Pathophysiology and mechanisms of primary sarcopenia (Review)

Int J Mol Med. 2021 Aug;48(2):156. doi: 10.3892/ijmm.2021.4989. Epub 2021 Jun 29.


Aging causes skeletal muscle atrophy, and myofiber loss can be a critical component of this process. In 1989, Rosenberg emphasized the importance of the loss of skeletal muscle mass that occurs with aging and coined the term 'sarcopenia'. Since then, sarcopenia has attracted considerable attention due to the aging population in developed countries. The presence of sarcopenia is closely related to staggering, falls and even frailty in the elderly, which in turn leads to the need for nursing care. Sarcopenia is often associated with a poor prognosis in the elderly. Therefore, it is crucial to investigate the causes and pathogenesis of sarcopenia, and to develop and introduce interventional strategies in line with these causes and pathogenesis. Sarcopenia can be a primary component of physical frailty. The association between sarcopenia, frailty and locomotive syndrome is complex; however, sarcopenia is a muscle‑specific concept that is relatively easy to approach in research. In the elderly, a lack of exercise, malnutrition and hormonal changes lead to neuromuscular junction insufficiency, impaired capillary blood flow, reduced repair and regeneration capacity due to a decrease in the number of muscle satellite cells, the infiltration of inflammatory cells and oxidative stress, resulting in muscle protein degradation exceeding synthesis. In addition, mitochondrial dysfunction causes metabolic abnormalities, such as insulin resistance, which may lead to quantitative and qualitative abnormalities in skeletal muscle, resulting in sarcopenia. The present review article focuses on age‑related primary sarcopenia and outlines its pathogenesis and mechanisms.

Keywords: mechanism; myofiber; myokine; primary sarcopenia; satellite cell.

Publication types

  • Review

MeSH terms

  • Aged
  • Aging / metabolism*
  • Aging / physiology
  • Cytokines / metabolism*
  • Humans
  • Muscle Proteins / metabolism*
  • Muscle, Skeletal / metabolism*
  • Muscle, Skeletal / pathology
  • Muscle, Skeletal / physiopathology
  • Muscular Atrophy / metabolism*
  • Muscular Atrophy / physiopathology
  • Myofibrils / metabolism
  • Sarcopenia / metabolism*
  • Sarcopenia / pathology
  • Sarcopenia / physiopathology
  • Satellite Cells, Skeletal Muscle / metabolism


  • Cytokines
  • Muscle Proteins