The silent burden: Sarcopenia in Pakistan's elderly

Abstract

Dear Editor,

Pakistan’s population is ageing rapidly. In 2019, an estimated 15 million Pakistanis were over the age of 60. Despite this steadily ageing population, geriatric syndromes receive little to no attention. Sarcopenia, which is defined as an age-related decline in muscle strength, function, and mass (1), is a major cause of disability and loss of independence in older adults. If left unchecked, it can lead to increased dependence and frequent hospitalisations. A recent DEXA-based study reported that 47.2% of urban Pakistanis met the diagnostic criteria for sarcopenia—one of the highest rates reported in the region (2). Yet there is a concerning lack of awareness and guidelines regarding this condition. Local experts note that the available data and clinical guidance on sarcopenia are minimal, despite the significant scale of the issue.

Key risk factors for sarcopenia, such as malnutrition and physical inactivity, are common in our elderly population. Many older adults face protein-energy malnutrition as well as vitamin D and micronutrient deficiencies, which accelerate the loss of muscle strength and mass. Fortunately, sarcopenia is modifiable. Evidence reports that timely interventions like protein and vitamin D supplementation, and regular exercise can slow its progression (3,4). However, these preventive measures are rarely included in routine care, and most clinicians remain unaware of effective interventions for sarcopenia. Pakistan’s healthcare system is not prepared for the growing burden of frailty syndromes.

With studies showing that one in six people globally will be over 60 by 2030, Pakistan must act to confront this issue. We therefore strongly encourage physicians to start using simple screening methods for sarcopenia in everyday practice, such as the SARC-F questionnaire or basic physical tests including hand grip strength, gait speed, or chair stand time (4,5). These tests are affordable, easy to perform, and can identify patients at risk of sarcopenia. Early identification enables timely referral for nutrition counselling and fall-prevention measures.

To summarise, sarcopenia is a prevalent but often overlooked condition among older adults in Pakistan. Despite the scale of the issue, local data are scarce, and clinical guidance is lacking. Therefore, we urge the JPMA and the wider medical community to raise awareness regarding this "silent burden" by incorporating it into medical education and supporting further research on its epidemiology and management in Pakistan. Simple screening and timely interventions can help mitigate the burden of sarcopenia. With robust data, guidelines, and education, we can reduce the associated health challenges, disability, and costs that Pakistan will face with its steadily ageing population.