degeneration of the MSK system with age

Question 1

ageing

Answer 1

• affects the balance of mechanisms which ensures homeostasis within organs
• alters tissue response to injury
• associated with accumulation of genetic damage
• elicits antagonistic/compensatory mechanisms- initially beneficial but chronicity leads to further damage- results in phenotype alterations
• may overlap with pathological syndromes

Question 2

generic processes with ageing

Answer 2

• decreasing amount of tissue
• altered molecular disposition of matrix
• accumulation of degraded molecules
• reduced efficiency of functional tissue elements
• reduced synthetic capacity of differentiated cells
• altered levels of trophic hormones, growth factors/cytokines

Question 3

consequences of MSK ageing

Answer 3

Altered gait and balance leading to falls and fear of falls

Increased risk of injury, particularly fracture

Chronic pain in 50% of community dwelling elderly and 80% of those in care

Social isolation if living independently

Loss of independence and admission to care home

Question 4

osteoarthritis

Answer 4

A disorder of synovial joints which occurs when damage triggers repair processes leading to structural changes withina joint

The most common joint disease world wide affecting 18% of women and 10% of men over the age of 60yrs

A complex and multifactorial condition involving genetic, biological and biomechanical factors which affect risk

Concept of simple “wear and tear” damage now outmoded
Knee > hip > hands and wrists > ankle and foot

Question 5

osteoarthiritis - pathogenesis

Answer 5

draw out

Question 6

treatment of osteoarthiritis

Answer 6

• therapeutic exercise and weight management
• topical NSAIDs for knee
• oral NSAIDs considered but long term risk taken to account
• paracetamol/weak opioids for short term pain relief
• intra-articular steriods (short term)
• consider joint replacement

Question 7

osteoporosis

Answer 7

A progressive bone disease characterised by low bone mass and microarchitectural deterioration of bone tissue which leads to an increased risk of fragility fractures

Question 8

boen remodelling

Answer 8

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

Resorption: osteoclasts digest mineral matrix (old bone)

Reversal: end of resorption

Formation: osteoblasts synthesize new bone matrix

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

Question 9

risk factors of osteoporosis

Answer 9

non- modifiable: previous fracture, parental history, early menopause, age, female gender
modifiable- low BMI, smoking, alcohol intake

coexisting disease- diabetes, RA/SLE, IBS, chronic liver disease, asthma, HIV

drug therapy- long term antidepressants, PPIs

Question 10

treatment of osteoporosis

Answer 10

• antiresorptive (reduces bone turnover): bisphosphonates, denosumab, romosoumab

anabolic (stimulates bone formation)- romosozumab, teriparatide

Question 11

sacropenia

Answer 11

• progressive/generalised skeletal muscle disorder. associated with increased likelihood of adverse outcomes including falls, fractures, physical disability/mortality

Question 12

treatment of sarcopenia

Answer 12

• resistance of aerobic exercise
• increased protein intake