Musculoskeletal Disorders of the Elderly

Elderly of ages greater than or equal to 65 years represent nearly 20% of the US population. Physiological functions of nearly all organ systems decline and the prevalence of major diseases increase with aging. Progressive musculoskeletal disabilities of the elderly with vestibular and proprioceptive neural dysfunction lead to poor balance, unsteady gait, and frequent falls that are the leading cause of fatal and non-fatal injuries in those greater than or equal to 65 years of age. Osteoporosis, defined by a marked decrease in mineral bone density, as quantified by dual-energy x-ray absorptiometry, is common at ages greater than 50 years and predisposes the elderly to fragility fractures of the hips, pelvis, vertebrae, proximal humerus, distal radius, and wrists. A detailed evaluation of medications or alcohol use that could impair balance, home obstacles or surfaces needing holding bars, vision, and muscle strength may reveal correctible defects. Prevention of fragility fractures also requires optimal diet, regular resistance exercises, and treatment of osteoporosis. Orthopedic involvement is especially necessary for complex pattern fractures, those of the hip, pelvis, vertebrae, distal fibula, and scaphoid carpal bone, as well as rotator cuff tears.