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Msk 2 > Aging and MSK > Flashcards

Aging and MSK Flashcards

1
Q

What causes an accelerated loss of bone density with age?

A

low reproductive hormones
poor calcium and or vitamin D status,
inactivity, endocrine or GI pathologies

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2
Q

What often accompanies loss of bone mineral?

A

Changes in trabecular architechure –> makes bone less strong

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3
Q

What is sarcopenia?

A

Loss of muscle mass due to loss of muscle fibres and reduced muscle cross-sectional area

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4
Q

Describe the changes in muscle with age.

A

sarcopenia
loss of muscle contractility
loss of neuronal innervation

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5
Q

Describe the changes in terms of percentages for body weight composition from adult to over 75.

A

adult: 30% of body weight is muscle and 20% adipose

age 75: 15% muscle, 40% adipose

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6
Q

Name 3 clinical consequences of ageing.

A

osteoporosis
fractures
osteoarthritis

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7
Q

What is osteoporosis?

A

A disease in which there is a reduction in bone mass in the presence of normal mineralisation

  • low bone mass per unit volume
  • deterioration of micro-architechture
  • increased bone fragility
  • increased susceptilbity to low trauma fractures
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8
Q

How would you define osteoporosis clinically?

A

osteoporosis is a bone mineral density of more than 2.5SD below the mean (in young adults of the same sex)

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9
Q

How would you define osteopenia clinically?

A

1-2.5 SD below mean bone mineral density (mean is in young adults)

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10
Q

How would you diagnose osteoporosis?

A

Dual Energy Xray Absorptiometry (DEXA scan)

  • assesses bone mineral density (BMD)
  • X rays at 2 different energies
  • aimed at femur and L-spine
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11
Q

What does the T score from a BMD report indicate?

A

T score - number of SD below mean for sex and race matched healthy young adult pop (25-35y)

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12
Q

What does the Z score of a BMD report indicate?

A

The number of SD below the mean for age, sex and race compared with their peirs

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13
Q

Give some risk factors for osteoporosis

A

Age, low bone mass, Caucasian/asian, previous fragility fracture, positive family history, low BMI, early menopause

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14
Q

Discuss the pathophysiology of osteoporosis.

A

osteoporosis caused by a loss of coupling in the bone remodelling process

  • due to increased bone resorption, decreased bone formation or both
  • loss of coupling –> net loss of bone volume
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15
Q

Which type of bone is most affected in osteoporosis?

A

trabecular bone due to its greater metabolic activity

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16
Q

What is type 1 osteoporosis?

A

post menopausal

loss of oestrogen - accelerated loss (2-3%) over 6-10 years

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17
Q

What is type 2 osteoporosis?

A

senile

age related, hyperparathyroidism, Ca2+ deficiency

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18
Q

What drugs are used to treat osteoporosis and what is their effect on bone?

A 
Bisphosphonates -  anti-resorptive agents which effect osteoclasts (bone resorption)
effect on bone:
- decrease bone turnover
- increase bone mineralisation
- minimal effect on bone volume
19
Q

How do bisphosphonates work?

A

Inhibit osteoclastic bone resorption by reducing osteoclastic activity and promoting osteoclast apoptosis
bisphosphanates inhibit mevalonate pathway
osteoclasts lose their ruffled border –> inactivated

20
Q

Give an example of a bisphosphanate.

A

Risedronate

21
Q

How many hip fractures in the UK per year?

A

75,000

22
Q

Describe the blood supply to the hip joint

A

medial and lateral circumflex arteries and the artery to the head of the femur
circumflex arteries are branches of the profunda femoris artery –> anastamose at the base of the femoralneck to form a ring
Medial circumflex artery is responsible for majority of arterial supply

23
Q

What can happen in an intracapsular fracture of the hip joint?

A

damage to the medial circumflex femoral artery found around neck of femur –> avascular necrosis of the femoral head

24
Q

What are the main types of femoral neck fractures?

A

Intracapsular and extracapsular

25
Q

What type of femoral neck fractures are grouped under intracapsular fractures?

A

supcapital
basicervical
transcervical

26
Q

What type of femoral neck fractures are grouped under extracapsular fractures?

A

intertrochanteric

subtrochanteric

27
Q

What is the treatment for intracapsular neck of femur fracture?

A

operative - hemiarthroplasty (unipolar, bipolar, cemented, uncemented)
total hip arthroplasty
internal fixation
non-operative - those who are too ill to undergo anaesthesia and people who were unable to walk before

28
Q

What is a hemiarthroplasty?

A

only the articular surface of the femoral head is replaced
unipolar hemiarthroplasty - replacement of femoral head and neck
bipolar - replacement of femoral neck, head and addition of an acetabular cup

29
Q

What is the treatment for an extracapsular neck of femur fracture?

A

dynamic hip screw

intramedullary hip screw

30
Q

What are possible consequences of hip fractures?

A

high mortality rate (up to 30% at 1 year)

high morbitity rate - PE, DVT, MI, pressure sores, chest infections, UTIs, reduced mobility, confusion

31
Q

What is osteoarthritis?

A

a disorder of the synovial joints that is characterised by:

  • focal areas of damage to the articular cartilage
  • remodelling of underlying bone and formation of osteophytes - new bone at joint margins
  • mild synovitis
32
Q

Who gets osteoarthritis?

A

eventually everyone

80% of over 80 year olds

33
Q

What is the common type of pain associated with OA?

A

hip OA pain
knee OA pain
joints of cervical spine (cervical spondylosis)

34
Q

What are the clinical features of osteoarthritis?

A

pain, stiffness, deformity, joint swelling

35
Q

Discuss the pathogenesis of OA.

A

earliest changes - fragmentation and fibrillation of normally smooth surface of articular cartilage (these changes v. common with ageing and may not progress to symptomatic OA)
with disease progression - increasing loss of articular cartilage accompanied by abortive attempts at regen.
later changes: reactive proliferation at the subchondral bone plate
articular surfaces become deformed

36
Q

What are some radiological features of OA?

A

decreased joint space (bone articulating against bone = eburnation)
sclerosis - hardening of tissue
osteophytes - bone spurs; most specific sign of OA but is only seen in advanced disease
bone cysts

37
Q

What is the non-operative treatment for osteoarthritis?

A

weight loss, exercise, physiotherapy, analgesia/NSAIDs, joint injection

38
Q

What are the possible operative treatments for osteoarthritis?

A
  • arthroscopy - key hole surgery
  • osteotomies - bone is cut to shorten, lengthen or change its alignments
  • arthrodesis - artificial induction of joint ossification between 2 bones - done to relieve intractable pain.e.g. using a bone graft
  • arthroplasty - articular surface of joint is replaced
39
Q

What is the point in replacing a hip?

A

in the past: relief of pain, improve function, return to life, better ROM
in the future: relief of pain, back to work, improve function, better ROM

40
Q

What are the components of a total hip replacement?

A

acetabular component
femoral head
femoral stem

41
Q

what is the most common type of total hip replacement implant?

A

metal on polyethylene

42
Q

What are local complications of hip and knee replacements?

A 
leg length inequality
dislocation
infection
loosening 
neurovascular damage - sciatic/femoral
43
Q

What are some systemic complications of hip and knee replacement?

A

UTIs/chest infection
DVT
PE
death

44
Q

From what age does bone mineral start to decline?

A

from age 30 rate of loss is 0.5-1% per year

Msk 2 (2 decks)

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