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people at common places in the village like temple, riverbeds. Problems should be immediately dealt with and feelings should be ventilated. Mental health is vital. A comprehensive approach on these general principles in mind does help to promote health in the elderly.

THE ABOVE LECTURE WAS DIVIDED INTO TWO SESSIONS OF ONE HOUR EACH. AT THE END OF THE LECTURE HALF A DOZEN CASES OF ELDERLY PATIENTS WERE DEMONSTRATED.. ADVICE REGARDING HEALTH PROMOTION AND ILLNESS PREVENTION WAS GIVEN TO THEM DURING THE DEMONSTRATION.

-R. L. Hanoomanthen

BONE AND JOINT DISEASES

Four major groups of disorders namely :

1. Osteoporosis with or without osteomalacia, 2. Degenerative arthritis, 3. Non- specific inflamatory arthritis like rheumatoid arthritis, and 4. All other joint disorders of earlier years of life are encountered. From the outpatient records of the Rheumatology clinic of the Govt. Rajaji Hospital, it is found that in patients 50 years of age and above, osteoporosis occurs in 80-82%. That it is associated with osteomalacia has not been proved, as ours is a tropical country. Rheumatoid arthritis occurs in 18% of cases. Degenerative arthritis is found always to coexist with generalised osteoporosis and Rheumatoid arthritis. Symptoms as low back ache, pain in the knee and ankle joints, vague muscle pain and stiffness, difficulty in using the hands in the morning are some of those frequently occurring in the elderly.

Generalised osteoporosis

This is localised or generalised. It is characterised by reduction in the bone mass without alteration in chemical composition. The important etiological factors are (i) immobilisation, (ii) idiopathic as in senility, (iii) associated disorders as Cushing syndrome and acromegaly and (iv) use of drugs like steroids. There occurs rarefaction of the bone, brittleness of the bone and decrease in size of the bone with the lamella more affected than the cortex. Microscopically there is no osteoblastic or osteoclastic activity.

Clinical features

(i) Brittleness of bone leads to pathological fractures. As new bone formation is poor, healing is also poor. (ii) As muscles get attached to bones, using the muscle produces pain, hence patients complain of generalised body pain and pain during activities such as lifting weights, cycling, walking. Pain aggravates on exertion and is relieved by rest. It is observed that patients are comfortable in the morning, develops pain as day advances owing to activities and have to take adequate rest before they recover the muscle functions next morning. An elderly lady presenting with a stoop is an example of osteoporotic bone involvement. An occasional low serum

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