Lecture 11.1: Clinical Effects of the Ageing Musculoskeletal System Flashcards
(29 cards)
What is the definition of Ageing?
Lifelong accumulation of molecular and cellular damage caused by multiple mechanisms under the regulation of a complex maintenance and repair network
Non-Modifiable Risk Factors (6)
- Age
- Female sex
- Ethnicity (Caucasians)
- Previous fracture
- Family History
- Late menarche (>16 y.o.), early menopause (<47 y.o.)
Modifiable Risk Factors (5)
- Bone Mineral density
- Alcohol (>3.5 units/day)
- Weight (BMI < 20)
- Smoking
- Physical inactivity
Which Medications are associated with Risk Factors? (8)
- Long-Term Antidepressants
- Antiepileptics
- Aromatase Inhibitors
- Long-Term DMPA
- GnRH Agonists (in men with prostate cancer)
- PPIs
- Oral Glucocorticoids
- Thiazolidinedione for DM TZDs
Diagnosis of Osteoporosis
• 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
Normal BMD
T-score of −1 SD or above
Osteopenia
T-score of between −1 and −2.5 SD
Osteoporosis
T-score of −2.5 SD or below
Established Severe Osteoporosis
T-score of −2.5 SD or below with one or more associated fractures
What is a DEXA Scan?
- Dual Energy Xray Absorptiometry
- Assess bone mineral density (BMD)
- X-Rays of 2 different energies
- Aimed at femur and L-spine (L3)
National Institute of Allergy and Infectious Disease (NIAID) Classification (3)
- Group I – Pathogens that have been newly recognised in the last 20 years
- Group II – Reemerging pathogens
- Group III – Agents with bioterrorism potential, subdivided
What is the T-Score?
Number of SD below mean for sex and race matched healthy young adult population (25-35y age)
What is the Z-Score?
Number of SD below mean for an age, sex and race matched young adult population
What are Fragility Farctures?
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
Lifestyle Interventions: Exercise
- Static/Dynamic weight bearing exercise (low and high force)
- Muscle resistance training and balance
Lifestyle Interventions: Diet
- Supplementation with 10 micrograms/day of vitamin D (400 IU)
- Dietary calcium
- Vit B, Vit K
- Reduce salt
- Balanced diet
What is the effect of Bisphosphonates on Bones?
- Anti-resorptive agents
- Effect osteoclasts (bone resorption)
- Reduce bone turnover
- Increase bone mineralisation
What is the Purpose of the Best Practice Tariff (BPT)?
To improve and universalise care in an area with significant unexplained variation in quality of clinical practice
What is the role of an Orthogeriatrician?
- 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
Pneumonic for Osteoarthritis Features
LOSS: L: oss joint space O: steophytes S: clerosis S: ubchondral cysts
Local Complications of Hip Replacement (6)
- 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)
Systemic Complications of Hip Replacement (5)
- 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%)
What is Sarcopenia?
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
What is Cachexia?
Weakness and wasting of the body due to severe chronic illness
