Anatomy of Ageing

Question 1

What changes occur to POSTURE and HEIGHT during ageing?

Answer 1

• changes to vertebral column, becomes more C-shaped
• loss of height (-1cm per decade at >40yr)
• narrowing of inter-vertebral discs
• osteoporosis
• vertebral collapse
• kyphosis
• loss of foot arches

Question 2

Why does OSTEOPOROSIS occur during ageing?

Answer 2

• loss of bone density
• prevalence: 50% for >50yo
• more prevalent in post-menopausal women (80%)

Increased risk for

• # neck of femur
• Colles’ # radius

Rx: oestrogen replacement, bisphosphonates and calcium supplements
Exercise, reduced EtOH and smoking

Mx: bone densitometry scan (DEXA)

Question 3

Why does FRACTURED NECK OF FEMUR occur more during ageing?

Answer 3

• age related (increased prevalence in mid-70s)
• F>M
• commonly osteoporotic, but must also consider malignant cause
• <1/3 die within 1yr of fracture
• several classifications used (e.g. Garden’s0
• classic: shortened, externally rotated leg (due to psoas traction)

Rx: surgical

Question 4

What is PAGET’S DISEASE OF THE BONE?

Answer 4

• excessive breakdown and formation of bone
• disorganised bone remodelling
• localised
• elevated ALP levels (isolated)

=> weakness and fractures
=> pain/pressure on nerves

• sarcoma: rare complication

Question 5

What is PAGET’S DISEASE of the SKULL?

Answer 5

= osteoporosis circumscripta

• nerve compression
• loss of vision/hearing
• loosening of teeth
• pathognomonic radiological findings

Question 6

What is OSTEOARTHRITIS?

Answer 6

• age-related joint degeneration
• can be primary/secondary
• 4 stages of disease
• affects articular cartilage and subchondral bone
• creates loss of joint space
• affects hands (DIP, PIP) and feet and large weight bearing joints

Sx: pain, stiffness, loss of function
osteophytes inflamed joint capsule

Question 7

How can ageing affect JOINTS?

Answer 7

• VALGUS vs VARUS

VARUS IS THE PIG - sitting on pig - to remember which way around they are

• Hallux valgus = bunions
• osteophytes
• nerve compression

=> SPONDYLOSIS
type of arthritis spurred by wear and tear to the spine. It happens when discs and joints degenerate, when bone spurs grow on the vertebrae, or both

=> SPONDYLOLYSIS
defect or stress fracture in the pars interarticularis of the vertebral arch, most affecting L5

• SPONDYLOLITHESIS
  affects the lower vertebrae (spinal bones). This disease causes one of the lower vertebrae to slip forward onto the bone directly beneath it

Question 8

What is HALLUX VAGUS?

Answer 8

• subluxation of 1st metatarsal-pharyngeal joint
• lateral deviation of big toe
• medial deviation of metatarsal head
  => destabilised joint
• abductor halls slips below metatarsal head
• loss of stability of intrinsic muscles

movement of muscles into 1st web space:

• extensor hallucis longus
• flexor hallucis longus

Question 9

Where does CALCIFICATION occur during ageing?

Answer 9

• arteries
• heart valves
• cartilage
• breast
• brain
• pineal gland (in ventricles in brain)
• lungs
• kidneys
• metastases

Question 10

What SKIN CHANGES occur during ageing?

Answer 10

• genetically determined, sun exposure is also major factor
• loss of collagen + elastin
• causes wrinkling and sagging
• increased fragility and injury
• PURPURA: fragile vessels
• dryness: reduced sebum production
• pallor: reduced melanocytes
• reduced s.c fat: loss of padding/insulation
• reduced thermoregulation: less sweat

Question 11

What FACIAL CHANGES occur during ageing?

Answer 11

• loss of pigment from hair
• hair loss from scalp
• excess hair in nose/ears
• skin wrinkles
• skin laxity
• lengthening of ears and nose
• sunken eyes
• reduced jaw mass (bone/gum)
• prominent forehead

Question 12

What EYE CHANGES occur during ageing?

Answer 12

CATARACTS

• most common
• gradual loss of vision
• affect 90% by 80yo
• 3 types:
• > nuclear sclerosis
• > cortical
• > posterior subcapsular

CORNEAL ARCUS
related to cholesterol deposits or hyperlipidaemia
previously called Marcus sensilis

XATHALAMSMATA

Question 13

What is ECTROPION?

Answer 13

= out-turning of lower eyelid

• weakness of palpebral ligaments
• may be related to Bell’s palsy
• may expose cornea
• cause of watery eye
• surgical Rx

Question 14

What is ENTROPION?

Answer 14

= inward turning of lower eyelid

• weakness of peri-orbital muscles
• eyelashes irritate the cornea
• Rx: surgical

Question 15

What is MACULAR DEGENERATION?

Answer 15

• age-related
• loss of central vision
• affects 1/3 by >75yr
• major cause of blindness
• risk factors: smoking and obesity

- 2 main types 
EXUDATIVE 'wet'
vessels form between choroid and retina
more severe 
related to VEGF
- retinal haemorrhage and fibrosis 

NON-EXUDATIVE ‘dry’
90% of cases, accumulation of cellular debris between retina and choroid
may cause retinal detachment
- DRUSEN’S SPOTS: seen on fundoscopy

Question 16

What is PRESBYOPIA?

Answer 16

= age-related vision loss/long-sightedness

• loss of ability to ‘accommodate’ near objects
• loss of lens elasticity
• near objects focus behind retina
• commonly need glasses >40yo

Question 17

What is GLAUCOMA?

Answer 17

= raised intra-ocular pressure

• damages retina and optic nerve
• loss of vision
• age-related and progressive
• obstruction of trabecular network in the ‘canal of Schlemm’
• aqueous formation > absorption
• pressure on lens -> vitreous humour -> choroid -> retina

2 main types:

• CLOSED ANGLE (10%)
• OPEN ANGLE (90%)

acute = emergency