Sarcopenia in older adults: A narrative review of current concepts in diagnosis and treatment.

Sarcopenia is a multifactorial geriatric syndrome characterized by progressive declines in skeletal muscle strength, muscle mass, and physical performance. It is associated with disability, loss of independence, and increased mortality in older adults. Despite being recognized as distinct disease entity, heterogeneity in diagnostic criteria, assessment methods, and therapeutic approaches continue to hinder the translation of research findings into routine clinical practice. This review aims to provide a comprehensive and integrated overview of current knowledge on sarcopenia, highlighting advances in pathophysiology, diagnostic assessment, and emerging therapeutic strategies. Key biological mechanisms underlying sarcopenia include anabolic resistance, neuromuscular degeneration, chronic inflammation, hormonal dysregulation, mitochondrial dysfunction, as well as systemic regulators such as the renin-angiotensin system and microRNAs. Contemporary diagnostic frameworks remain heterogeneous with respect to definitions, terminology, and assessment components. In this context, the Global Leadership Initiative on Sarcopenia (GLIS) has proposed a conceptual framework that seeks to distinguish the core biological components from downstream clinical outcomes. Resistance exercise and nutritional optimization remain the cornerstone of sarcopenia management, while pharmacological and molecular strategies targeting anabolic and metabolic pathways are considered adjunctive or investigational. Although many pharmacological agents demonstrate increases in muscle mass, the translation of these gains into consistent and clinically meaningful improvements in muscle strength and physical performance remains limited. This review underscores the need for harmonized diagnostic concepts and individualized, multimodal treatment strategies, and suggests that future advances in sarcopenia management will likely depend on refined phenotyping and targeted combination therapies rather than single-target interventions.