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Musculoskeletal case > The ageing skeleton > Flashcards

The ageing skeleton Flashcards

1
Q

What is sarcopenia Latin for

A

povert of the flesh

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2
Q

What is sarcopenia

A

Used to describe inevitable loss of muscle mass and strength that occurs in ageing muscle, even in the healthy elderly

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3
Q

What is important about muscle gaining and age

A

Muscle gaining will not prevent loss of muscle mass

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4
Q

What are one of the easiest ways of measuring strength

A

Hand grip

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5
Q

What is isometric strength

A

Strength when the muscle is not changing shape

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6
Q

Compare rate of loss of force and reduction in muscle area

A

Loss of force is greater than reduction in area

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7
Q

What happens to motor units through age

Effect?

A 
Fewer fast motor units
Slow motor neurons sprouting 
Motor units become denervated by slow motor neurons making them into slow motor units
More fibres per motor unit
less muscle fibres
atrophy
More slow muscles
slow muscle reflexes
Poor coordination
Increase risk of falls
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8
Q

What is a motor unit

A

A. motor unit is the term applied to a single motor neuron and all of the muscle fibres that it stimulates

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9
Q

What factors contribute to sarcopenia

A

Nutritional
Hormonal
Immunological
Physical activity less activity

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10
Q

What leads to sarcopenia

A 
loss of motor units 
increase in muscle fibres
muscle fibres atrophy
which leads to:
loss of muscle mass
loss of muscle strength
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11
Q

What does sarcopenia mean for patients

A

Weakness and decreased mobilty

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12
Q

What does sarcopenia lead to

A

disability and loss of independence

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13
Q

How does sarcopenia lead to dependency 5

A 
Loss of muscle mass
Loss of muscle strength
Decreased physical activity
Increase risks of fall
Loss of autonomy
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14
Q

How is osteopenia characterised?

A

bone loss
reduced bone mineral density (BNAD)
micro-architecture deterioration

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15
Q

What happens with patients with osteopeania

A

Bones become more fragile

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16
Q

What percentage of men and women are affected by osteopaenia?

A

50% women

30% men

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17
Q

What area of the body of most at risk of osteopenia

A

Vertebrae
hip
wrist

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18
Q

What important aspect of fractures?

A

Previous fracture increases risk of future fracture

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19
Q

How is osteopania defined/diagnosed

A

By the T-score

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20
Q

What calculates a T-score

A

DEXA

21
Q

What does DEXA stand for

A

dual energy X-ray absorptiometry

22
Q

What measures bone density/ bone loss

A

DEXA

23
Q

What does DEXA measure

A

bone loss

24
Q

What T-score is classified as osteopenia

A

-1- -2.5

25
Q

What T-score is classified as osteoporosis

A

LESS than -2.5`

26
Q

What T-score is classified as normal

A

more than -1

27
Q

How does cortical bone strength decrease over time (rate)

A

by 2 % per decade from 20 years old

28
Q

How does toughness decrease over time

A

by 7% per decade

29
Q

What type of bone is affected more due to ageing and why

A

trabecular bone affected more than cortical due to thinning and
loss of trabeculae

30
Q

How does hormone affect bone and what happens with ageing

A

stimulate bone formation

hormone levels decreases, with age (men too!)

hormones also affect bone via muscle!

31
Q

How does menopause effect bone strength? how is it treated?

A

menopause: bone loss becomes twice as fast in
women

effect is systemic (so other factors operate)

hormone replacement therapy (HRT) reverses
some of effects of menopause

32
Q

Out of diet genes, hormones, and

exercise which has the least effect on bone density

A

diet has less effect than genes, hormones, and

exercise

33
Q

How does ageing affect fibrous tissue

A

Cell content/ morphology changes

Collagen cross-links increase and mature (become
non-reducible)
Cross-links increase tissue strength & stiffness and brittle

Non-enzymic glycation (NEG) makes tissue yellow
and stiffer

Microdamage accumulates and makes tissue weaker
Cells become less responsive to mechanical stimuli - growing for example

NEG uncontrolled by cells: problem in tissues with low turnover

34
Q

What causes bone to be more brittle?

A

Increase in cross links

35
Q

What are the two main crosslinks

A

deoxypyridinoline

pyridinamine

36
Q

How are does collagen crosslinking become the cause of stiffness and brittleness

A

Collagen molecules normally linked with crosslinks
But normal crosslinks are changed by non-enzymatic glycation which makes them sticky
less flexible
more brittle

37
Q

What is non-enzymatic glycation

A

When a reducing sugar is added to a protein without using an enzyme

38
Q

What are two types of tendon cells

A

Elongated cells - long processes - fat fibroblasts

thin tenocytes/fibrocytes

39
Q

Where do you find elongated tendon cells

A

Immature tissue

40
Q

Where do you find thin tenocytes tendon cells

A

mature tissue

41
Q

What happens to tendons throughageing

A

Tendon thins becomes harder less flexible

42
Q

What happens to ligaments with age?

A

Become stiffer

43
Q

Age-related change in cartiladge

A

less proteoglycan content

less aggregation of PG’s

increase collagen content and cross-linking
increase levels of non-enzymatic glycation
increase apoptosis

increase stiffness
Cartilage cell density decrease with age
Chondrocytes stop dividing at skeletal maturity

44
Q

Age related changes in spine

A

Disc degeneration

45
Q

Stages of disc degeneration

A

annulus fibrosus looks hydrated
nucleus pulposus more jelly like
loss of hydration of the nucleus pulposus becomes more solid in older people

discolouration of white annulus fibrosus due to non- enzymatic glycation
may become damaged, and prolapse.
In very old tissue Damage to annulus fibrosus (outer layer)
pressure has changed as a result and softer inner pulposus can actually leak out through the damaged outer layer and pushes on nearby nerves leading to the pain associated with this
Damaged intervertebral disk- no nucleus pulpous change in overall structure
Overtime-
tissue becomes more fibrous

46
Q

What is annulus fibrosus

A

the tough circular exterior of the intervertebral disc

47
Q

What is nucleus pulposus

A

Inner core of the invertebra disk

48
Q

What happens with vertebral osteoporosis

A

Trabecula thining
more porous
#

49
Q

What does vetebral osteoporosis lead to? What does that do?

A

Vertebral osteoporosis fracture leads to kyphotic deformity

Musculoskeletal case (8 decks)

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