Information for Health Professionals & Researchers
Musculoskeletal diseases affect a significant percentage of our Australian ageing population. At AIMSS, we focus our efforts to identify the mechanisms that explain the pathophysiology of several musculoskeletal diseases. Our activities also focus on identifying novel diagnostic methods to be applied in the musculoskeletal system. In addition, our clinical programs include a Clinical Trials Unit, a Gait and Balance Gym and a Falls and Fractures Clinic. Here is some additional information on the diseases we are trying to prevent and treat:
Osteosarcopenia is considered as a subset of patients suffering from both osteoporosis and sarcopenia at the same time. These two conditions are usually interrelated through several mechanisms and metabolic pathways. Osteosarcopenic patients are frailer and are considered at higher risk of institutionalisation, falls and fractures, therefore, identification of this syndrome in our older population is pivotal.
Although there is not a pharmaceutical compound targeting muscle and bone at the same time, effective interventions for osteosarcopenia include osteoporosis treatment, vitamin D supplementation, healthy lifestyle, appropriate dietary calcium and regular resistance and balance exercise. In addition, patients at high risk of falls and fractures should be referred to a comprehensive geriatric assessment, optimally at one of the Falls and Fractures Clinics available in your area.
When bones lose minerals, including calcium, more rapidly than they are replaced, a loss of bone density occurs, resulting in low bone density, or osteoporosis. Due to low bone density, fragility fractures are common, particularly at the hip, wrist and spine. Fractures result in a loss of independence, reduced quality of life, increased morbidity and earlier mortality. Importantly, suffering one fracture substantially increases the risk for another; this is often referred to as the ‘fracture cascade’.
In Australia, the prevalence of poor bone health in adults in 2012 was estimated within a nationwide economic burden analyses to be 66% of people aged 50 years and older. This translates to over 4.74 million Australians aged 50 years and older, with an annual cost of $2.75 billion in 2012. It is estimated that this number will rise by 31% to 6.2 million Australians by 2022, resulting in the total cost of fractures over the next 10 years reaching $22.7 billion (1).
Further information regarding treatment guidelines, and the prevention, diagnosis and management of osteoporosis in postmenopausal women and men over 50 years of age can be accessed from https://www.osteoporosis.org.au/
1. Watts JJ, Abimanyi-Ochom J, Sanders KM. Osteoporosis costing all Australians: a new burden of disease analysis-2012 to 2022. Osteoporosis Australia
The two main types of arthropathies seen are inflammatory and mechanical. Due to huge improvements in the diagnosis, and treatment of inflammatory arthropathies it is unusual to see new patients with rheumatoid arthritis, psoriatic arthritis or ankylosing spondylitis suffer from joint deformities, and progression of disease. This is mainly due to the advent of biological agents.
The high cost of therapy is largely offset by the huge savings in terms of joint damage and having to undergo joint replacements, being able to keep people at the prime of their lives in gainful employment and/or caring for their families; not dependant on the state or their family to care for them.
Another large area of referrals to rheumatology are those with connective/auto immune diseases. Early diagnosis and categorisation can help save extra unnecessary cost and investigations, allay anxiety. The main mechanical diseases seen are back pains and osteoarthritis, mainly of the weight bearing joints. It is well studied now, that people with mechanical disease should be triaged and seen by specialised multidisciplinary teams, and not wait to see a surgeon. The majority of patients would not need to see a surgeon or require surgery. A team consisting of a rheumatologist, physiotherapist, dietitian , working closely with the surgeon and primary care will yield the best outcomes for patients.
In the acute setting, the management of monoarthritis especially at emergency is best with consultation with a rheumatology team. Prompt diagnosis can be made, sometimes with joint aspiration, to help exclude sepsis, will help prevent unnecessary investigations, arthroscopic surgery, and antibiotics, and further delays in relieving the patient of a painful condition.
Sarcopenia, meaning “poverty of the flesh”, was coined to describe the loss of muscle mass as individuals age, but can affect people at any age. Now including measures of function, sarcopenia is most popularly defined as values of relative muscle mass (appendicular lean mass as measured by DXA) divided by height squared (m2) or relative to BMI. Recent consensus from the European Working Group on Sarcopenia (EWGSOP)1 and the Foundations of National Institutes for Health (FNIH)2 suggest cut-points for muscle mass that should be applied for low identifying low muscle mass. Performance measures, such as handgrip strength (HGS), gait speed or stair climb power should also be considered in the diagnosis. Given its ease of collection, reliability, and association with a range of mass and strength measures, HGS is recommended and cut-points also suggested1,2. However, investigation of HGS over time will allow identification of any rapid changes in strength, which generally precede mass changes, and is recommended to be implemented as part of a routine check-up. Sarcopenia now has an ICD-10 code, so recognising and diagnosing sarcopenia will be important for referring patients for appropriate exercise and dietary advice. Given bone and muscle health are related, the same scan for bone health will also provide muscle mass measures, while first line treatments such as resistance exercise, high protein diets and adequate levels of vitamin D need to be encouraged.