degeneration of the MSK system with age

Question 1

what are some generic processes that occur with ageing?

Answer 1

-decreased tissue
-altered molecular disposition of the matrix
-accumulation of degraded molecules
-reduced efficiency of functional tissue elements
-reduced synthetic capacity of differentiated cells

Question 2

what are some consequences of MSK ageing?

Answer 2

-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

Question 3

what is the MSK ageing syndrome of the muscle?

Answer 3

sarcopenia

Question 4

how can OA be diagnosed without imaging?

Answer 4

1. 45 and over
2. have activity related joint pain
3. no morning joint related stiffness or morning stiffness that lasts no longer than 30 mins

Question 5

generally how long can intra articular steroids be effective for?

Answer 5

2-10 weeks

Question 6

what are the stages of bone remodelling?

Answer 6

activation
resorption
reversal
formation
quince

Question 7

what is the activation stage of bone remodelling?

Answer 7

activation - preosteoclasts are stimulated and differentiate under the influence of cytokines and growth factors into mature active osteoclasts

Question 8

what is the resorption stage of bone remodelling?

Answer 8

osteoclasts digest mineral matrix (old bone)

Question 9

what is the reversal stage of bone remodelling

Answer 9

end of resorption

Question 10

what is the formation stage of bone remodelling?

Answer 10

osteoblasts synthesise new bone matrix

Question 11

what is the quiescence stage of bone remodelling?

Answer 11

osteoblasts become resting bone lining cells on the newly formed bone surface

Question 12

what are the non modifiable risk factors for OP?

Answer 12

previous fracture
parental history of OP
history of early menopause
female
age

Question 13

what drug therapies have some risk factors for OP?

Answer 13

long term antidepressants
anti epileptics
aromatase inhibitors
PPIs
oral glucorticosteroids
GnRH antagonists (prostate cancer)

Question 14

which fracture is most common with increased age?

Answer 14

femur

Question 15

how can OP be diagnosed?

Answer 15

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

Question 16

what are some antiresorptive treatments for OP?

Answer 16

reduce bone turnover
-bisphosponates (alendrotnic acid PO and zoledronic acid IV)
denosumab (SC)
romosozumab (SC)

Question 17

what are some anabolic treatments for OP?

Answer 17

stimulates boen formation
-romosozumab (SC)
-teriparatide (SC)

Question 18

what happens during sarcopenia?

Answer 18

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

Question 19

what is sarcopenia?

Answer 19

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

Question 20

how much skeletal muscle mass makes up our total body mass?

Answer 20

45%

Question 21

what causes activity related secondary sarcopenia?

Answer 21

bed rest
reconditioning
sedentary lifestyle
zero gravity

Question 22

what causes disease related secondary sarcopenia?

Answer 22

advanced organ failure
malignancy
inflammatory or endocrine disease

Question 23

what causes nutrition related secondary sarcopenia?

Answer 23

inadequate dietary intake of energy or protein

Question 24

how can muscle function be tested?

Answer 24

handgrip strength
chair stand test
short physical performance battery
gait speed
time up and go

Question 25

how can muscle mass be tested?

Answer 25

CT/MRI - research gold standard
DXA
bioimpedance analysis - inexpensive and portable but not necessarily reproducible

Question 26

what treatment options are available for sarcopenia?

Answer 26

resistance and aerobic exercise - strong recommendation
attention to nutrition with increased protein intake
no pharmacological therapies (yet)