Aging of Musculoskeletal

System

SIVAPORN VONGPIPATANA, M.D.

Department of Rehabilitation Medicine Faculty of Medicine Ramathibodi Hospital Mahidol University

Objective Explain physiologic change of musculoskeletal system in aging process

Identify risk factors for aging process in musculoskeletal system

recognize commom conditions and diseases associated in MSK in elderly

Recognize the importance of non-pharmacologic treatment in elderly

Recognize the effect of pharmacological treatment in elderly

What happens when we are aging?

• Nervous system • Cardiopulmonary • Endocrine

• Muscles • Cartilages and joints • Bone

What are appearance of an elderly man/woman in terms of musculoskeletal system?

Appearance of older person

•back kyphosis (a forward bending of spine)

• loss of height

• less flexibility

• neck pain

• back pain

• knee pain

The musculoskeletal system

Collagenous tissue

Cartilage

Bone

Collagenous tissue Is the component of

Skin

Tendon

Ligament

Fascia

Collagenous tissue in elderly

Stiffness of collagenous

tissue

dehydration

Increase collagen crosslinks

Accumulation of waste products

Less flexibility of

collagenous tissue

Cartilage Articular cartilage

Hyaline cartilage

Cartilage in aging process

Cartilage break down

Poorly hydrated

Poorly nourished

No weight bearing

Decreased joint space

Bone

Imbalance

between

osteoclast & osteoblast

Decline in circulatory level of vitamin D

Decreased bone mass in elderly

Common diseases and conditions in elderly

Common disease and condition •Sarcopenia

•Frailty Syndrome

•Osteoarthritis

•Degenerative joint disease

•Osteoporosis

Sarcopenia

Sarcopenia

•muscle wasting of old age

• dual-energy x-ray absortionmetry : < 2or more SD below values of young adult

Sarcopenia

Sarcopenia Loss of muscle

strength Decreased

functional ability

Causes of Sarcopenia • Lifestyle behaviors : physical inactivity

• Loss of neuromuscular function : loss of alpha motor neuron

• Decreased vit D and Parathyroid hormone level

• Increased level of cytokines

• Obesity

• Genetic

• Low nutritional intake & low protein intake

Management

• Resistive exercise: the best • Aerobic exercise • Nutrition • + Hormone: controversey

Frailty Syndrome

Frailty • lack of consensus definition

• Fried “… an aggregate expression of risk resulting from age- or disease-associated physiologic accumulation of sub-threshold decrements affecting multiple physiologic systems”

Frailty: suspected clinical •Increased inflammatory response

•Decreased cardiopulmonary and renal reserve

•Sarcopenia

•Weight loss

•Exhaustion

•Weak grip strength

•Slow walking speed

•Low level of physical activity

Fried Phenotype model of frailty 1. Weakness: grip strength < 20th percentiles

2. Slowness: walking time(15 feet) – slower 20% by sex and height

3. Low level of physical activity: bottom 20th percentile of calculated Kcal as measured by the Minnesota Leisure Time Activity Questionnaire

4. Exhaustion: self-reported, based on items in the Center for Epidermiologic Studies Depression Scale

5. Weight loss: >10% of unintentional weight loss during the prior year

Subcategories of Frailty

•Physical frailty

•Cognitive frailty

Management

•Physical activity

• Multicomponent exercise: strength, endurance, balance

• each intervention should be at least •3 times/week 30-45 minutes and • sustained for >5 months

Osteoarthritis

Common sites • knees •hands •fingers

Management • Phamalogical management • Paracetamol

• NSAIDS

• Hyaluronic acid supplement

• non-phamalogical management • Lifestyle modification

• Exercise

• Surgery

Degenerative joint diseases - CERVICAL SPONDYLOSIS

- LUMBAR SPONDYLOSIS

Management • Medication

• Rest

• Education

• Exercise

Osteoporosis

Osteoporosis • absolute decreased in the amount of normal bone

• osteoclast > osteoblast

• Bone Marrow Density (BMD): T score < 2.5

• Osteopenia

Causes of osteoporosis • estrogen deficiency

•testosterone deficiency

• malabsorption of Ca

• Ca deficiency in diet

• endocrine disorders

• immobility localized osteoporosis

What are the effect of immobilization? •Increase muscle insulin resistance

•Increase bone lose

•decreased pulmonary function and exercise capacity

•Orthostatic hypotension

•Impair balance and coordination

Non-pharmacological management

Exercise

•Strengthening exercise

•Stretching exercise

•Aerobic exercise

•Aquatic exercise

•Tai chi

Other non-pharmacological management

•Gait aids

•Physical modalities: hot, cold pack

•Assistive device

•Environmental designs

Pharmacological management

Common drugs used in pain •NSAIDs

•Weak opioids

•Opioids

•Muscle relaxants

•Anti-epileptic drugs

•Steroids

Drugs affected on Exercise

Common Drugs •Anti-diabetic drugs: insulin injection

•Steroids

•diuretics

•anti-hypertensive drugs: alpha blocker, Beta blocker

Question?