From the Guidelines
The key geriatric musculoskeletal diseases in rank order of frequency required for board certification training are osteoarthritis, osteoporosis, polymyalgia rheumatica, gout, rheumatoid arthritis, and sarcopenia. These conditions are crucial to recognize and manage due to their significant impact on mobility, independence, and quality of life in older adults. Some of the key points to consider in the management of these conditions include:
- Osteoarthritis, the most common condition, affecting over 30% of older adults, primarily impacting weight-bearing joints and causing pain, stiffness, and functional decline 1.
- Osteoporosis, characterized by decreased bone density leading to fracture risk, with treatment including calcium and vitamin D supplements, as well as medications like bisphosphonates.
- Polymyalgia rheumatica, presenting with proximal muscle pain and stiffness, typically treated with prednisone.
- Gout, causing acute inflammatory arthritis from urate crystal deposition, managed with colchicine for acute attacks and allopurinol for prevention.
- Rheumatoid arthritis, an autoimmune disease requiring disease-modifying antirheumatic drugs.
- Sarcopenia, involving age-related muscle loss, addressed through resistance training and adequate protein intake, as noted in the context of geriatric care and nutritional support 1. It is essential to prioritize these conditions in geriatric care, considering their frequency and impact on the quality of life and morbidity of older adults.
From the Research
Key Geriatrics Diseases for the Musculoskeletal System
The following are the key geriatrics diseases for the musculoskeletal system in rank order of frequency:
- Osteoarthritis (OA) 2, 3, 4, 5
- Rheumatoid arthritis (RA) 2, 3, 4
- Polymyalgia rheumatica 2, 4
- Gout 2, 4
- Pseudogout 2, 4
- Fractures 3
- Osteoporosis 3, 6
- Sarcopenia 5
- Tendinopathies 5
Frequency of Musculoskeletal Disorders
The frequency of musculoskeletal disorders in the elderly population is significant, with OA being the most common condition 2, 3, 4. The resulting loss of mobility and physical independence can be particularly devastating in this population 3.
Management of Musculoskeletal Disorders
The management of musculoskeletal disorders in the elderly requires a comprehensive approach, including education, advice, strengthening exercises, aerobic fitness training, and drug treatments such as paracetamol and topical NSAIDs 4. In cases of RA, DMARD therapy should be used according to disease severity, and corticosteroids may be effective but require careful consideration of potential toxicity 4.
Research and Disease Burden
Research on musculoskeletal disorders in the elderly is increasing, with a significant disease burden attributed to this population 6. The global disability-adjusted life years (DALYs) for musculoskeletal disorders are dominated by those aged 70 years and older, highlighting the need for continued research and management of these conditions 6.