Effects of Ageing on Bone: Difference between revisions

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== Ageing ==
== Introduction ==
[[File:Older person.jpg|thumb|Older person]]
[[File:Older person with osteoporosis.png|thumb|298x298px|Osteoporotic posture]]
Aging refers to the physiological changes that occur in the human body from the attainment of adulthood, and ending in death. These changes involve a decline of biological functions, and are accompanied by psychological, behavioural, and other changes. Some of these changes are quite obvious, while others are subtle.<ref name="brit">http://www.britannica.com/EBchecked/topic/1354293/human-aging</ref> <br>
As a result of the ageing process, [[bone]] deteriorates in composition, structure and function, which predisposes to [[osteoporosis]]. Bone is a dynamic organ that serves mechanical and homeostatic functions. It undergoes a continual self-regeneration process called remodelling ie removing old bone and replacing it with new bone. Bone formation and  bone resorption is coupled tightly in a balance to maintain bone mass and strength. With aging this balance moves in a negative direction, resulting in greater bone resorption than bone formation. This combination of bone mass deficiency and reduction in strength ultimately results in osteoporosis and [[Insufficiency Fracture|insufficiency fractures]].<ref name=":1">Demontiero O, Vidal C, Duque G. Aging and bone loss: new insights for the clinician. Therapeutic advances in musculoskeletal disease. 2012 Apr;4(2):61-76. Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3383520/ (accessed 2.12.2022)</ref>
== Ageing Bone Dynamics ==
[[File:Bone cells.jpeg|thumb|426x426px|Bone cells]]
As people age the rate of bone resorption by osteoclast cells (multinucleated cells which contain [[mitochondria]] and lysosomes that is responsible for bone resorption) exceeds the rate of bone formation so bone weaken.<ref>https://www.boundless.com/physiology/textbooks/boundless-anatomy-and-physiology-textbook/appendix-b-development-and-aging-of-the-organ-systems-1417/bone-development-1497/bone-tissue-and-the-effects-of-aging-1500-11222/</ref> The reasons for this are multi factorial, including:. 


== The Aging Bone  ==
Non-Modifiable Risk Factor 
[[File:Bone Comparison of Healthy and Osteoporotic Vertibrae.png|thumb|Bone Comparison: Healthy and Osteoporotic Vertebrae]]
[[Bone|Bones]] undergo a lifelong process of remodeling – mature bone tissue is removed and new bone tissue is formed. Bone remodeling is a highly regulated process that maintains a balance between bone resorption and formation, thus maintaining skeletal integrity.<ref name="remodel">Hadjidakis DJ, Androulakis II. Bone Remodeling. Ann N Y Acad Sci. 2006 Dec;1092:385-96.</ref>


This balance changes with increasing age, resulting in loss of bone tissue. The ageing bone has reduced mineral content, and is prone to [[osteoporosis]] – a condition in which bones are less dense, more fragile, and prone to fractures.<ref name="aaos">http://orthoinfo.aaos.org/topic.cfm?topic=A00191</ref>
* [[Genetics and Health|Genetics]] eg family history of osteoporosis
 
* Peak [[Bone Density|bone mass]] accrual in youth
As people age the rate of bone resorption by osteoclast cells (multinucleated cells which contain [[mitochondria]] and lysosomes that is responsible for bone resorption) exceeds the rate of bone formation so bone weaken.<ref>https://www.boundless.com/physiology/textbooks/boundless-anatomy-and-physiology-textbook/appendix-b-development-and-aging-of-the-organ-systems-1417/bone-development-1497/bone-tissue-and-the-effects-of-aging-1500-11222/</ref>
* Alterations in cellular components
 
* Older than 50 years of age
And this all happens due to:
* [[Multimorbidity|Comorbid]] medical conditions eg [[Hyperthyroidism]], [[Hyperparathyroidism]]
 
* [[Neonatal Intensive Care Unit (NICU)|Premature birth]]
*Inactive life style
* [[Hormones|Hormonal]], biochemical and vasculature status eg low levels of estrogen
*[[Hormones|Hormonal]] changes
*[[Sarcopenia]]
*Loss of calcium and other minerals in bone<ref>https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/ageing-muscles-bones-and-joints</ref>
*[[Epilepsy|Seizure]] disorder<ref name=":0">Andrew A, Rita A, Dale A. Geriatric Physical Therapy. Third Edition. Elsevier Mosby. 2012</ref>


== Effects of Changes in Aging Bone<ref>http://www.nlm.nih.gov/medlineplus/ency/article/004015.htm</ref>  ==
Modifiable Risk Factor


*[[File:Osteoprosis of Spine.jpg|thumb|Osteoprosis of Spine]]Osteoporosis is a common problem among [[Older People Introduction|older people]], especially post-[[Menopause|menopausal]] women, and is a major cause of [[Hip Fracture|hip fractures]] in the elderly.
* Nutrition eg [[Hypocalcemia|Calcium intake of less than 1200 mg/day]], Insufficient [[Proteins|protein]] intake, [[Vitamin D Deficiency|Inadequate Vitamin D]] intake, [[Body Mass Index|BMI]] <18.5,
*<span style="line-height: 1.5em;">Reduced bone density of the [[Thoracic Vertebrae|vertebrae]], combined with the loss of fluid in [[Biomechanics of Lumbar Intervertebral Disc Herniation|intervertebral discs]], result in a curved and shortened trunk.</span>
* Physical activity, 
*This reduced bone density, and resulting [[Thoracic Hyperkyphosis|poor posture]], leads to pain, reduced mobility, and other musculoskeletal problems.
* Drugs eg Excessive intake of [[Alcoholism|alcohol]], Cigarette [[Smoking and Exercise|smoking]]<ref name=":0" /><ref name=":1" />  
*The risk of injury increases because gait changes, instability, and loss of [[balance]] may lead to falls.<ref>https://medlineplus.gov/ency/article/004015.htm</ref>


== Ageing Joints  ==
== Adverse Effects ==
[[File:Osteoprosis of Spine.jpg|thumb|Osteoprosis of Spine]]The effects of bone structure changes may bring about:


Joint motion becomes more restricted and flexibility decreases with age because of changes in tendons and ligaments.<br>As the cushioning cartilage begins to break down from a lifetime of use, joints become inflamed and arthritic.<ref>http://orthoinfo.aaos.org/topic.cfm?topic=A00191</ref>For more see [[Effects of Ageing on Joints]]
* Osteoporosis: a major cause of [[Femoral Neck Hip Fracture|hip fractures]] in the elderly, a type of insufficiency fracture
=== Modifiable Risk factors for Bone loss in Aging Bone<ref name=":0">Andrew A, Rita A, Dale A. Geriatric Physical Therapy. Third Edition. Elsevier Mosby. 2012</ref> ===
* [[Lumbar Compression Fracture|Spinal Compression Fracture]]: Most occur at the thoracolumbar junction. 40% of the women over 80 years have received at least one compression fracture.<ref>Lumbar Compression [[Lumbar Compression Fracture|Fracture]]</ref>See also [[Osteoporotic Vertebral Fractures]]
* <span style="line-height: 1.5em;">Reduced bone density of the [[Thoracic Vertebrae|vertebrae]]: Combined with the loss of fluid in [[Biomechanics of Lumbar Intervertebral Disc Herniation|intervertebral discs]], result in a curved and shortened spine and possible</span> [[Thoracic Hyperkyphosis|poor posture]], leads to pain, reduced mobility, and other musculoskeletal problems.<ref>http://www.nlm.nih.gov/medlineplus/ency/article/004015.htm</ref><ref>https://medlineplus.gov/ency/article/004015.htm</ref>


* [[Hypocalcemia|Calcium intake of less than 1200 mg/day]]
=== Prevention ===
* Excessive intake of [[Alcoholism|alcohol]]
* Cigarette [[Smoking and Exercise|smoking]]
* [[Body Mass Index|BMI]] <18.5
* Low levels of estrogen
* Inactivity and immobilization
* Insufficient [[Muscle Function and Protein|protein]] intake
* [[Vitamin D Deficiency|Inadequate Vitamin D]] intake
* [[Hyperthyroidism]]
* [[Hyperparathyroidism]]
 
=== Non-Modifiable Risk Factor for Bone loss in Aging Bone ===
 
* [[Genetic Conditions and Inheritance|Genetic factor]]
* Caucasian race
* Hispanic women
* Older than 50 years of age
* Family history of osteoporosis
* Premature birth
* Childhood malabsorption disease
* [[Sarcopenia|Age-related loss of muscle mass]]
* [[Epilepsy|Seizure]] disorder<ref name=":0" />
 
== Prevention ==
[[File:Gym ladies.jpeg|thumb|Ladies gym]]
[[File:Gym ladies.jpeg|thumb|Ladies gym]]
[[Therapeutic Exercise|Exercise]] is important for preserving bone density, however care must be taken to avoid high-impact exercises and exercises that present the risk of falling. Useful exercises include:
For more see the informative on prevention, management and physiotherapy for see [[Osteoporosis]]  
 
*Weight-bearing exercises e.g. [[Walking: Muscles used|walking]]
*[[Strength Training|Strengthening exercises]] using free weights, elastic bands, [[Dumbbell Exercise|dumbbells]] etc.
*[[Balance]] exercises e.g. [[Tai Chi and the Older Person|tai chi]]<br>
A healthy diet, including adequate dosage of Vitamin D and Calcium, is also useful for preserving bone mass.  And it is important to limit [[Caffeine and Exercise|coffee]], alcohol and tobacco consumption as they may have deleterious effect on bone mineral  density<ref>http://www.nlm.nih.gov/medlineplus/ency/article/000360.htm</ref><ref>Coronado-Zarco R, de León AO, García-Lara A, Quinzaños-Fresnedo J, Nava-Bringas TI, Macías-Hernández SI. Nonpharmacological interventions for osteoporosis treatment: Systematic review of clinical practice guidelines. Osteoporosis and sarcopenia. 2019 Sep 1;5(3):69-77.</ref>.
 
For more see the informative [[osteoporosis]] page.
 
== Exercise and Ageing  ==


[[Exercise Physiology|Exercise]] is wonderful for health — but to get gain without pain, you must do it wisely, using restraint and judgment every step of the way. Here are a few tips:  
# [[Therapeutic Exercise|Exercise]]:  (See also [[Age and Exercise]]) Ageing is associated with reduced physical activity and mechanical loading. Decreased mechanical loading exerts a decreased effect upon osteoblasts.  Functional loading has been shown to improve bone mass in humans. However exercise training programs can prevent or reverse almost 1% of bone loss per year in both lumbar spine (LS) and femoral neck (FN) for both premenopausal and postmenopausal women.<ref name=":1" /> It is important exercise to preserve bone density, however care must be taken to avoid high-impact exercises and exercises that present the risk of falling. Functional loading  exercises include: Weight-bearing exercises e.g. [[Walking: Muscles used|walking]]; [[Strength Training|Strengthening exercises]] using free weights, elastic bands, [[Dumbbell Exercise|dumbbells]] etc.; [[Balance]] exercises e.g. [[Tai Chi and the Older Person|tai chi]]
#[[Nutrition|Diet]]: A healthy diet, including adequate dosage of Vitamin D and Calcium, is also useful for preserving bone mass.  And it is important to limit [[Caffeine and Exercise|coffee]], alcohol and tobacco consumption as they may have deleterious effect on bone mineral  density<ref>http://www.nlm.nih.gov/medlineplus/ency/article/000360.htm</ref><ref>Coronado-Zarco R, de León AO, García-Lara A, Quinzaños-Fresnedo J, Nava-Bringas TI, Macías-Hernández SI. Nonpharmacological interventions for osteoporosis treatment: Systematic review of clinical practice guidelines. Osteoporosis and sarcopenia. 2019 Sep 1;5(3):69-77.</ref>.


*Get a medical check-up before you begin a moderate to vigorous exercise program, particularly if you are older than 40, if you have medical problems, or if you have not exercised previously.
*Eat and drink appropriately. Don’t eat large meals for one hour before you exercise, drink plenty of water before, during, and after exercise, particularly in warm weather.
*Warm up before you exercise and cool down afterward. 
*Dress simply, aiming for comfort, convenience, and safety rather than style.
*Use good equipment, especially good shoes.
*Exercise regularly.
*Listen to your body. Learn warning signals of [[Coronary Artery Disease (CAD)|heart disease]], including chest pain or pressure, disproportionate [[Dyspnoea|shortness of breath]], fatigue, or sweating, erratic [[Pulse rate|pulse]], lightheadedness, or even indigestion. Do not ignore aches and pains that may signify injury; early treatment can often prevent more serious problems. Do not exercise if you are feverish or ill. Work yourself back into shape gradually after a layoff, particularly after illness or injury.<ref>http://www.health.harvard.edu/newsweek/Exercise_and_aging_Can_you_walk_away_from_Father_Time.htm</ref>
It is important to note that in other to improve bone mineral density it requires combination of several types of exercises majorly resistance training. Kawao & Kaji <ref>Kawao, N., & Kaji, H. (2017). Influences of resistance training on bone. ''Clinical calcium'', ''27''(1), 73-78.</ref> noted that while  in healthy bone resistance training  maintains and improves bone mineral density(BMD)and bone strength, however, in [[osteoporosis]] patients it takes resistance training with other types of exercises to maintain BMD.<br>
== References  ==
== References  ==


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[[Category:Anatomy]]
[[Category:Anatomy]]
[[Category:Conditions]]
[[Category:Conditions]]
[[Category:Bone - Conditions]]

Latest revision as of 12:04, 19 December 2022

Original Editor Oyemi Sillo

Top Contributors - Lucinda hampton, Esraa Mohamed Abdullzaher, Oyemi Sillo, Andeela Hafeez, Tolulope Adeniji, Kim Jackson, Lauren Lopez, Tony Lowe, Scott Buxton, WikiSysop and Jasrah Javed


Introduction[edit | edit source]

Osteoporotic posture

As a result of the ageing process, bone deteriorates in composition, structure and function, which predisposes to osteoporosis. Bone is a dynamic organ that serves mechanical and homeostatic functions. It undergoes a continual self-regeneration process called remodelling ie removing old bone and replacing it with new bone. Bone formation and bone resorption is coupled tightly in a balance to maintain bone mass and strength. With aging this balance moves in a negative direction, resulting in greater bone resorption than bone formation. This combination of bone mass deficiency and reduction in strength ultimately results in osteoporosis and insufficiency fractures.[1]

Ageing Bone Dynamics[edit | edit source]

Bone cells

As people age the rate of bone resorption by osteoclast cells (multinucleated cells which contain mitochondria and lysosomes that is responsible for bone resorption) exceeds the rate of bone formation so bone weaken.[2] The reasons for this are multi factorial, including:.

Non-Modifiable Risk Factor

Modifiable Risk Factor

Adverse Effects[edit | edit source]

Osteoprosis of Spine

The effects of bone structure changes may bring about:

Prevention[edit | edit source]

Ladies gym

For more see the informative on prevention, management and physiotherapy for see Osteoporosis

  1. Exercise: (See also Age and Exercise) Ageing is associated with reduced physical activity and mechanical loading. Decreased mechanical loading exerts a decreased effect upon osteoblasts. Functional loading has been shown to improve bone mass in humans. However exercise training programs can prevent or reverse almost 1% of bone loss per year in both lumbar spine (LS) and femoral neck (FN) for both premenopausal and postmenopausal women.[1] It is important exercise to preserve bone density, however care must be taken to avoid high-impact exercises and exercises that present the risk of falling. Functional loading exercises include: Weight-bearing exercises e.g. walking; Strengthening exercises using free weights, elastic bands, dumbbells etc.; Balance exercises e.g. tai chi
  2. Diet: A healthy diet, including adequate dosage of Vitamin D and Calcium, is also useful for preserving bone mass. And it is important to limit coffee, alcohol and tobacco consumption as they may have deleterious effect on bone mineral density[7][8].

References[edit | edit source]

  1. ↑ 1.0 1.1 1.2 Demontiero O, Vidal C, Duque G. Aging and bone loss: new insights for the clinician. Therapeutic advances in musculoskeletal disease. 2012 Apr;4(2):61-76. Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3383520/ (accessed 2.12.2022)
  2. ↑ https://www.boundless.com/physiology/textbooks/boundless-anatomy-and-physiology-textbook/appendix-b-development-and-aging-of-the-organ-systems-1417/bone-development-1497/bone-tissue-and-the-effects-of-aging-1500-11222/
  3. ↑ 3.0 3.1 Andrew A, Rita A, Dale A. Geriatric Physical Therapy. Third Edition. Elsevier Mosby. 2012
  4. ↑ Lumbar Compression Fracture
  5. ↑ http://www.nlm.nih.gov/medlineplus/ency/article/004015.htm
  6. ↑ https://medlineplus.gov/ency/article/004015.htm
  7. ↑ http://www.nlm.nih.gov/medlineplus/ency/article/000360.htm
  8. ↑ Coronado-Zarco R, de León AO, García-Lara A, Quinzaños-Fresnedo J, Nava-Bringas TI, Macías-Hernández SI. Nonpharmacological interventions for osteoporosis treatment: Systematic review of clinical practice guidelines. Osteoporosis and sarcopenia. 2019 Sep 1;5(3):69-77.
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