विवरण
As people age, their musculoskeletal system undergoes changes that can lead to various orthopedic conditions. Bones lose density, which can result in osteoporosis and bone fractures. Muscle weakness associated with aging can also occur. Osteoarthritis is a common condition that can cause pain and stiffness in the joints, especially in the morning or after overuse of the joint. The cartilage in the joints can wear out over time, leading to bones rubbing painfully against each other. Other common musculoskeletal conditions include back pain, arthritis, and broken bones. To keep the musculoskeletal system healthy, it is important to maintain a healthy weight, exercise regularly, and eat a balanced diet.
सारांश
- Osteoporosis is a significant health concern affecting millions globally, particularly in the US, Europe, and Japan. While data for India is less comprehensive, it's expected to be substantial. Prevalence increases with age, affecting a higher percentage of women than men, particularly after 50. Diagnosis involves bone densitometry, focusing on spine, hip, and wrist density, with T-scores below -2.5 indicating osteoporosis.
- Sarcopenia, or loss of muscle mass, is a critical factor in hip fractures, especially in elderly women. Dietary factors, like the Mediterranean diet, protein intake, and vegetable consumption, alongside physical activity, are crucial for bone health. Biomarkers such as low vitamin D and HbA1c levels are also indicative of fracture risk.
- Factors accelerating muscle mass loss include aging, immobility, unbalanced diet, chronic inflammation, and stress. Conditions such as COPD, rheumatoid arthritis, and chronic liver diseases are associated with increased risk of sarcopenia. Elevated C-reactive protein indicates inflammation and can predict sarcopenia.
- Osteoporotic fractures are classified as vertebral or non-vertebral, with hip, wrist, and humerus fractures being more common. Risk factors include personal or maternal history of fractures, low weight, and specific particle types. Low bone density, diabetes, and female sex also elevate risk. Survival rates decrease after hip fractures, highlighting the condition's severity.
- Treatment involves anti-resorptive and anabolic agents, with anti-resorptive drugs decreasing bone loss and anabolic agents promoting bone formation. Lifestyle changes, including a balanced diet, vitamin D and calcium intake, physical activity, and avoiding smoking and excessive alcohol, are vital. Bisphosphonates reduce resorption and increase bone matrix, with potential side effects like osteonecrosis of the jaw.
- Estrogens and selective estrogen receptor modulators (SERMs) like Raloxifene, along with Vitamin D preparations and strontium ranelate, are used. Parathyroid hormone and calcitonin are also beneficial. Calcium salts are important, with calcium carbonate being noted for its phosphate-binding properties. Cinacalcet is used for hyperparathyroidism, and Denosumab is a popular therapy, especially for spine osteoporosis.
- Surgical interventions for osteoporotic fractures include fixation, external fixators, and vertebroplasty. Joint replacements may be necessary for femoral fractures, while tibial fractures may require specific diagnostic and treatment approaches. Periprosthetic fractures are a concern after joint replacements, emphasizing the need for post-operative bone health follow-up. Treatment order sometimes favors osteoporosis management before addressing joint issues to prevent iatrogenic fractures.
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