Effects of Ageing on Joints

Original Editor - Wendy Walker

Top Contributors - Wendy Walker, Lucinda hampton, Lauren Lopez, Laura Ritchie and Tony Lowe  

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Introduction

No matter how healthy an individual is, as they age their joints will show some changes in mobility, due in part to changes in the connective tissues.
As joint range of movement has a direct effect on posture and movement, this can result in marked alteration of function.

Age-related Changes in Connective Tissue

Cellular Changes

Alterations in circulating humoral factors (hormones, cytokines, growth factors) that occur in ageing, coupled with built in cellular senescence (loss of a cell's power of division and growth) exaggerated by a slower turnover of many connective tissue cell populations, and the age-associated alterations in matrix molecule cross-linking, predispose the elderly to altered connective tissue biology. This decreased proliferation and altered control of apoptosis (programmed cell death) causes a decrease in effective maintenance of tissue homeostasis[1].

Gross Changes

  • Increased stiffness
  • Decreased strength
  • Reduction in water content

Age-related Changes in Bone

Bony changes have a direct effect on joint mobility, influencing the joint surfaces to alter joint mechanics. See Effects of Ageing on Bone

Subchondral bone (the layer directly below the articular cartilage) undergoes reduction in thickness and density with increased age[2].

Age-related Changes in Cartilage

As you age, joint movement becomes stiffer and less flexible because the amount of lubricating fluid inside your joints decreases and the cartilage becomes thinner. Ligaments also tend to shorten and lose some flexibility, making joints feel stiff.[3]

Age in the cartilage is likely due to ageing changes in cells and tissues that make the joint more susceptible to damage and less able to maintain homeostasis ie an imbalance exists between catabolic and anabolic activity driven by local production of inflammatory mediators in the cartilage and surrounding joint tissues. There is a close relationship between chondrocyte activity and local articular environment changes due to cell senescence, followed by secretion of inflammatory mediators.[4] The senescent secretory phenotype likely contributes to this imbalance through the increased production of cytokines and MMPs (matrix metalloproteinases) and a reduced response to growth factors. Oxidative stress appears also to play an important role in the degradation of cartilage seen in ageing with excessive ROS (reactive oxygen species ) affecting cell function[5].

Age-related Changes in Synovial Fluid

Synovial fluid lubricates your joints for smooth movement. Healthy joints contains high amounts of high molar mass hyaluronic acid (HA) molecules in the synovial fluid giving it the required viscosity for its function as lubricant solution, which naturally cushion your joints and other tissues. With age, the size of the hyaluronic acid molecules in your joints decreases inhibiting its ability to work as effectively in support cushioning and lubrication.

The video below gives an insight of the role HA plays in the joints health. Due to cellular senescence HA degrades.
[6]

Age-related Changes in Collagen

Collagen is part of your connective tissue, and is found in your cartilage, ligaments, tendons and bones as well as your skin. Collagen fibers keep your skeletal system flexible, but collagen levels in the body start to decline after about age 25. These declines can cause ligaments tendons bones and cartilage to become less flexible and more brittle over time.[7]

Age-related changes in collagen including senescence-related secretory phenotypes, chondrocytes' low reactivity to growth factors, mitochondrial dysfunction and oxidative stress, and abnormal accumulation of advanced glycation end products all lead to this altered structure and decreased functional ability in collagen in eg ligaments and tendons become stiffer and brittle.[8]Collagen 03.png The image is of a collagen triple helix

Range of Movement

Joint range of movement (ROM) decreases with increasing age; passive and active ROM both decrease, but often within a single joint the active ROM reduces more than the passive ROM.

Reduction in ROM is not uniform, and different joints show different degrees of restricted movement, as well as different patterns of directional limitations.

Specific Joint ROM Changes

Cervical spine - extension and side flexion show the greatest reduction in ROM.

Thoracic and lumbar spine - extension is the most limited movement in older adults and rotation shows little or no age-dependent decline[9].

Hip - extension ROM has been shown to reduce by 20% when comparing 25 to 39 year olds to 60 to 74 year olds.

Ankle - dorsiflexion ROM is reduced with age.

Upper limb: there is less influence of age on joint ROM (compared to spine and lower limb).

The shoulder complex shows the greatest changes in the upper limb, whereas no age-associated decline in ROM of the elbow or wrist have been noted[10] (in the absence of disease).

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Physiotherapy

Exercise can prevent many age-related changes to muscles, bones and joints – and reverse these changes as well. It’s never too late to start living an active lifestyle and enjoying the benefits.

Research shows that:

Exercise can help slow the rate of bone loss and make bones stronger.

Older people can increase muscle mass and strength through muscle-strengthening activities.

Balance and coordination exercises, such as tai chi, can help reduce the risk of falls.

Physical activity in later life may delay the progression of osteoporosis as it slows down the rate at which bone mineral density is reduced.

Weight-bearing exercise, such as walking or weight training, is the best type of exercise for maintenance of bone mass. There is a suggestion that twisting or rotational movements, where the muscle attachments pull on the bone, are also beneficial.

Older people who participate in hydrotherapy (which is not weight bearing) still experience increases in bone and muscle mass compared to sedentary older people.

Stretching also is excellent to help maintain joint flexibility.[3]

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References

  1. Freemont AJ, Hoyland JA: Morphology, mechanisms and pathology of musculoskeletal ageing. J Pathol 211:252-259, 2007 Available from: https://www.ncbi.nlm.nih.gov/pubmed/17200936 (last accessed 26.5.2019)
  2. Yamada K, Healey R, Amiel D, et al: Subchondral bone of the human knee joint in aging and osteoarthritis. Osteoarthritis Cartilage 10:360-369, 2002 Available from: https://www.ncbi.nlm.nih.gov/pubmed/12027537 (last accessed 26.5.2019)
  3. 3.0 3.1 Better health Ageing- muscles bones and joints Available from: https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/ageing-muscles-bones-and-joints (last accessed 26.5.2019)
  4. Rezuș E, Cardoneanu A, Burlui A, Luca A, Codreanu C, Tamba BI, Stanciu GD, Dima N, Bădescu C, Rezuș C. The link between inflammaging and degenerative joint diseases. International journal of molecular sciences. 2019 Jan;20(3):614. Available from: https://www.mdpi.com/1422-0067/20/3/614/htm (last accessed 26.5.2019)
  5. Loeser RF. Age-related changes in the musculoskeletal system and the development of osteoarthritis. Clinics in geriatric medicine. 2010 Aug 1;26(3):371-86. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2920876/ (last accessed 26.5.2019)
  6. thejocdocMD. HA and osteoarthritis of the knee Available from: https://www.youtube.com/watch?v=l0sKstpunO4&app=desktop (last accessed 26.5.2019)
  7. Schiff How aging affects your joints Available from: https://www.schiffvitamins.com/blogs/health-wellness/how-aging-affects-your-joints (last accessed 26.5.2019)
  8. Li Y, Wei X, Zhou J, Wei L. The age-related changes in cartilage and osteoarthritis. BioMed research international. 2013;2013. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3736507/ (last accessed 26.5.2019)
  9. Bible JE, Simpson AK, Emerson JW, et al: Quantifying the effects of degeneration and other patient factors on lumbar segmental range of motion using multivariate analysis. Spine 33:1793-1799, 2008
  10. Doriot N, Wang X: Effects of age and gender on maximum voluntary range of motion of the upper body joints. Ergonomics 49:269-281, 2006