MECHANISMS of DISEASE SKELETAL CHANGES OVER THE LIFE SPAN Recall from 8 thal enlarge during. i TTD: the nati and cfectvener of he remoting proces, ofen characterize aging-associated skeletal changes—both normal and pathological. For evample, in the skull, fontanels close, sutures appear, teeth erupt, the paranasal simises enlarge and assume their adult placement, and the size of the eraninm enlarges fo accommodate a growing brain. All these changes occur in a pre- dictable ss snd reaul rom normal skeletal aging processes I hot the age of appearance of ossifica- tion centers and, later, the closure of epiphyseal growth plates are serie lel celiac Fe 59 on 217 GMMR es re 88 Figure 89 on p. 207) and epiphyseal growth plates appear, en- Tatge, mature, and close in an orderly fashion. Such orderly pro- sression makes itposible to estimate child's potential for growth and ultimate height from the number and location of esification centers and the status of closures visible on iographs. Once the epi long bones oti, they sea plates ‘can no Tonger lengthen and growth in height ceases. Physicians often compare an individual's “bone age,” which is determined by the number of ossification centers visible ona radiograph, with “chronological age.” This type of information can prove useful in the diagnosis or treatment of many genetic, metabolic, or Aacatory skeletal diseases characterized by abnonmlly rapid delayed skeletal maturity In the absence of disease, now bone mass produced after Derty, and generally into the early thirties, i properly calcified tbat not brite. Ir exhibits both the hardness an reared to ress fractures, Dasing this period, “iy sults in the deposition of more bone than is resorbed in the ‘emodeling process. Before puberty this process results in bones that continue to grow until they reach adult size and proportions, Instead of growth in bone size, the skeletal remodeling process in the immediate postpuberal years and, generally into the second decade of life results in the replacement of younger and weal svith bone that is more dense and has higher quali ‘Ths the skeletal aging process in early adulthood pre- ‘duces a postive outcome —stronger bones. Unfortunately, the of ficiency of the remodeling process during the next decade begins 4 progressive decline that can be slowed only by good mutton and a healthy lifestyle, but never fully stopped. "The negative out- comes of skeletal aging soon appear, and they con lifetime. Degenerative aging processes affec befor pact bone and generally begin between 30 and 40 years of age In many cases, problems arise because of abnormalities in bone remodeling that result from both a decrease in esteablats and a gradual increase ha ‘numbers and activity. In ad- dition, the osteoblasts that are formed during late adulthood are Tess ol gia aa mats Furthermore, i , oldet to shrink and coalesce, resulting inthe appearance of tiny, honeycomb-ike ‘open spaces. The result is bone thinning and lose of density. Theete Eco crane, Balloon kyphoplzsty isan orthopedic procedure used to teat the ver {wbral compression tracure that occur in steoporsis, as a rest of ‘certain tumors, or after prolonged use of steroid drugs. Fractured (co! lapse) vertebrae see Figure 8-22 on p. 214 result in shortened hight and spinal deformity and may be the cause of etcnic pain. The bloon| Iyphoplasty procedure involves the insertion of anintabebllonike ‘device called a hone tamp throug a smal incision in the skin an then through channel ile int the body ofthe fractured verter Expar= ‘sion ofthe balloon restores the vertebra toa noumal height. The balloon is then detated and removed, and tne surgeon uses the needle t tl skeleton as 2 whole loses strength, bones become britile, and the risk for facture increases. It's the loss of trabecitlae and resting compression fractures inthespongy bone of vertebrae that case the progresive decrease in height thats atypical consequence of aging, Its true—all of us “sink with age.” And the process begins earlier than you might think about age 35, However, «regular weight-bearing exercise program coupled with good nutrition, especially adequate cal= ium and vitamin D intake, will help minimize the degenerative cffcts of skeletal aging. ‘The severe and repeated vertebral compression fractures com ‘mon in osteoporosis cause not only a decrease in height but also spinal deformity and loss of mobility (Box 9-3). Recall that ‘osteoporosis (see p- 216) is characterized by los of bome mass, especially spongy bone, and demineralization of mattis, No dis ‘cussion of skeletal aging is complete without empharizing the im- portance of this very common and serious bone disease. You are ‘encouraged to review the discussion of osteoporosis in Chapter 8. Unfortunately, advancing age i offen accompanied by the appear ance of other metabolic, genetic, or inlaimmatory disease cond affect skeletal tissues, bones, and joints. the cavity witha typeof “superglue” bone cement that quickly hardens ‘nd thus tables and cals the tractus. An eator procedure, callad verteroplasty also involves injecting bone cement, ut without us Inga balloon. Both procedures are cost-effective, have shot recovery petods, and in many cases may eliminate he nor dificult and exe Densive spinal surgery. However, as wi all surgical procedures, both the physician and patent need to fly vate the risks and rewards before. Specialized physician traning and experience in partoxm ing te procedure are important, as isthe avalbilty of hospital spinal suger sevice facies and personne if problems should occur