Musculoskeltal Aging

Carlos M. Isales, MD, FACP

Augusta Universityhttps://www.myhealth.va.gov/mhv-portal-web/anonymous.portal?_nfpb=true&_nfto=false&_pageLabel=spotlightArchive&contentPage=spotlight/September%202011/spotlight_sept2011_bonehealth.html

AgingAging can be described as a process or group of processes occurring in living organisms that with the passage of time lead to a loss of adaptability, functional impairment and eventually death.

•      Aging often results in a decline in function of various physiological systems:

•    Cardiorespiratory• Musculoskeletal•    Neuroendocrine•    Immune•    Gastrointestinal•    Auditory, Visual, Vestibular

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Frailty (musculoskeletal aging)Frailty is a relatively modern concept. Fried et al. describe it as a syndrome that includes: -self-reported exhaustion -reduced physical activity-slow walking speed -reduced grip strength

-unintentional weight loss (Fried et al. 2001).

Frailty is present when three or more of these five characteristics are present.

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Aging and Muscle Loss (Sarcopenia)•As a normal part of the aging process, individuals experience a loss of skeletal muscle referred to as sarcopenia. Sarcopenia starts to set in around age 45, when muscle mass begins to decline at a rate of about 1 percent per year.

•By the seventh and eighth decades of life, a decrease in the maximal contractile strength on the order of 20-40% for both men and women is observed.

• The weakness associated with sarcopenia has been shown to be associated with difficulty in rising from a chair and getting out of bed.

CT Scans

Young, healthy muscle

Elderly muscle

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Aging Effects on Strength

• Strength peaks around age 30, begins to decline after age 50 and after about age 60, strength levels fall more rapidly, independent of training.

• The decreased strength is due to atrophy of muscle fibers.

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Aging Effects on Strength

Augusta UniversityJournal of Gerontology: BIOLOGICAL SCIENCES 1997, Vol. 52A, No. 5, B267-B276

Age-Related Muscle Loss and Weakness Leads to Disabilities

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A profile of older Americans 2011; Department of Health and Human Services

Aging Effects on Bone-Osteoporosis is a systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture.-Over a life span women lose approximately 42% of their spinal and 58% of their femoral bone mass.

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Normal Moderate

Osteoporosis Severe

Osteoporosis

Images by Dr. A. Boyde, London

Osteoporotic Fractures

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Wasnich RD. Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism. 4th ed, Philadelphia, PA: Lippincott Williams & Wilkins;1999:257-259

• 1.5 million fractures/yr in US

• $10 billion direct costs

• 300,000 hip fractures/yr– 20% die– 25% confined to long-term

facilities– 50% long-term loss of

mobility

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Osteoporotic Fractures

Aging Menopause

Increased bone loss

FRACTURESPropensity

to fallHigh bone turnover

Low peakbone mass

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Why Recognize & Treat Osteoporosis?Why Recognize & Treat Osteoporosis?

Osteoporosis is frequently a silent disease and will not be detected until a fracture occurs.

The best predictor for fracture risk is history of a previous fracture. Having had one fracture increases the risk for another fracture by 2-4 times, having had two fractures increases the risk for another fracture between 6-12 times. Thus, all patients with a fracture should be screened to prevent another fracture.

However, of patients seen in orthopaedics for a fracture only 6-10% are screened for osteoporosis and only 10-20% are put on any treatment

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Risks for OsteoporosisRisks for Osteoporosis

In young women

• Low calcium intake

• Low body weight

• Limited exercise

• Hypoestrogenism

In others

• Menopausal/postmenopausalstatus—without HRT

• Cigarette smoking

• Low-trauma fractures

• Hyperparathyroidism

• Chronic corticosteroid use

Aging American Population

• It is expected that a significant number of those born after 1990 will live beyond age 100.

• It is estimated that the odds of living to 100 years has risen from approximately 1 in 20 million to 1 in 50 for women.

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Aging in Georgia

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Aging in Georgia

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Population Males vs Females

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Census Data

Lifespan vs. Healthspan

Gurkar AU, Niedernhofer LJ. Comparison of mice with accelerated aging caused by distinct mechanisms. Exp Gerontol. 2015;68:43-50. Augusta University

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Thank You!

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NIA funded aging centers