Guest lecture the ageing joints

22 important questions on Guest lecture the ageing joints

What is the 'problem' of ageing

  • Changes in several organ systems
  • increase susceptibility to many diseases
    • genetic factors, lifestyle choices & environmental exposure

What are the positive neutral and negative characteristics of the bone

  • Cyclic remodelling of microdamage 
  • With ageing
    • Less osteoblasts, reduced osteoblast function, increased apoptosis
    • Increase in osteoclast activity
    • Hormonal changes
      • less ostrogens
      • less growth hormones, reduced sensitivity to IGF-1
  • Less bone formation > net loss of bone!
  • Changes in bone deposition > reduction in bone strength

How is osteoporosis diagnosed

  • Bone Mineral Density (BMD)
  • DEXA scan (hip/spine)
    • BMD is compared to 2 norms
      • healthy young adults (25-35 yr)(T-score)
      • age-matched adults (Z-score)
    • Risk for none fracture doubles with every SD below normal
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What are the risk factors for osteoporosis?

  • Women and postmenopausal women
  • men with significant smoking hisotry
  • alcohol
  • smoking
  • family history
  • inactive lifestyle
  • thin and/or small frame
  • calcium and vitamin D deficiency
  • getting older
  • low testosterone levels (men)
  • corticosteroids and anti-seizure medications
  • medical conditions that weaken calcium absorption

What are the signs & symptoms of osteroporosis

  • Fracture with little or no trauma
  • Loss of height over time
  • Neck or back pain due to fractures
  • Bone pain or tenderness
  • Stooped posture

What are the signs & symptoms of osteroporosis

  • Fracture with little or no trauma
  • Loss of height over time
  • Neck or back pain due to fractures
  • Bone pain or tenderness
  • Stooped posture

How can osteoporosis be prevented?

Healthy bones without osteoporosis 
  • 15 minutes of sun DAILY
  • NO smoking
  • Responsible drinking
  • 1000 mg daily calcium intake
  • REGULAR exercise

What is osteoporosis treatment?

Non-pharmalogical
  • EXERCISE!
  • calcium / vitamin D
  • (surgery in case of #)


Pharmalogical
  • Biphosphonates
  • Calcitonin
  • Hormone replacement therapy
  • Selective estrogen receptor modulators
  • Anabolic agents

What are the risk factors for sarcopenia?

  • Ageing
    • age-associated muscle loss
  • Disease
    • inflammatory conditions
    • osteoarthritis
    • neurological disorders
  • Inactivity
    • sedentary behavior
    • physical inactivity
  • Malnutrition
    • under-nutrition or malabsorption
    • medication-related anorexia
    • over-nutrition/obesity

How can sarcopenia be prevented?

In early life - maximize peak
Adult life - maintain peak
Older life - minimize loss

What is the treatment for osteo-arthritis?

  • Exercise --> weight loss
  • begin with acetaminophen and continue if still effective, or step up to  NSAID
  • Start NSAID therapy; over-the-counter ibuprofen or naproxen
  • etc
  • etc

What is a tendon?

  • Highly organized structure
    • fibroblasts / tenosytes
    • extracellular matrix
      • collagen type 1
      • proteoglycans / glycosaminoglycans
      • elastin
  • Movement and stabilization of joints

What happens with the tendon when aging

  • Reduced blood flow
  • Changes in tendon homeostasis
  • Changes in extracellular matrix
    • less water, collagen disorientation
  • (over)load dependent fibrillar changes
  • impaired healing response
  • 50% of patients over age 40 have tendon degeneration (rotator cuff)

What is the tendinopahty - load

Image

What are the risk factors for tendinopathy?

Intrinsic factors
  • age & gender
  • genetics
  • body shape & kinetic chain
  • basic motor characteristics
  • metabolic / hormonal changes
  • previous injury
  • tenson abnormalities
  • microbiome
  • psychological state

Extrinsic factors
  • LOAD!
  • technique
  • equipment
  • circumstances
  • diet
  • medication
  • coach/boss/team
  • oppponents
  • crowd & media
  • money

What are the signs & symptoms of tendinopaty?

  • Load dependent pain
  • Swelling
  • Morning pain & stiffness


it can be shown on an ultrasound and on MRI

What are the signs & symptoms of tendinopaty?

  • Load dependent pain
  • Swelling
  • Morning pain & stiffness


it can be shown on an ultrasound and on MRI

What is the prevention of tendinopathy?

  • Start low, go slow!
  • Recovery time
  • reduce weight
  • strengthening exercises
  • correct biomechanical abnormalities
  • healthy diet
  • proper technique & equipment
  • (hormone replacement therapy)

What is the treatment for tendinopaty?

Explain the problem
management of expectation
pain management
load management
strengthening exercises
address risk factors
gelatin / vitamin C

  • rest
  • exercise therapy
  • massage
  • ultrasound
  • laser
  • NSAID
  • dry needling
  • etc
  • etc

What is the dosage of exercise?

  • At least 150 to 300 minutes moderate-intensity aerobic PA (week)
  • At least 75 to 150 minutes vigorous-intensity aerobic PA (week)

Additional health benefits:
  • on at least 2 days a week muscle-strengthening activities at moderate or greater intensity that involve all major muscle groups

What does the exercise prescription contain?

  • Indications
  • Dosage
  • Side effects
  • Use in pregnancy
  • Warning & precautions
  • Screening & prescription
  • Compliance

What are the warnings/precautions of exercise

  • Start low, go slow
  • At least one hour after your meal
  • In combination with healthy food, plenty of water and enough sleep
  • do not combine with smoking
  • Be careful in the heat/sun
  • beware of addiction
  • in case of high risk: preparticipation health screening & physical examination

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