Degenerative conditions OA Flashcards
what is sarcopenia
the loss of skeletal muscle mass and strength as a result of ageing.
how much muscle mass do you loose between the ages of 30-80
Normal individuals exhibit an approx. 30% decrease in total muscle mass (sarcopenia) between the ages of 30 to 80 years.
what is the cause of sarcopenia
low sex hormones
low IGF-1 levels
decrease in activity
osteoarthritis and neuronal degeneration
describe how much muscle mass you loose per decade after the age of 30
3% to 5% of muscle mass lost per decade after age 30
what does loss of muscle mass lead to
Leads to camptocormia,
frailty and falls
what are the three reasons for loss of height with age
1, disc degeneration
2, sarcopenia and camptocormia
3, osteoporosis and vertebral collapse
how do you prevent and treat sarcopenia
- Exercise
- vitamin D repletion
- HRT if menopause is premature
What is spondylosis
Degenerative condition of discal articulation of the spine.
describe what an osteoarthritis radiography looks like
- evidence of cartilage loss - joint space narrowing
- evidence of bone response (presence of osteophytes and sclerosis)
what are risk factors for osteoarthritis
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
what are herberdens nodes
Heberden’s nodes are bony swellings of the DIP joint or distal interphalangeal join
What are bouchards nodes
Bouchard’s nodes are hard, bony outgrowths or gelatinous cysts on the proximal interphalangeal joints (the middle joints of fingers or toes
Name nodal generalised OA
Heberden’s nodes
Bouchard’s nodes
CMC of thumb
Hallux valgus/rigidus
Knees & hips
Apophyseal joints- synovial joints at the back of the spine
What is Hallux valgus
Hallux valgus is a deformity of the first metatarsophalangeal joint
what is crystal associated OA
- this is when there is calcium deposition within the cartilage
- calcium pyrophosphate dehydrate occurs mainly in elderly women and affects the knee principally
what is crystal associated OA associated with
hips and shoulders and knees of elderly women
- often has a poor outcome
what can cause OA of premature onset
Previous menisectomy
Haemochromatosis
What are the physical signs in OA
Crepitus
Bony enlargement
Deformity
Instability
Restricted movement
Effusion
Muscle weakness or wasting
name an exercise that you can do for OA of the knee
- 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
how many people does osteoporosis affect
affects an estimated 75 million people in Europe, the US, and Japan; this figure is projected to double over the next 50 years1
how many people experience an osteoporotic fracture
1 in 2 women and 1 in 5 men over the age of 50 worldwide will experience an osteoporotic fracture
what does an osteoporotic spine look like
it is kyphotic
describe the fracture cascade
- in patients who have already have a fracture there is an increased risk of 86% of sustaining another fracture
what is the three types of osteoporosis
Type I (postmenopausal)
Type II (senile)
Idiopathic(at ages <50
as you increase in age what fractures become higher
- vertebrae and hip increase in prevalence
- colles increases but more or less stays stable
how many women have vertebral fractures
Vertebral fractures affect 20 % of women.
Most vertebral fractures are asymptomatic.
how many women are affected by hip fractures
Hip fractures affect 25 % of women living to the age 85.
what are the clinical consequences of osteoporosis
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
How can we prevent osteoporosis
☻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
how can you optimise peak bone mass
Exercise- regular and weight-bearing
Dietary Calcium-especially during growth
How do you reduce the rate of bone loss
Regular exercise
Maintain calcium intake
Moderate alcohol intake
Stop smoking
HRT in selective cases
what other measures can you use to protect against osteoporosis
Prevention of falls
Hip protectors
Patient’s education
Name the treatment of osteoporosis
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
