al. Fall prevention with supplemental and active forms of vitamin D:a metaanalysis of randomised controlled trials. BMJ 2009;339:b3692.

6) Dhesi JK, Jackson SH, Bearne LM, et al. Vitamin D supplementation improves neuromuscular function in older people who fall. Age Ageing 2004;33(6):589-95.

7) Ito S, Harada A, Kasai T, et al. Use of alfacalcidol in osteoporotic patients with low muscle mass might increase muscle mass:an investigation using a patient database. Geriatr Gerontol Int 2014;14(Suppl 1):122-8.

8) Ferrando AA, Paddon-Jones D, Hays NP, et al. EAA supplementation to increase nitrogen intake improves muscle function during bed rest in the elderly. Clin Nutr 2010;29:18-23.

9) Bφrsheim E, Bui QU, Tissier S, et al. Effect of amino acid supplementation on muscle mass, strength and physical function in elderly. Clin Nutr 2008;27(2):189-95.

10) Trendelenburg AU, Meyer A, Rohner D, et al. Myostatin reduces Akt/TORI/p70S6K signaling, inhibiting myoblast differentiation and myotube size. Am J Physiol Cell Physiol 2009;296(6):1258-70.

11) Murphy KT, Koopman R, Naim T, et al. Antibody-directed myostatin inhibition in 21-mo-old mice reveals novel roles for myostatin signaling in skeletal muscle structure and function. FASEB J 2010;24(11):4433-42.

12) Snyder PJ, Peachey H, Hannoush P, et al. Effect of testosterone treatment on body composition and muscle strength in men over 65 years of age. J Clin Endocrinol Metab 1999;84(4):2647-53.

13) Liu H, Bravata DM, Olkin I, et al. Systematic review:the safety and efficacy of growth hormone in the healthy elderly. Ann Intern Med 2007;146(2):104-15.

14) Kamalakkannan G, Petrilli CM, George I, et al. Clenbuterol increases lean muscle mass but not endurance in patients with chronic heart failure. J Heart Lung Transplant 2008;27(4):457-61.

15) Giovannini S, Marzetti E, Borst SE, et al. Modulation of GH/IGF-l axis:potential strategies to counteract sarcopenia in older adults. Mech Ageing Dev 2008;129(16):593-601.

16) Howe TE, Shea B, Dawson LJ, et al. Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database Syst Rev 2011;7:CD000333.

17) Korpelainen R, Keinänen-Kiukaanniemi S, Heikkinen J, et al. Effect of impact exercise on bone mineral density in elderly women with low BMD:a population-based randomized controlled 30-month intervention. Osteoporos lnt 2006;17(1):109-18.

18) Shirado O, Doi T, Akai M, et al. Multicenter randomized controlled trial to evaluate the effect of home-based exercise on patients with chronic low back pain:the Japan low back pain exercise therapy study. Spine(Phila Pa 1976) 2010;35(17):E811-E819.

19) 宮地元彦，西脇祐司，安藤大輔・他．虚弱高齢者に対する運動介入の効果：Geriat Med 2011;49(3):319-22.

20) 西脇祐司．運動器の機能向上分科会サマリー．第4章．介護予防に関する科学的知見の収集及び分析委員会(委員長　武林亨)．日本公衆衛生協会，2010．

21) Physical Activity Guidelines Advisory Committee report, 2008. To the Secretary of Health and Human Services. Part A:executive summary. Nutr Rev 2009;67(2):114-20.