Abstract
Bone changes occur with normal ageing. Structural changes play a significant role in the age-related alterations of bone strength and quality. In ageing osteoclastic activity is greater than osteoblastic activity and results in net bone loss. With ageing there is decrease in bone mass and strength, and there is potential interrelationship between muscle quality and skeletal health. Osteoporosis is characterised by low bone mass and architectural deterioration of bone tissue leading to enhanced fragility and increase in fracture risk. Osteomalacia is a bone disorder characterised by failure in mineralisation of a newly formed organic matrix. In Paget’s disease there is increased resorption of the bone followed by intense osteoblastic response to repair resulting in disordered bone formation. Associated disorders such as fractures of the hip and vertebral and sacral insufficiency fractures are included in the chapter.
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Appendices
Multiple Choice Questions
-
1.
The following age-related bone changes are true, EXCEPT:
-
A.
Bone mass peaks in both men and women between 25 and 30 years and then plateaus for about 10 years and diminishes thereafter.
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B.
Men in their fifth and sixth decade of life and women in their fourth decade develop a gradual loss of skeletal mass.
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C.
Several studies have shown an increase in the level of PTH with age and calcitonin, and the most active metabolites of vitamin D3 are seen to decrease with age.
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D.
The amount of trabecular bone loss on the iliac crest and spine is different in both genders during ageing.
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A.
-
2.
The following are true in regard to the pathogenesis of osteoporosis, EXCEPT:
-
A.
Age-related osteoporosis occurs in men and women over the age of 70 and affects cortical and trabecular bone.
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B.
The osteoclasts differentiated from mesenchymal cells lay down the matrix in the formation phase.
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C.
Parathyroid hormone, calcitriol and other hormones such as glucocorticoids, growth, thyroid and sex hormones are the major systemic regulators.
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D.
The disruption of the microarchitecture in trabecular bone, decreased density and changed bone material quality lead to bone fragility.
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A.
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3.
The following are true of Paget’s disease, EXCEPT:
-
A.
There is increased bone resorption.
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B.
The disordered bone may be largely avascular.
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C.
Genetic and environmental factors are implicated in Paget’s disease.
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D.
Any one of the several bones may be affected most in the skull, tibiae, vertebrae and clavicle.
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A.
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4.
The following in relation to fractures in the elderly with osteoporosis are true, EXCEPT:
-
A.
Vertebral fractures are the result of a combination of ageing and bone fragility.
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B.
The fracture sites in osteoporosis are the ribs, clavicle and vertebrae.
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C.
Sacral insufficiency fractures occur in osteoporotic bone, metabolic bone disease and following radiotherapy.
-
D.
In men vertebral fractures are associated with severe trauma.
-
A.
Answers to MCQs
1 = D; 2 = B; 3 = B; 4 = B.
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Nagaratnam, N., Nagaratnam, K., Cheuk, G. (2016). Metabolic Bone Disorders in the Elderly. In: Diseases in the Elderly. Springer, Cham. https://doi.org/10.1007/978-3-319-25787-7_10
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