Musculoskeletal disease in the aged. Diagnosis and management

Musculoskeletal diseases are the most prevalent conditions affecting the elderly today and cause significant suffering and disability in this population. The diagnosis of musculoskeletal disorders in older persons requires knowledge of the diseases which affect this age group, familiarity with the signs and symptoms, and a working knowledge of laboratory and radiographic abnormalities. Treatment of these disorders is based upon the principles of pain relief and maintenance of function. A multifaceted approach includes physical therapy, patient education, psychological support and the use of medications. Simple analgesics like paracetamol (acetaminophen) are gaining increased importance in the treatment of symptomatic disease. Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most utilised pharmacological treatment and are effective in relieving pain and improving function in most patients. However, elderly persons are at increased risk for NSAID-induced toxicity, and drug choices should be made with this in mind. New data are becoming available as to the relative toxicity of the different NSAIDs, and this should help in choosing between these medications. Disease-modifying drug therapy is the most difficult to administer in elderly subjects. Potential toxicity must be weighed against realistic benefit in older persons prior to and during remittive therapy. With appropriate precautions, these agents can prove invaluable in the treatment of older persons with serious musculoskeletal disease.