Musculoskeletal and Rheumatologic Disorders
What to know
Osteoporosis: screen with DXA (women ≥65, men ≥70 or risk factors); assess fracture risk (FRAX); treat with bisphosphonates, calcium/vitamin D, and fall prevention. Osteoarthritis is the most common arthritis; manage with exercise, weight loss, acetaminophen/NSAIDs cautiously (renal/GI risk). Rheumatoid arthritis can present late; treat to prevent disability. Polymyalgia rheumatica (proximal stiffness, elevated ESR/CRP) and giant cell arteritis (headache, jaw claudication, vision loss-urgent steroids) are classic geriatric rheumatology. Gout is common; watch for diuretic triggers. Sarcopenia and frailty overlap with musculoskeletal decline.
Traps
NSAIDs in elders risk GI bleeding, AKI, and heart failure-use cautiously. Bisphosphonates require renal function assessment and attention to esophageal precautions. GCA is a vision-threatening emergency: start steroids before biopsy if suspected. Don't miss vertebral compression fractures presenting as back pain or height loss. Atypical RA presentations can delay diagnosis.
Rule of thumb
"Protect the bone and the kidney": prioritize fall prevention and renal-safe analgesia in osteoporosis and arthritis care.
Worked example
A 75-year-old with new temporal headache, jaw claudication, and elevated ESR: start high-dose corticosteroids immediately and arrange temporal artery biopsy; do not wait for biopsy to treat.
Worked example 2
An elder with knee OA and CKD: avoid systemic NSAIDs; use topical agents, acetaminophen, exercise, and weight management.