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Chapters

0:00 Introduction
0:29 Osteoarthritis
1:30 Osteoporosis



Osteoarthritis (OA) is a type of degenerative joint disease that results from breakdown of joint cartilage and underlying bone.[5] The most common symptoms are joint pain and stiffness.[1] Usually the symptoms progress slowly over years.[1] Initially they may occur only after exercise but can become constant over time.[1] Other symptoms may include joint swelling, decreased range of motion, and, when the back is affected, weakness or numbness of the arms and legs.[1] The most commonly involved joints are the two near the ends of the fingers and the joint at the base of the thumbs; the knee and hip joints; and the joints of the neck and lower back.[1] Joints on one side of the body are often more affected than those on the other.[1] The symptoms can interfere with work and normal daily activities.[1] Unlike some other types of arthritis, only the joints, not internal organs, are affected.[1]

Causes include previous joint injury, abnormal joint or limb development, and inherited factors.[1][2] Risk is greater in those who are overweight, have legs of different lengths, or have jobs that result in high levels of joint stress.[1][2][6] Osteoarthritis is believed to be caused by mechanical stress on the joint and low grade inflammatory processes.[7] It develops as cartilage is lost and the underlying bone becomes affected.[1] As pain may make it difficult to exercise, muscle loss may occur.[2][8] Diagnosis is typically based on signs and symptoms, with medical imaging and other tests used to support or rule out other problems.[1] In contrast to rheumatoid arthritis, in osteoarthritis the joints do not become hot or red.[1]

Treatment includes exercise, decreasing joint stress such as by rest or use of a cane, support groups, and pain medications.[1][3] Weight loss may help in those who are overweight.[1] Pain medications may include paracetamol (acetaminophen) as well as NSAIDs such as naproxen or ibuprofen.[1] Long-term opioid use is not recommended due to lack of information on benefits as well as risks of addiction and other side effects.[1][3] Joint replacement surgery may be an option if there is ongoing disability despite other treatments.[2] An artificial joint typically lasts 10 to 15 years.[9]

Osteoarthritis is the most common form of arthritis, affecting about 237 million people or 3.3% of the world's population.[4][10][11] It becomes more common as people become older.[1] Among those over 60 years old, about 10% of males and 18% of females are affected.[2] Osteoarthritis is the cause of about 2% of years lived with disability.[10]
Osteoporosis is a systemic skeletal disorder characterized by low bone mass, micro-architectural deterioration of bone tissue leading to bone fragility, and consequent increase in fracture risk. It is the most common reason for a broken bone among the elderly.[3] Bones that commonly break include the vertebrae in the spine, the bones of the forearm, and the hip.[8] Until a broken bone occurs there are typically no symptoms. Bones may weaken to such a degree that a break may occur with minor stress or spontaneously. After the broken bone heals, the person may have chronic pain and a decreased ability to carry out normal activities.[3]

Osteoporosis may be due to lower-than-normal maximum bone mass and greater-than-normal bone loss. Bone loss increases after the menopause due to lower levels of estrogen, and after Andropause due to lower levels of Testosterone.[9][10] Osteoporosis may also occur due to a number of diseases or treatments, including alcoholism, anorexia, hyperthyroidism, kidney disease, and surgical removal of the ovaries. Certain medications increase the rate of bone loss, including some antiseizure medications, chemotherapy, proton pump inhibitors, selective serotonin reuptake inhibitors, and glucocorticosteroids. Smoking, and too little exercise are also risk factors.[3] Osteoporosis is defined as a bone density of 2.5 standard deviations below that of a young adult. This is typically measured by dual-energy X-ray absorptiometry (DXA or DEXA).[4]

Prevention of osteoporosis includes a proper diet during childhood and efforts to avoid medications that increase the rate of bone loss. Efforts to prevent broken bones in those with osteoporosis include a good diet, exercise, and fall prevention. Lifestyle changes such as stopping smoking and not drinking alcohol may help.[3] Bisphosphonate medications are useful to decrease future broken bones in those with previous broken bones due to osteoporosis. In those with osteoporosis but no previous broken bones, they are less effective.[5][6][needs update][11] They do not appear to affect the risk of death.[12]

Osteoporosis becomes more common with age. About 15% of Caucasians in their 50s and 70% of those over 80 are affected.[7] It is more common in women than men.[3]