نبذة مختصرة : Orthopaedic problems in the elderly are frequently associated with degeneration and trauma. They decrease capacity of being mobile, cause pain and limit activity levels. Aging cannot be prevented but facing orthopaedic problems in the elderly age group can be delayed. Most of the orthopaedic problems are related with osteoporosis. Osteoporosis, osteoporosis related fragility fractures, osteoarthrosis and arthrosis related soft tissue problems are the main orthopaedic problems in the elderly. Even with simple falls, life threatening fractures may occur. Osteoporosis is a systematic skeletal disorder characterized by low bone mass and microarchitectural deterioration of bone tissue, with a consequent increase in bone fragility. According to its etiology, osteoporosis can be separated into two groups as primary and secondary. Primary osteoporosis may be grouped into three subgroups as idiopathic, postmenopausal and senile. Secondary osteoporosis is the result of endocrine or other systemic disorders. When assessed according to the localization, osteoporosis can be systemic and local. Local osteoporosis can be the result of fractures, immobilization, rheumatoid arthritis, osteomyelitis, primary and secondary tumors, sympathetic dystrophia, muscular paralysis, tendon rupture or denervation, sickle cell hemoglobinopathy, alcaptanury and transient osteoporosis of the hip. Bone is a dynamic structure which can renew itself. Bone undergoes continuous remodeling, involving bone resorption and bone formation. These two processes are tightly coupled and bone mass depends on the balance between resorption and formation. In metabolic bone disease, including osteoporosis, there is an imbalance between formation and resorption. Bone mineral density is related to the risk of fragility fractures. Osteoporosis is a major health problem through its association with fractures. Proximal femur (hip), vertebrae and distal forearm (wrist) are the most frequently affected parts of the body for osteoporosis-related fractures. Fractures in all these sites are associated with increased disability and reduced quality of life and often lead to a decrease in physical and mental health. One year mortality rates are high in especially hip fractures. Mortality rates following hip fracture repair increase with patient age. Non-hip fractures are much less likely to result in death; for instance, wrist fractures have no impact on mortality rate. The risk of subsequent fracture after a fragility fracture may be reduced by lifestyle interventions that improve bone health and reduce fall risk, as well as pharmacologic treatment for osteoporosis. Osteoarthritis is another orthopaedic problem in the elderly age group. Degeneration at the ligaments and joints may cause arthrosis in the vertebral column and joints. Arthritis is a wide spectrum including inflammatory and non-inflammatory disorders of the synovial joints. Patients with arthrosis have significant pain, loss of motion and joint deformity. Osteoarthritis is a common age-related disorder associated with articular hyaline cartilage damage. Variable degrees of synovitis are present. Narrowing of the joint space, osteophytes and changes in the subchondral bone are visible on plain roentgenograms in the advanced period patients. Osteoarthritis can arise in any synovial joint in the body, but occurs most commonly in the hands, feet, knees, hips and spine. Knee osteoarthritis is characterized clinically by usage-related pain Yaşlılarda Ortopedik Sorunlar 9 and/or functional limitation. It is a complex joint disorder showing focal cartilage loss, new bone formation and involvement of all joints. In adults older than 40 years with usage-related knee pain, short morning stiffness, functional limitation and one or more examination findings like crepitus, restricted movement or bony enlargement, knee osteoarthritis can be diagnosed without roentgenogram. Laboratory studies are not needed for non-inflammatory arthritis. Treatment of hip osteoarthritis should be organized according to hip risk factors (obesity, adverse mechanical factors, physical activity, dysplasia), general risk factors (age, sex, comorbidity, co-medication), level of pain intensity, disability, handicap, location and degree of structural damage and expectations of the patient. Osteotomy and joint preserving surgical procedures should be considered in young adults with symptomatic hip osteoarthritis. The aim of management of patients with osteoarthritis is to control pain and swelling, minimize disability and maintain quality of life. Exercise to strengthen the muscles and improve flexibility, as well as weight loss, should be implanted immediately. In the early period of osteoarthritis, conservative treatment modalities such as pharmacologic treatment, weight loss, physical therapy and intra-articular injections may be used. For advanced cases, surgical treatment methods such as arthroscopic techniques, osteotomies and arthroplasties can be performed. Prevention of the highly morbid orthopaedic problems increases quality of life of the elderly [ABSTRACT FROM AUTHOR]
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