Bone and Joint Disorders

Musculoskeletal diseases often cause chronic pain and dysmobility and contribute considerably to the overall burden of disease in older adults. This chapter focuses on the commonest age-related bone and joint disorders: osteoporosis, osteoarthritis, gout, polymyalgia rheumatica, and giant cell arteritis. Osteoporosis is a systemic skeletal disease characterized by low bone strength and increased fracture risk. The diagnosis can be made after a low-energy fracture, by vertebral fracture assessment, bone densitometry, or based on clinical risk factors. Antiresorptive or osteoanabolic drugs can be used, while ensuring sufficient vitamin D levels and calcium intake. Osteoarthritis is a degenerative whole-joint disorder involving damaged cartilage, synovial inflammation, osteophyte formation, and subchondral bone sclerosis. Any joint may be involved but hand, hip, knee, shoulder, and spine osteoarthritis account for most disability. Physiotherapy and non-steroidal anti-inflammatory drugs are the mainstay of treatment. Joint prosthesis surgery remains the most effective option in late-stage hip, knee, or glenohumeral osteoarthritis. Gout is one of the commonest causes of acute mono- or oligoarthritis in older adults. Despite several effective treatment options for flares and urate-lowering therapies, gout remains poorly treated. Calcium pyrophosphate deposition disease has both similar and distinctive clinical features and treatment. Polymyalgia rheumatica and giant cell arteritis should be suspected in patients with sudden proximal limb pain and weakness, headache, jaw claudication, and/or visual disturbances. Diagnostic or treatment delay may lead to irreversible ischemic optic neuropathy. Extended glucocorticoid courses remain the cornerstone to treat these types of large vessel vasculitis, with attention to potential glucocorticoid side effects.