Osteoarthritis and sarcopenia: treatment perspectives

BACKGROUND. Osteoarthritis (OA) is a major medical and social problem in modern society, as it is the leading cause of impaired mobility, loss of independence, and disability. Sarcopenia, which often coexists with OA, minimizes the effectiveness of non-pharmacological treatment programs for osteoarthritis. There is considerable clinical interest in the efficacy of symptomatic slow-acting drugs (disease-modifying agents), focused on the clinical manifestations of sarcopenia.

OBJECTIVE. To evaluate changes in muscle strength and function during therapy with a bioactive concentrate derived from small marine fish in patients with chronic nonspecific musculoskeletal pain and probable sarcopenia.

MATERIALS AND METHODS. A single-center, open-label, prospective, phase IV comparative post-marketing study was designed to assess changes in muscle strength and function during treatment with a bioactive concentrate derived from small marine fish in 60 geriatric patients with probable sarcopenia and chronic nonspecific musculoskeletal pain.

RESULTS AND DISCUSSION. During therapy, an increase in muscle strength was observed in both the intervention and control groups. Handgrip strength increased by 44.3 % over 2 months in the intervention group (from  14.7 kg to 21.2 kg), compared with a 5.9 % increase in the control group. Over the observation period, «Timed Up and Go» decreased by 40.6 % in the intervention, with most patients reaching the reference value compared to a 22.9 % reduction in the control. Gait speed increased by 6.5 % in the first month versus 2.4 % in the second month in the intervention. Pain reduction reached 83.1 % in the group after 2 months, compared to 22.8 % in the control (p = 0.02).

CONCLUSION. The inclusion of a bioactive concentrate from small marine fish in the comprehensive management of pain exacerbations in patients with chronic nonspecific musculoskeletal pain and probable sarcopenia resulted in a greater reduction in pain compared to the control group. Under pain control conditions, indicators of muscle strength were significantly improved in the group receiving the bioactive concentrate compared to those in the control group.

1. Tan, J., Zhu, Z., Wang, X. et al. Global burden and trends of musculoskeletal disorders in postmenopausal elderly women: a 1990–2021 analysis with projections to 2045. Arthritis Res Ther. 2025 ; 27 (1) : 127. doi: 10.1186/s13075-025-03587-8.

2. Castell M. V., van der Pas S., Otero A., et al. Osteoarthritis and frailty in elderly individuals across six European countries: results from the European Project on OSteoArthritis (EPOSA). BMC Musculoskelet Disord. 2015 ; 16 : 359. doi: 10.1186/s12891-015-0807-8.

3. Papalia R., Zampogna B., Torre G., et al. Sarcopenia and its relationship with osteoarthritis: risk factor or direct consequence? Musculoskelet Surg. 2014 ; 98 (1) : 9–14. doi: 10.1007/s12306-014-0311-6.

4. Naumov A. V., Khovasova N. O., Meshkov A. D., et al. Management of older patients with osteoarthritis (Guidelines of the Russian Association of Gerontologists and Geriatricians). Russian Journal of Geriatric Medicine. 2025 ; (2) : 125–144. (In Russ.)]. doi: 10.37586/2686-8636-2-2025-125-144.

5. De Ceuninck F., Fradin A., Pastoureau P. Bearing arms against osteoarthritis and sarcopenia: when cartilage and skeletal muscle find common interest in talking together. Drug Discov Today. 2014 ; 19 (3) : 305–311. doi: 10.1016/j.drudis.2013.08.004.

6. Alexandre T. D. S., Duarte Y. A. O., Santos J. L. F., Lebrão M. L. Prevalence and associated factors of sarcopenia, dynapenia, and sarcodynapenia in community-dwelling elderly in São Paulo — SABE Study. Prevalência e fatores associados à sarcopenia, dinapenia e sarcodinapenia em idosos residentes no Município de São Paulo — Estudo SABE. Rev Bras Epidemiol. 2019 ; 21 Suppl 02 (Suppl 02) : e180009. doi: 10.1590/1980-549720180009.supl.2.

7. Lee K., Shin Y., Huh J., et al. Recent issues on body composition imaging for sarcopenia evaluation. Korean J Radiol. 2019 ; 20 (2) : 205–217. doi: 10.3348/kjr.2018.0479.

8. Pedersen B. K., Fischer C. P. Beneficial health effects of exercise — the role of IL-6 as a myokine. Trends Pharmacol Sci. 2007 ; 28 (4) : 152–156. doi: 10.1016/j.tips.2007.02.002.

9. Kelly M., Gauthier M., Saha A. K., Ruderman N. B. Activation of AMP-Activated Protein Kinase by Interleukin-6 in Rat Skeletal Muscle. Diabetes. 2009 ; 58 (9) : 1953–1960. doi: 10.2337/db08-1293.

10. Morley J. E. Sarcopenia in the elderly. Fam Pract. 2012 ; 29 (suppl. 1) : i44–i48. doi: 10.1093/fampra/cmr063.

11. Stabler T. V., Huang Z., Montell E., et al. Chondroitin sulphate inhibits NF-κB activity induced by interaction of pathogenic and damage associated molecules. Osteoarthritis Cartilage. 2017 ; 25 (1) : 166–174. doi: 10.1016/j.joca.2016.08.012.

12. Fioravanti A., Collodel G. In vitro effects of chondroitin sulfate. Adv Pharmacol. 2006 ; 53 : 449–465. doi: 10.1016/S1054-3589(05)53022-9.

13. Ewald C. Y. Drug Screening Implicates Chondroitin Sulfate as a Potential Longevity Pill. Front Aging. 2021 ; 2 : 741843. doi: 10.3389/fragi.2021.741843.

14. Olariu L., Pyatigorskaya N., Dimitriu B., et al. In vitro chondroregenerative potential of Alflutop® demonstrated on chondrocyte cultures. Romanian biotechnological letters. 2016 ; 22 (6) : 12047–12053. (In Russ.)].

15. Shirokov V. A., Valamina I. E., Isaikin V. A., et al. Experimental evidence of improved posttraumatic tendon reparation under original bioactive small marine fish concentrate. Russian journal of pain. 2020 ; 18 (4) : 50–58. (In Russ.)]. doi: 10.17116/pain20201804151.