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Musculoskeletal System > Session 11 - Ageing in the MSK > Flashcards

Session 11 - Ageing in the MSK Flashcards

1
Q

What is sarcopenia?

A

-Loss of muscle mass due to loss of muscle fibres and reduced muscle cross sectional area

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2
Q

What happens to bone with age?

A

-The bone mineral density decreases

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3
Q

What are the consequences of sarcopenia?

A
  • Loss of muscle strength and endurance
  • Increased fall risk
  • Increased fracture risk
  • Reduction in ability to perform movements
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4
Q

When does bone mineral begin to decline?

A

-30 years

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5
Q

What promotes the loss of bone in addition to ageing?

A
  • Low reproductive hormone levels
  • Poor calcium and/or vitamin D,
  • Inactivity
  • Endocrine or gastrointestinal pathologies
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6
Q

What happens to the bone architecture with age?

A

-The trabecular network changes resulting in a irregular, weaker architecture = bone having decreased strength

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7
Q

What is the result of sarcopenia?

A

-Loss of muscle mass= loss of contractility

=Loss of neuronal innervation

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8
Q

Why do the elderly have an increased fall risk resulting in fracture?

A
  • Decreased mobility
  • MSK-related changes in posture and gait
  • Neuro-related gait and proprioception changes
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9
Q

What are the three most common clinical consequences to bone of ageing?

A
  • Osteoporosis
  • Fractures
  • Osteoarthritis
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10
Q

What is osteoporosis?

A

-A skeletal bone disease characterised by a low bone mass, with deterioration of micro-architecture causing increased bone fragility and susceptibility to fractures

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11
Q

What is a DEXA scan?

A

-Dual Energy Xray Absorptiometry scan used to assess bone mineral density

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12
Q

List some risk factors for osteoporosis

A
  • Increasing age
  • Early menopause
  • Caucasian/Asian
  • Previous fragility fracture
  • Low BMI (under 19)
  • Lifestyle (smoking, diet)
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13
Q

What is the pathophysiology of osteoporosis?

A

-Increased osteoclastic activity (Type 1)
or
-Attenuated osteoblastic activity (type 2)

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14
Q

What is type 1 osteoporosis associated with?

A

-Oestrogen withdrawal

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15
Q

What is type 2 osteoporosis related to?

A

-Age/Ca2+ deficiency, hyperparathyroidism

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16
Q

How do bisphosphonates help prevent osteoporosis?

A

They are anti-resorptive agents which inhibit osteoclastic activity and thus decrease bone turnover

17
Q

How do bisphosphonates work?

A
  • The bisphosphonates are taken up by the osteoclasts and inhibit the mevanolate pathway responsible for the activation of small GTPases which cause membrane ruffling
  • Without membrane ruffling, the osteoclasts cannot sit on the lining of bone and resorb it
18
Q

How many hip fractures per year in the UK?

A

-Approx 80,000

19
Q

Why is there a risk of avascular necrosis with intracapsular NOF fractures?

A

-The medial circumflex femoral artery forms retinacular anastamoses around the femur head and is disrupted during the fracture leavinf a relatively scarce blood supply and avascular necrosis ensues

20
Q

What are the morbidities associated with hip fractures?

A
  • PE/DVT
  • Pressure sores
  • Chest infections/UTI
21
Q

What is osteoarthritis?

A

-A disorder of synovial joints that is characterised by focal areas of damage to the articular cartilage and undergoes remodelling of the underlying bone with the formation of osteophytes

22
Q

What is the prevalence of symptomatic OA in the UK?

A

-8.5 million people

23
Q

What are the clinical features of OA?

A
  • Pain
  • Stiffness
  • Deformity
  • Joint swelling
24
Q

What are the radiological features of OA?

A
  • Decreased joint space
  • Osteophytes
  • Sclerosis
  • Bone cysts
25
Q

Name some non-operative treatments of OA

A
  • Weightloss
  • Exercise/physiotherapy
  • Analgesia/NSAIDs
  • Joint injection
26
Q

What are the operative treatments of OA?

A
  • Atheroscopy
  • Osteotomy (Spreads the weight load)
  • Arthrodesis (fusion of bones across a joint space which eliminates movement)
  • Arthroplasty (Surgical refashioning of a joint)
27
Q

What are the components of a total hip replacement?

A
  • Acetabular component

- Femoral head and femoral stem

28
Q

What are possible local complications of hip replacements?

A
  • Leg length inequality
  • Dislocation
  • Infection
  • Loosening
  • Neurovascular damage
29
Q

What are the possible systemic complications of THR?

A
  • UTI/chest infections
  • Clinical DVT
  • Non-fatal PE
  • Fatal PE
30
Q

What MSK structures become affected by age?

A
  • Bone
  • Cartilage
  • Fibrous tissue (ligaments, tendons etc)
  • Skeletal muscle
  • Fat

Musculoskeletal System (34 decks)

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