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?
- 15 minutes of sun DAILY
- NO smoking
- Responsible drinking
- 1000 mg daily calcium intake
- REGULAR exercise
What is osteoporosis treatment?
- 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?
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
What are the risk factors for tendinopathy?
- 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?
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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