Lecture 11.1: Clinical Effects of the Ageing Musculoskeletal System

Question 1

What is the definition of Ageing?

Answer 1

Lifelong accumulation of molecular and cellular damage caused by multiple mechanisms under the regulation of a complex maintenance and repair network

Question 2

Non-Modifiable Risk Factors (6)

Answer 2

• Age
• Female sex
• Ethnicity (Caucasians)
• Previous fracture
• Family History
• Late menarche (>16 y.o.), early menopause (<47 y.o.)

Question 3

Modifiable Risk Factors (5)

Answer 3

• Bone Mineral density
• Alcohol (>3.5 units/day)
• Weight (BMI < 20)
• Smoking
• Physical inactivity

Question 4

Which Medications are associated with Risk Factors? (8)

Answer 4

• Long-Term Antidepressants
• Antiepileptics
• Aromatase Inhibitors
• Long-Term DMPA
• GnRH Agonists (in men with prostate cancer)
• PPIs
• Oral Glucocorticoids
• Thiazolidinedione for DM TZDs

Question 5

Diagnosis of Osteoporosis

Answer 5

• Based on Bone Mineral Density (BMD) expressed as the T-score
• Which is the number of SD below the mean BMD of young adults at their peak
bone mass

Question 6

Normal BMD

Answer 6

T-score of −1 SD or above

Question 7

Osteopenia

Answer 7

T-score of between −1 and −2.5 SD

Question 8

Osteoporosis

Answer 8

T-score of −2.5 SD or below

Question 9

Established Severe Osteoporosis

Answer 9

T-score of −2.5 SD or below with one or more associated fractures

Question 10

What is a DEXA Scan?

Answer 10

• Dual Energy Xray Absorptiometry
• Assess bone mineral density (BMD)
• X-Rays of 2 different energies
• Aimed at femur and L-spine (L3)

Question 11

National Institute of Allergy and Infectious Disease (NIAID) Classification (3)

Answer 11

• Group I – Pathogens that have been newly recognised in the last 20 years
• Group II – Reemerging pathogens
• Group III – Agents with bioterrorism potential, subdivided

Question 12

What is the T-Score?

Answer 12

Number of SD below mean for sex and race matched healthy young adult population (25-35y age)

Question 13

What is the Z-Score?

Answer 13

Number of SD below mean for an age, sex and race matched young adult population

Question 14

What are Fragility Farctures?

Answer 14

Result from mechanical forces that would not ordinarily result in fracture, known as low-level trauma e.g. fall from a standing height or less

Question 15

Lifestyle Interventions: Exercise

Answer 15

• Static/Dynamic weight bearing exercise (low and high force)
• Muscle resistance training and balance

Question 16

Lifestyle Interventions: Diet

Answer 16

• Supplementation with 10 micrograms/day of vitamin D (400 IU)
• Dietary calcium
• Vit B, Vit K
• Reduce salt
• Balanced diet

Question 17

What is the effect of Bisphosphonates on Bones?

Answer 17

• Anti-resorptive agents
• Effect osteoclasts (bone resorption)
• Reduce bone turnover
• Increase bone mineralisation

Question 18

What is the Purpose of the Best Practice Tariff (BPT)?

Answer 18

To improve and universalise care in an area with significant unexplained variation in quality of clinical practice

Question 19

What is the role of an Orthogeriatrician?

Answer 19

• Ensures that patient receive the highest standards geriatric care
• Knowledge & expertise of age-related changes in physiology & pharmacology
• Provide Holistic care with a person-centred approach to clinical management
• Co-ordinates the MDT team and discharge plan

Question 20

Pneumonic for Osteoarthritis Features

Answer 20

LOSS:
L: oss joint space
O: steophytes
S: clerosis
S: ubchondral cysts

Question 21

Local Complications of Hip Replacement (6)

Answer 21

• Leg length inequality ( Love and Wright 18% >1.5cm)
• Dislocation (3%)
• Infection (2-3%)
• Loosening (usually after 10-15 yrs)
• Neurovascular damage (sciatic/femoral nerve)
• Revision THRs (7.5%) (common peroneal nerve TKRs)

Question 22

Systemic Complications of Hip Replacement (5)

Answer 22

• UTIs/chest infections (10%) [UTI is most common (7-14% after THR)]
• Clinical DVT (2%)
• Non-fatal PE (1%)
• Fatal PE (<0.5%)
• Mortality (<0.5%)

Question 23

What is Sarcopenia?

Answer 23

A syndrome characterised by progressive and generalised loss of skeletal muscle mass and strength, with a risk of adverse outcomes such as physical disability, poor quality of life and death

Question 24

What is Cachexia?

Answer 24

Weakness and wasting of the body due to severe chronic illness

Question 25

Criteria for the Diagnosis of Sarcopenia (3)

Answer 25

1) Low muscle mass
2) Low muscle strength
3) Low physical performance

Question 26

Possible Reasons for Sarcopenia (6)

Answer 26

• Age Related Factors
• Cachexia
• Starvation/Malabsorption
• Endocrine Issues
• Disuse
• Neurodegenerative Diseases

Question 27

What is the Definition of Physical Frailty?

Answer 27

• Frailty is a medical syndrome with multiple causes and contributors • Characterised by diminished strength, endurance, and reduced physiologic
function
• Increases an individual’s vulnerability for developing increased dependency
and/or death

Question 28

Frailty: Potential Interventions (3)

Answer 28

• Exercise: positive impact on musculoskeletal, endocrine and immune systems
• Nutritional Intervention: Caloric and Protein support and Vitamin integration
• Reduction of polypharmacy: STOPP and START criteria

Question 29

Who is involved in the care of the Elderly? (9)

Answer 29

• Geriatrician
• Old Age Psychiatry
• Parkinson’s Nurse
• Adult Safeguarding Team
• Dietician
• Occupational therapist
• Physiotherapist
• GP
• ….And You!