Sarcopenia is 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. Primary sarcopenia is considered to be
age-related when no other cause is evident, other than ageing itself. Secondary sarcopenia should be considered when one
or more other causes are evident, such as activity-, disease-, or nutrition-related sarcopenia. In this narrative review that
focused on human studies, we summarize the pharmaceutical therapies (testosterone, dehydroepiandrosterone, estrogen,
growth hormone, ghrelin, vitamin D, angiotensin converting enzyme inhibitor, and eicosapentaenoic acid) and nonpharmaceutical
therapies (resistance training, protein and amino acid supplementation, and non-smoking) for
counteracting primary sarcopenia. Testosterone and growth hormone improve muscle mass and muscle strength, but have
several side effects. Although there are some intriguing pharmaceutical therapies to combat sarcopenia, resistance training
combined with supplements containing amino acids are the most effective for preventing and treating age-related muscle
wasting and weakness. The etiology of sarcopenia in the elderly is multi-factorial. Patients with disuse syndrome and
deconditioning often complicate the diagnosis, of not only activity-related sarcopenia, but also age-, disease-, and
nutrition-related sarcopenia. In these cases a comprehensive approach to sarcopenia treatment should include
pharmaceutical therapies for age-related sarcopenia and comorbid chronic diseases, resistance training, early ambulation,
nutrition management, protein and amino acid supplementation, and non-smoking. The effect of pharmaceutical therapies
for sarcopenia can be enhanced by this comprehensive approach. Future research on pharmaceutical therapies for
counteracting sarcopenia should consider non-pharmaceutical therapies and also the causes of sarcopenia.
Amino acids, ghrelin, growth hormone, non-smoking, rehabilitation, resistance training, sarcopenia, testosterone.
Department of Rehabilitation Medicine, Yokohama City University Medical Center, 4-57 Urafune-chou, Minami ward, Yokohama City, 232-0024, Japan.