Carlos Isales, MD, FACP Augusta University Presentation to the Georgia Senate Women's Adequate Healthcare Study Committee www.gacommissiononwomen.org

1. Musculoskeltal Aging
Carlos M. Isales, MD, FACP
Augusta University
https://www.myhealth.va.gov/mhv-portal-web/anonymous.portal?_nfpb=true&_nfto=false&_pageLabel=spotlightArchive&contentPage=spotlight/September

2. Aging
Aging can be described as a process or group of
processes occurring in living organisms that with
the passage of time lead to a loss of adaptability,
functional impairment and eventually death.
• Aging often results in a decline in function of
various physiological systems:
• Cardiorespiratory
• Musculoskeletal
• Neuroendocrine
• Immune
• Gastrointestinal
• Auditory, Visual,
Vestibular
Augusta University

3. Frailty (musculoskeletal aging)
Frailty is a relatively modern concept.
Fried et al. describe it as a syndrome that
includes:
-self-reported exhaustion
-reduced physical activity
-slow walking speed
-reduced grip strength
-unintentional weight loss (Fried et al. 2001).
Frailty is present when three or more of these
five characteristics are present.
Augusta University

4. Aging and Muscle Loss (Sarcopenia)
•As a normal part of the aging process,
individuals experience a loss of skeletal
muscle referred to as sarcopenia.
Sarcopenia starts to set in around age 45,
when muscle mass begins to decline at a
rate of about 1 percent per year.
•By the seventh and eighth decades of life, a
decrease in the maximal contractile strength
on the order of 20-40% for both men and
women is observed.
• The weakness associated with sarcopenia
has been shown to be associated with
difficulty in rising from a chair and getting out
of bed.
CT Scans
Young, healthy muscle
Elderly muscle
Augusta University

5. Aging Effects on Strength
• Strength peaks
around age 30, begins
to decline after age
50 and after about age
60, strength levels fall
more rapidly,
independent of
training.
• The decreased
strength is due to
atrophy of muscle
fibers.
Augusta University

6. Aging Effects on Strength
Augusta UniversityJournal of Gerontology: BIOLOGICAL SCIENCES 1997, Vol. 52A, No. 5, B267-B276

7. Age-Related Muscle Loss and Weakness Leads to
Disabilities
Augusta University
A profile of older Americans 2011; Department of Health and Human Services

8. Aging Effects on Bone
-Osteoporosis is a systemic
skeletal disease
characterized by low bone
mass and microarchitectural
deterioration of bone tissue,
with a consequent increase
in bone fragility and
susceptibility to fracture.
-Over a life span women lose
approximately 42% of their
spinal and 58% of their femoral
bone mass.
Augusta University
Normal
Moderate
Osteoporosis
Severe
Osteoporosis
Images by Dr. A. Boyde, London

9. Osteoporotic Fractures
Augusta University
Wasnich RD. Primer on the Metabolic Bone Diseases and
Disorders of Mineral Metabolism. 4th ed, Philadelphia, PA:
Lippincott Williams & Wilkins;1999:257-259
• 1.5 million fractures/yr in US
• $10 billion direct costs
• 300,000 hip fractures/yr
– 20% die
– 25% confined to long-term
facilities
– 50% long-term loss of
mobility

10. Augusta University
Osteoporotic Fractures
Aging Menopause
Increased bone loss
FRACTURES
Propensity
to fall
High bone
turnover
Low peak
bone mass

11. Augusta University
Why Recognize & Treat Osteoporosis?Why Recognize & Treat Osteoporosis?
 Osteoporosis is frequently a silent disease and will not be
detected until a fracture occurs.
 The best predictor for fracture risk is history of a previous
fracture. Having had one fracture increases the risk for
another fracture by 2-4 times, having had two fractures
increases the risk for another fracture between 6-12 times.
Thus, all patients with a fracture should be screened to
prevent another fracture.
 However, of patients seen in orthopaedics for a fracture
only 6-10% are screened for osteoporosis and only 10-
20% are put on any treatment

12. Augusta University
Risks for OsteoporosisRisks for Osteoporosis
In young women
• Low calcium intake
• Low body weight
• Limited exercise
• Hypoestrogenism
In others
• Menopausal/postmenop
ausal
status—without HRT
• Cigarette smoking
• Low-trauma fractures
• Hyperparathyroidism
• Chronic corticosteroid
use

13. Aging American Population
• It is expected that a
significant number of
those born after 1990
will live beyond age
100.
• It is estimated that
the odds of living to
100 years has risen
from approximately 1
in 20 million to 1 in 50
for women.
Augusta University

14. Augusta University
Aging in Georgia

15. Augusta University
Aging in Georgia

16. Augusta University
Population Males vs Females

17. Augusta University
Census Data

18. Lifespan vs. Healthspan
Gurkar AU, Niedernhofer LJ. Comparison of mice with accelerated aging caused by distinct mechanisms. Exp Gerontol. 2015;68:43-50. Augusta University

19. Augusta University
Thank You!

20. Augusta University
NIA funded aging centers