2 - SARCOPENIA & OSTEOPOROSIS Flashcards
SARCOPENIA: def
= age-associated loss of skeletal muscle mass & function
- Complex syndrome that is associate with muscle mass loss along or in conjunction with increased fat mass
SARCOPENIA: muscle & aging
- Strength & size gains very limited after 80 y.o
SARCOPENIA: multifactorial causes
- Disuse
- Chronic diseases
- Endocrine function changes
- Insulin resistance
- Nutritional deficiencies
- Inflammation
SARCOPENIA: rate of muscle mass loss & contributing factors
Rate of muscle mass loss:
- 4-6% per decade
- Women age 40
- Men age 60
Contributing factors
- Poor nutrition
- Physical inactivity
- Comorbidities / illness
- Genetics
- Trauma
- Neuromuscular dysfunction
Impacts of sarcopenia
- Higher risk of falls
- ADLs impaired
- Often associated it’s heart disease, respiratory diseases, cognitive impairment
- Increased risk of hospitalization
- Increase medical health care costs
Screening of sarcopenia
- Noted decline in function, strength, health status
- Self reported mobility related difficulty
- History of recurrent falls
- Recent unintentional weight loss (> 5%)
- Post hospitalization
- Other chronic conditions
Who is at risk for sarcopenia?
- Assess physical functioning in at-risk patients
- Patients who are non ambulatory or cannot rise from chair unassisted
- Assess habitual gait speed over 4 meter course
- Patient with habitual gait speed < 1,0 m/sec considered for quantitative measurement fo body composition by dual x-ray absorptiometry
Practical recommendations for sarcopenia
1) Total daily protein intake around 1,6 - 1,8 g/kg/day
2) 3 main meals containing 0,6 g/kg of high quality protein sources
3) At least 5g of leucine per meal
4) When protein supplementation necessary, prioritize high-quality, fast digestive protein
5) Despite acute & short term evidence showing benefits of isolated leucine supplementation to mixed meals,
more long)term data required to recommend supplemental leucine properly
6) Ensure adequate energy supply to avoid negative energy balance since it reduces post-prandial muscle
protein synthesis (MPS) to protein ingestion & exacerbates anabolic resistance
7) Resistance exercise at least twice a week
8) Reduce sedentary time (< 6h/day or 6000-10000 steps daily)
Early identification & management have better success rates with treatment
PT / sport science have important role in improving functional tasks & quality of life of people suffering sarcopenia
Osteoporosis: def & characteristics
= systemic skeletal disease characterized by low bone density & micro-architectural deterioration of bone tissue with consequent increase in bone fragility
= systemic bone disorder, characterized of low body mass
- More than 200 million people affected wolrdwide
- Osteoporotic fractures: common in elderly
- Increase significantly with aging, causing imbalance between bone formation & bone resorption
OSTEOPOROSIS: bone & aging: components of bone & effects of aging
Components of bone
- Cortical (compact) bone
* Appears solid
* Hard outer shell of bone
- Cancellous (spongy) bone
* Interior of bones
* Contains latticework of strong, mineralized fibers
* Provides strength without too much weight
Effect of aging on bone:
- Greater loss of cancellous bone > loss of cortical bone
OSTEOPOROSIS: prevalence
- Increases with age & depends of demography of population
- Most common in females > 55y
- Major healthcare burden
Osteoporosis & menopause
- Up to 20% of bone loss can happen during menopause
- Reduction on estrogens
- Increased osteoclast associated with increased bone resorption
Screening & laboratory testing of osteoporosis
- Patients with risk factors should be assessed for osteoporosis
- Bone internal density (BMD) described as T score:
- Operational definition of osteoporosis based on T-score for BMD defined as T-score below 2,5 SD (T- score < - 2,5) or less at femoral neck & spine
- Osteopenia = low bone mass
—> Defined by bone densitometry as T score between 1 & 2,5 SD (T score < -1 & > -2,5)
—> Midway point to osteoporosis
Risk factors modifiables & non modifiables of osteoporosis
Tableau
Osteoporotic fractures: description, & different types
- Vertebral fractures: account for 70% of all fractures
- Non vertebral fractures (hip fracture)
Types of fractures
Vertebral fractures
- Caused by moderate or minimal trauma
- Associated with lifting or changing position. Can be clinically silent
Hip fractures:
- Females (almost double) > men from 70y
- Caused by fall from standing position
- Related with high rate of mortality & morbidity, most deaths occur in first 3-6 months following event - 50% of fracture-related deaths in females due to hip fractures
Distal forearm fractures
- Occurs due to falls on outstretched hand, more frequent in women, rarely requiring hospitalization
