Degenerative conditions OA

Question 1

what is sarcopenia

Answer 1

the loss of skeletal muscle mass and strength as a result of ageing.

Question 2

how much muscle mass do you loose between the ages of 30-80

Answer 2

Normal individuals exhibit an approx. 30% decrease in total muscle mass (sarcopenia) between the ages of 30 to 80 years.

Question 3

what is the cause of sarcopenia

Answer 3

low sex hormones

low IGF-1 levels

decrease in activity

osteoarthritis and neuronal degeneration

Question 4

describe how much muscle mass you loose per decade after the age of 30

Answer 4

3% to 5% of muscle mass lost per decade after age 30

Question 5

what does loss of muscle mass lead to

Answer 5

Leads to camptocormia,

frailty and falls

Question 6

what are the three reasons for loss of height with age

Answer 6

1, disc degeneration
2, sarcopenia and camptocormia
3, osteoporosis and vertebral collapse

Question 7

how do you prevent and treat sarcopenia

Answer 7

• Exercise
• vitamin D repletion
• HRT if menopause is premature

Question 8

What is spondylosis

Answer 8

Degenerative condition of discal articulation of the spine.

Question 9

describe what an osteoarthritis radiography looks like

Answer 9

• evidence of cartilage loss - joint space narrowing

- evidence of bone response (presence of osteophytes and sclerosis)

Question 10

what are risk factors for osteoarthritis

Answer 10

Obesity especially OA knee

Abnormal mechanical loading eg menisectomy, instability and dysplasia

Inherited type II collagen in premature polyarticular OA

Inheritance in nodal OA

Occupation eg farmers & OA hip

Non-gonococcal septic arthritis

Question 11

what are herberdens nodes

Answer 11

Heberden’s nodes are bony swellings of the DIP joint or distal interphalangeal join

Question 12

What are bouchards nodes

Answer 12

Bouchard’s nodes are hard, bony outgrowths or gelatinous cysts on the proximal interphalangeal joints (the middle joints of fingers or toes

Question 13

Name nodal generalised OA

Answer 13

Heberden’s nodes

Bouchard’s nodes

CMC of thumb

Hallux valgus/rigidus

Knees & hips

Apophyseal joints- synovial joints at the back of the spine

Question 14

What is Hallux valgus

Answer 14

Hallux valgus is a deformity of the first metatarsophalangeal joint

Question 15

what is crystal associated OA

Answer 15

• this is when there is calcium deposition within the cartilage
• calcium pyrophosphate dehydrate occurs mainly in elderly women and affects the knee principally

Question 16

what is crystal associated OA associated with

Answer 16

hips and shoulders and knees of elderly women

- often has a poor outcome

Question 17

what can cause OA of premature onset

Answer 17

Previous menisectomy

Haemochromatosis

Question 18

What are the physical signs in OA

Answer 18

Crepitus

Bony enlargement

Deformity

Instability

Restricted movement

Effusion

Muscle weakness or wasting

Question 19

name an exercise that you can do for OA of the knee

Answer 19

• Quadriceps building exercises for OA of the knee
• rise it up
• count from 1-10 and put it down
• this reduces the risk of falling

Question 20

how many people does osteoporosis affect

Answer 20

affects an estimated 75 million people in Europe, the US, and Japan; this figure is projected to double over the next 50 years1

Question 21

how many people experience an osteoporotic fracture

Answer 21

1 in 2 women and 1 in 5 men over the age of 50 worldwide will experience an osteoporotic fracture

Question 22

what does an osteoporotic spine look like

Answer 22

it is kyphotic

Question 23

describe the fracture cascade

Answer 23

• in patients who have already have a fracture there is an increased risk of 86% of sustaining another fracture

Question 24

what is the three types of osteoporosis

Answer 24

Type I (postmenopausal)

Type II (senile)

Idiopathic(at ages <50

Question 25

as you increase in age what fractures become higher

Answer 25

• vertebrae and hip increase in prevalence

- colles increases but more or less stays stable

Question 26

how many women have vertebral fractures

Answer 26

Vertebral fractures affect 20 % of women.

Most vertebral fractures are asymptomatic.

Question 27

how many women are affected by hip fractures

Answer 27

Hip fractures affect 25 % of women living to the age 85.

Question 28

what are the clinical consequences of osteoporosis

Answer 28

Increased mortality- 20% in the first year after a hip fracture

Pain-early after fracture, prolonged pain due to secondary OA,costal margin impingement

Deformities-kyphosis,loss of height,abdominal protrusion

Loss of independence

Question 29

How can we prevent osteoporosis

Answer 29

☻Ensure an adequate calcium intake which meets the relevant dietary recommendations
in the country or region where they live

☻Avoid undernutrition and protein malnutrition

☻Maintain an adequate supply of vitamin D through sufficient exposure to the sun and through
diet

☻Participate in regular physical activity

☻Avoid smoking

☻Be educated about the risk of high alcohol consumption

Question 30

how can you optimise peak bone mass

Answer 30

Exercise- regular and weight-bearing

Dietary Calcium-especially during growth

Question 31

How do you reduce the rate of bone loss

Answer 31

Regular exercise

Maintain calcium intake

Moderate alcohol intake

Stop smoking

HRT in selective cases

Question 32

what other measures can you use to protect against osteoporosis

Answer 32

Prevention of falls

Hip protectors

Patient’s education

Question 33

Name the treatment of osteoporosis

Answer 33

Bisphosphonates- etidronate, alendronate, risedronate, ibandronate, pamidronate and zoledronate

Selective oestrogen receptor modulators –raloxifene

HRT in selective cases

Vitamin D & Calcium

Teriparatide in severe unresponsive cases (bone forming)

Denosumab