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Medicine 2.1 > Degeneration of MSK with Age > Flashcards

Degeneration of MSK with Age Flashcards

1
Q

What comprises the MSK system?

A
  • Bone
  • Skeletal muscle
  • Chondroid tissues (articular cartilage, IVD, meniscus)
  • Fibrous tissues of tendons, ligaments and joint capsule
  • Fat
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2
Q

What are the functions of the MSK?

A
  • Enables efficient means of limb movement
  • Acts as an endoskeleton for protection and support
  • Serves as a reserve for organic and inorganic molecules
  • Provides environment for marrow
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3
Q

What are ageing syndromes of MSK?

A
  • Osteoarthritis (joints)
  • Osteoporosis (bone)
  • Sarcopenia (muscle)
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4
Q

What generic processes occur during MSK ageing?

A
  • Decreasing ammount of tissue
  • Altered molecular disposition of the matrix
  • Accumulation of degraded molecules
  • Reduced efficiency of functional tissue elements
  • Reduces synthetic capacity of differentiated cells
  • Altered levels of trophic hormones, growth factors and cytokines, or altered ability of cells to respond
  • Alterations in the loading patterns of tissues or the tissues response to loading
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5
Q

What other problems can arise with ageing in respect to tissue response to injury?

A
  • Affects balance of mechanisms which ensure homeostasis within organs
  • Alters tissue response to injury
  • associated with accumulation of genetic damage
  • Elicits antagonistic or compensatory mechanisms initially beneficial but chronicity leads to further damage resulting in phenotypic alterations
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6
Q

What cells are in cartilage?

A

-Chondrocytes

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7
Q

Is cartilage innervated or vascularised?

A

No

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8
Q

How is articular cartilage reduced with ageing?

A
  • 50% of chondrocytes lost between 40-80 yrs
  • Compositional changes with age lead to reduction in water content in ECM (proteoglycans) with fragmentation of protein components and collagen leading to reduced tensile strength
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9
Q

Describe the process of ageing?

A
  • Reduction in osteoblast no. and proliferation
  • Less ability of osteoblasts to sense and rerspond to mechanical forces
  • Increase in osteoclast no.
  • Increased bone turnover and disruption of remodelling activity
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10
Q

With relation to boine ageing, what hormonal changes occur?

A
  • Gradual decline in secreted growth hormone.
  • Fall in IGF-1 levels and decreased sensitivity to its effect. (needed for osteoblast differentiation)
  • Oestrogen decrease follinng menopause
  • Increase in inflammatory cytokines
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11
Q

What is osteoarthritis?

A

-Disorder of synovial joints which occurs when damage triggers repair processes leading to structural damage within a joint.

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12
Q

What are some risk factors of osteoarthritis?

A
  • Female

- Ageing

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13
Q

Describe the pathogenesis of osteoarthritis?

A
  • Joint damage occurs, triggers repair processes
  • These processes alter structure of joint over time causing: localised loss of cartilage, mild synovitis, remodelling of adjacent bone and osteophyte formation.
  • Repair processes often leads to structurally altered, non-symptomatic joint, symptoms when repair processes cant fully compensate for damage (MMP’s and IL-1 involved)
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14
Q

How can osteoarthritis be diagnosed?

A
  • 45 or over
  • Activity related joint pain
  • Either no or short lived morning stiffness
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15
Q

What needs to be managed in osteoarthritis?

A

-Chronic pain and complex biophyscosocail issues

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16
Q

How can osteoarthritis be managed?

A
  • Agree a mangement plan (exercise, weight loss, suitable footwear)
  • Pharmacological: topical, oral or intra articular injections
  • Joint surgery for symptoms causing large impact on life quality (last resort)
17
Q

What are fragility fractures?

A

-Fractures that result from mechanical forces that wouldnt ordanarily result in fractures

18
Q

What are the pahses of bone remodelling?

A
  1. Activation
  2. Resorption
  3. Reversal
  4. Formation
  5. Quiescence
19
Q

What is osteoporosis?

A
  • Low bone mass and microarchitectural deteriation of bine tissues which lead to an increased fracture risk
  • Painless, nut complications arent (fragility fractures most feared outcome)
20
Q

Is it possible for a patient to have osteoarthritis and osteoporosis?

A

-Less likely to have arthrits and porosis but still possible

21
Q

What are the risk factors of osteoporosis?

A

-Fixed: female, ageing, fam history, RA, previous fracture
-Modifiable: smoking, alcohol, low BMI, poor nutrition, lack of exercise
(Longevity of population means it is more prevalent nowadays)

22
Q

How can osteoporosis be diagnosed?

A
  • Bone strength and density measurements
  • DXA scan
  • T scores
23
Q

Do we screen for osteoporosis and why or why not?

A

Not recommended

  • Assess fracture risk using Qfracture
  • So we use oppurtunistic case finding and screening of at risk populations done.
24
Q

What are methods of preventing osteoporosis?

A
  • Maximise peak bone mass
  • Healthy diet
  • Sufficient Vit D
  • Regular weight bearing exercise
  • Avoid smoking
  • Alcohol in moderation
25
Q

What are treatments for osteoporosis?

A 
-Antiresorptive:
Bisphosphonates (oral and IV)
Derosumab (SC)
HRT
-Anabolic (stimulates formation)
Teriparatide (SC)
26
Q

How does muscle age/decrease?

A
  • Progressive loss of skeletal mass and function

- 3-8%/decade lost after 30yrs old

27
Q

What is sarcopenia?

A

-Progressive and generalised skeletal muscle disorder that is associated with increased likelihood of adverse outcomes including falls, fractures, physical disability and mortality.

28
Q

What playds a key role in development of frailty syndrome?

A

-Decline in skeletal mass and funtion

29
Q

How can sarcopenia be categorised?

A
  • Low muscle strength primary parameter

- Physical performace to categorise severity

30
Q

What type of sarcopenia are there?

A

-Primary: age related
-Secondary: activity related
disease related
nutrition related

31
Q

What is the criteria for diagnosis of sarcopenia?

A
  • Low muscle strength
  • Low muscle quality or quantity
  • Low physical performance
32
Q

How can sarcopenia be diagnosed?

A
  • Muscle function; handgrip strength, chair stand strength

- Muscle mass; CT/MRI, DXA, Bioimpedance analysis

33
Q

What is the screening tool used for sarcopenia?

A
  • SARC-F questionairre
  • Rate each score 0,1 or 2
  • Rates strength, assistance in walking, rise from chair, climb stairs, falls
34
Q

What are the usual outcomes of sarcopenia?

A

-Increased mortality, hospitalisation, closely related to physical frailty/ frailty syndrome

35
Q

What are the treatments for sarcopenia?

A
  • Resistance/aerobic exercise
  • Attention to nutrition (increase protein) less evidence
  • Vit D supplements
  • No pharamlogical therapies yet
36
Q

What are the potential consequences of MSK ageing?

A
  • Altered gait and balance leading to falls and fear of falls.
  • Increased injury/fracture risk
  • Chronic pain
  • Social isolation if living alone
  • Loss of independance
  • Care home admission

Medicine 2.1 (29 decks)

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