Sarcopenia management is converging on a multi-modal clinical framework, with protein thresholds of 1.2–1.5 g/kg/day, β-hydroxy-β-methylbutyrate (HMB), and leucine-rich whey emerging as nutritional anchors, while exercise modalities including blood flow restriction training and neuromuscular electrical stimulation demonstrate efficacy beyond traditional resistance protocols. On the pharmacological frontier, Bimagrumab (anti-myostatin/activin) and LPCN 1148 (androgen receptor agonist) show measurable lean mass gains in trials, and metformin's pleiotropic effects on mTOR and AMPK pathways position it as a metabolically relevant candidate. The gut-muscle axis via probiotics and anti-TNF-α strategies represent earlier-stage but mechanistically coherent additions.
This review arrives as global sarcopenia prevalence is projected to affect over 500 million adults by 2050, making its clinical architecture urgently consequential. The protein dosing consensus (1.2–1.5 g/kg) meaningfully exceeds the outdated 0.8 g/kg RDA, a shift practitioners should act on now. However, as a narrative review rather than meta-analysis, effect-size heterogeneity and publication bias remain uncorrected. Bimagrumab's mass gains haven't consistently translated to functional strength—a critical gap separating surrogate endpoints from clinical outcomes. Diagnostic inconsistency across EWGSOP2, AWGS, and FNIH criteria continues to fragment the evidence base. The prehabilitation frameworks for CKD, heart failure, and cancer cohorts represent the most immediately actionable clinical advance here. Overall assessment: confirmatory and consolidating rather than paradigm-shifting, but clinically valuable as a practical synthesis.
