Osteoporosis and Musculoskeletal Health

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Questions and Answers

What significant risk factor for osteoporosis does Mrs. B display?

High physical activity level

Being male

High dietary calcium intake

Advanced age (correct)

Which of the following measurements is essential for diagnosing osteoporosis?

MRI of the spine

Urine calcium test

Complete blood count

DXA scan (correct)

What is the impact of estrogen on bone health?

Stimulates bone resorption

Inhibits osteoclast activity (correct)

Has no effect on bones

Promotes bone deposition only

What is a common effect of glucocorticoids on bone health?

Increase bone resorption Signup and view all the answers

What T-score indicates the diagnosis of osteoporosis?

Below -2.5 Signup and view all the answers

Which factor is NOT typically associated with increased fracture risk?

Professional athlete Signup and view all the answers

What is the primary characteristic of sarcopenia as it relates to skeletal muscle in older adults?

A decrease in appendicular muscle mass and strength Signup and view all the answers

Which of the following factors is a modifiable risk for osteoporosis?

Smoker status Signup and view all the answers

Which specific change in muscle fiber composition is associated with sarcopenia?

Conversion of type II fibers to type I fibers Signup and view all the answers

Which of the following factors is NOT clearly understood as a cause of sarcopenia?

High levels of physical activity Signup and view all the answers

What role does resistance training play in addressing sarcopenia in older adults?

It is the most powerful countermeasure against sarcopenia Signup and view all the answers

In the context of sarcopenic obesity, what impact does reduced resting metabolic rate (RMR) have?

Accelerates the loss of muscle mass Signup and view all the answers

Which modifiable factor has a direct inhibitory effect on osteoblast activity?

Tobacco smoking Signup and view all the answers

What is the RDA for calcium intake for men aged 51-70 years?

1000 mg/d Signup and view all the answers

What potential side effect can limit the usage of bisphosphonates?

GI reflux Signup and view all the answers

How does excessive exercise impact bone health?

It causes long-term bone exhaustion. Signup and view all the answers

What effect does low BMI have on bone health?

It can be a risk factor due to insufficient body weight. Signup and view all the answers

In which scenario would an individual likely have decreased calcium absorption?

Excessive alcohol intake Signup and view all the answers

Why is vitamin D activation critical for bone health?

It assists in calcium absorption. Signup and view all the answers

What is a recommended strategy for calcium intake throughout the day?

Spread intake to avoid exceeding absorption limits. Signup and view all the answers

What age-related factor increases the likelihood of osteoporosis in elderly individuals?

Decline in hormone levels Signup and view all the answers

What effect does physical fitness in later life have on elderly individuals regarding bone health?

It reduces the risk of falls. Signup and view all the answers

Study Notes

Ageing and Musculoskeletal Health

An 80-year-old woman tripped and broke her right hip.
She had been living alone and watching TV.
She had a prior history of a hip fracture 20 years prior.
She had fallen at home 6 months prior to the current injury.

Osteoporosis

Osteoporosis is a significant cause of morbidity and mortality.
Bone is constantly remodeling, with bone being reabsorbed by osteoclasts and new bone being deposited by osteoblasts.
An imbalance between bone resorption and bone formation leads to osteoporosis.
Inadequate peak bone mass (20-30 years) is a risk factor.
Estrogen suppresses osteoclast bone resorption. Lack of estrogen increases bone resorption and decreases bone formation.
DXA scan (dual energy x-ray absorptiometry) measures bone mineral density, lean body mass, and fat mass.
- The diagnosis of osteoporosis is made when bone mineral density is 2.5 SD below the comparison group (20-year-old sex-matched healthy adult).

Vitamin D and Bone Health

Factors that may affect Vitamin D in this age group include:
- Decreased intake
- Reduced time outside or institutionalization
- Reduced intestinal absorption
Vitamin D precursor 25-hydroxyvitamin D is measured to assess dietary vitamin D sufficiency.

Who is at risk? - Non-Modifiable Factors

Advanced age
Female
European and Asian ancestry
Family history of fracture
Previous fracture (≥2x)
Rheumatoid arthritis
Gastrointestinal disorders (Crohn's, Celiac, gastrectomy, severe liver disease)

Who is at Risk? - Modifiable Factors

Tobacco smoking inhibits osteoblast activity.
Low Body Mass Index (BMI)
Alcoholism inhibits calcium absorption, and liver disease interferes with vitamin D activation.
Soft drinks contain phosphoric acid, displacing calcium from the diet.
Insufficient activity impacts bone health. Weight-bearing exercises increase bone mass. Physical fitness reduces the risk of falls. Excessive exercise can cause structural bone exhaustion.
Serum 25-OH Vitamin D < 20 ng/mL
Calcium intake

Osteoporosis - Treatment

Bisphosphonates are commonly prescribed for osteoporosis.
They preferentially bind calcium, forming strong bonds with bone mineral.
They prevent bone resorption and increase bone formation for about a year.
Side effects can include GI reflux (Gastroesophageal Reflux Disease)

Sarcopenia

Age-related loss of skeletal muscle mass and strength.
Appendicular muscle mass is 2 standard deviations below the mean for young healthy adults (measured via DXA scan).
Sarcopenia is highly predictive of incident disability and all-cause mortality.
Causes are poorly understood. Potential causes include denervation of motor units, net conversion of fast-type II muscle fibers into slow-type I fibers (loss in muscle power), and lack of physical activity.

Sarcopenia - Prevention

Resistance training is an effective measure against this.
Positive influence on the neuromuscular system, hormone concentrations, and protein synthesis rates.
Studies show an increase in protein synthesis rates after just 2 weeks of resistance training in adults (76-92 years old).

Obesity in Older Adults (Sarcopenic Obesity)

Prevalence of older adults experiencing sarcopenia and obesity.
Variables that may be involved include: decreasing resting metabolic rate (RMR) and decreasing physical activity as well as potentially an increase in inflammatory cytokines and an accelerated loss of muscle mass.
High muscle mass, but poor quality muscle. This can impact the risk of frailty and loss of independence.

Sarcopenic Obesity - Treatments

Weight loss may exacerbate age-related declines in fat-free mass (FFM).
Diet-induced weight loss may result in 75% fat mass and 25% FFM.
Exercise may improve physical functioning but may not result in substantial weight loss.
The optimal treatment for sarcopenic obesity is controversial.

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Description

This quiz covers key concepts of osteoporosis and its impact on musculoskeletal health, particularly in the elderly. It includes information on bone remodeling, risk factors, and diagnosis of osteoporosis through DXA scans. Test your knowledge on how age affects bone health and fracture risks.