The ageing skeleton

Question 1

What is sarcopenia Latin for

Answer 1

povert of the flesh

Question 2

What is sarcopenia

Answer 2

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

Question 3

What is important about muscle gaining and age

Answer 3

Muscle gaining will not prevent loss of muscle mass

Question 4

What are one of the easiest ways of measuring strength

Answer 4

Hand grip

Question 5

What is isometric strength

Answer 5

Strength when the muscle is not changing shape

Question 6

Compare rate of loss of force and reduction in muscle area

Answer 6

Loss of force is greater than reduction in area

Question 7

What happens to motor units through age

Effect?

Answer 7

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

Question 8

What is a motor unit

Answer 8

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

Question 9

What factors contribute to sarcopenia

Answer 9

Nutritional
Hormonal
Immunological
Physical activity less activity

Question 10

What leads to sarcopenia

Answer 10

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

Question 11

What does sarcopenia mean for patients

Answer 11

Weakness and decreased mobilty

Question 12

What does sarcopenia lead to

Answer 12

disability and loss of independence

Question 13

How does sarcopenia lead to dependency 5

Answer 13

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

Question 14

How is osteopenia characterised?

Answer 14

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

Question 15

What happens with patients with osteopeania

Answer 15

Bones become more fragile

Question 16

What percentage of men and women are affected by osteopaenia?

Answer 16

50% women

30% men

Question 17

What area of the body of most at risk of osteopenia

Answer 17

Vertebrae
hip
wrist

Question 18

What important aspect of fractures?

Answer 18

Previous fracture increases risk of future fracture

Question 19

How is osteopania defined/diagnosed

Answer 19

By the T-score

Question 20

What calculates a T-score

Answer 20

DEXA

Question 21

What does DEXA stand for

Answer 21

dual energy X-ray absorptiometry

Question 22

What measures bone density/ bone loss

Answer 22

DEXA

Question 23

What does DEXA measure

Answer 23

bone loss

Question 24

What T-score is classified as osteopenia

Answer 24

-1- -2.5

Question 25

What T-score is classified as osteoporosis

Answer 25

LESS than -2.5`

Question 26

What T-score is classified as normal

Answer 26

more than -1

Question 27

How does cortical bone strength decrease over time (rate)

Answer 27

by 2 % per decade from 20 years old

Question 28

How does toughness decrease over time

Answer 28

by 7% per decade

Question 29

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

Answer 29

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

Question 30

How does hormone affect bone and what happens with ageing

Answer 30

stimulate bone formation hormone levels decreases, with age (men too!) hormones also affect bone via muscle!

Question 31

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

Answer 31

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

Question 32

Out of diet genes, hormones, and | exercise which has the least effect on bone density

Answer 32

diet has less effect than genes, hormones, and | exercise

Question 33

How does ageing affect fibrous tissue

Answer 33

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

Question 34

What causes bone to be more brittle?

Answer 34

Increase in cross links

Question 35

What are the two main crosslinks

Answer 35

deoxypyridinoline | pyridinamine

Question 36

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

Answer 36

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

Question 37

What is non-enzymatic glycation

Answer 37

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

Question 38

What are two types of tendon cells

Answer 38

Elongated cells - long processes - fat fibroblasts | thin tenocytes/fibrocytes

Question 39

Where do you find elongated tendon cells

Answer 39

Immature tissue

Question 40

Where do you find thin tenocytes tendon cells

Answer 40

mature tissue

Question 41

What happens to tendons throughageing

Answer 41

Tendon thins becomes harder less flexible

Question 42

What happens to ligaments with age?

Answer 42

Become stiffer

Question 43

Age-related change in cartiladge

Answer 43

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

Question 44

Age related changes in spine

Answer 44

Disc degeneration

Question 45

Stages of disc degeneration

Answer 45

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

Question 46

What is annulus fibrosus

Answer 46

the tough circular exterior of the intervertebral disc

Question 47

What is nucleus pulposus

Answer 47

Inner core of the invertebra disk

Question 48

What happens with vertebral osteoporosis

Answer 48

Trabecula thining more porous #

Question 49

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

Answer 49

Vertebral osteoporosis fracture leads to kyphotic deformity