degeneration of the MSK system with age Flashcards
what are some generic processes that occur with ageing?
-decreased tissue
-altered molecular disposition of the matrix
-accumulation of degraded molecules
-reduced efficiency of functional tissue elements
-reduced synthetic capacity of differentiated cells
what are some consequences of MSK ageing?
-altered gait and balance leading to falls and fear of falls
-increased risk of injury, particularly fracture
-chronic pain in 50%, 80% in care
-social isolation
-loss of independence
what is the MSK ageing syndrome of the muscle?
sarcopenia
how can OA be diagnosed without imaging?
- 45 and over
- have activity related joint pain
- no morning joint related stiffness or morning stiffness that lasts no longer than 30 mins
generally how long can intra articular steroids be effective for?
2-10 weeks
what are the stages of bone remodelling?
activation
resorption
reversal
formation
quince
what is the activation stage of bone remodelling?
activation - preosteoclasts are stimulated and differentiate under the influence of cytokines and growth factors into mature active osteoclasts
what is the resorption stage of bone remodelling?
osteoclasts digest mineral matrix (old bone)
what is the reversal stage of bone remodelling
end of resorption
what is the formation stage of bone remodelling?
osteoblasts synthesise new bone matrix
what is the quiescence stage of bone remodelling?
osteoblasts become resting bone lining cells on the newly formed bone surface
what are the non modifiable risk factors for OP?
previous fracture
parental history of OP
history of early menopause
female
age
what drug therapies have some risk factors for OP?
long term antidepressants
anti epileptics
aromatase inhibitors
PPIs
oral glucorticosteroids
GnRH antagonists (prostate cancer)
which fracture is most common with increased age?
femur
how can OP be diagnosed?
boen strength highly correlated with its density
inverse relationship between BMD and fracture risk
gold standard test for assessment of BMD is by dual energy x-ray absorpsiometry (DXA) at the hip and spine
what are some antiresorptive treatments for OP?
reduce bone turnover
-bisphosponates (alendrotnic acid PO and zoledronic acid IV)
denosumab (SC)
romosozumab (SC)
what are some anabolic treatments for OP?
stimulates boen formation
-romosozumab (SC)
-teriparatide (SC)
what happens during sarcopenia?
decline in skeletal muscle mass and function plays a key role in the development of the fragility syndrome
low muscle strength is the primary parameter of sarcopenia
physical performance is used to categorise its severity
what is sarcopenia?
progressive and generalised skeletal muscle disorder that is associated with increased likelihood of adverse outcomes including falls, fractures, physical disability and mortality
how much skeletal muscle mass makes up our total body mass?
45%
what causes activity related secondary sarcopenia?
bed rest
reconditioning
sedentary lifestyle
zero gravity
what causes disease related secondary sarcopenia?
advanced organ failure
malignancy
inflammatory or endocrine disease
what causes nutrition related secondary sarcopenia?
inadequate dietary intake of energy or protein
how can muscle function be tested?
handgrip strength
chair stand test
short physical performance battery
gait speed
time up and go
how can muscle mass be tested?
CT/MRI - research gold standard
DXA
bioimpedance analysis - inexpensive and portable but not necessarily reproducible
what treatment options are available for sarcopenia?
resistance and aerobic exercise - strong recommendation
attention to nutrition with increased protein intake
no pharmacological therapies (yet)
