•Frailty  syndrom
1.Loss of body weight 4-5 kg/year
2.Exhaustion
3.Low muscle strength / handgrip   20 %
4.Low velocity of gait                       20 %
5.Dimisched physical activity           20 %
•
•Frailty- weak bone, prone to fracture

•Frailty syndrom
•Subclinicaly
•Early frail
•Late  frail
•Endstage frailty syndrom:  terminal geriatric deterioration

•Frailty  syndrom
•Tendency to falls and to fractures
•Tendency to decompensation of other comorbidities
•Loss of cognitive functions
•Help in daily activities
•Sarcopenia
•Osteoporosis
•
•Bone density corelates with serum level of vit D
•Low level of vit. D corelates with loss of cognitive functions
•

•                     Prevalence
•
•Mostly in higher age
•In 7 % of people above 65 y. living at home
•In 25 % of people at the age above 75 years
•
•Loss of muscles of  20 % in people 65-70 let
•Loss of muscles of  60 % in people above 80 years
•
•The cause: long lasting insuficiency of vit D

•Risk factors of frailty syndrom
•Cardiovascular diseases
•Diabetes mellitus
•Atherosclerosis
•Renal diseases
•Neurological diseases
•Obesity
•Hormonal dysfunction
•Parkinson syndrom
•Multiple sclerosis
•Condition after cerebrovascular disease
•Cataracta
•
•

•Prevention and treatment of frailty syndrom
•Frailty syndrom is reversible
•
•Nurishment and uptake of proteins 1,3 g/kg/day
•Vit D 800 IU/day till 2000 IU/day
•Vigantol 1 drop = 500 IU, alpha kalcidol 1 µg
•
•Walking, resisted exercise for maintaing of muscle strength
•Exercise for balance and stability
•Prevention of atherosclerosis, management of metabolic diseases
•Mangement other comorbidities
•To relieve of pain
•Stop walking when talking

• Sarcopenia
•Loss of muscle material of 20-30 %
•
•Dysbalance between synthesis and degradation of muscles
•(myostatin, glucorticoids, sexual hormons, insulin, IGF-I )
•
•Osteopenia follows sarcopenia
•
•Bedridden patients
•Sedentary way of life
•Worsening of physical condition
•

•Sarcopenia
•Muscle densitometry: bellow 2 SD - male     bellow 7,26 kg/m2
•                                                         - female bellow  5,45 kg/m2
•MRI examination
•
•Hand grip- dynamometer
•Flexion and extension of knee joint
•Maximal rate of breathing out
•Velocity of walking
•Test for maintaining  of balance
•Get up and go test
•Test of  climbing stairs

•Consequences of sarcopenia
•Diminished physical activity
•
•Sarcoporosis
•
•Higher risk of falls
•
•

•Medication in sarcopenia
•Vit D 800 IU/day till 2000 IU/day
•Vigantol 1 drop = 500 IU
•Alpha calcidol 1 µg
•
•Testosteron
•Ghrelin
•Leptin
•Growth hormon secretogoga
•Estrogens
•

•Management
•Farmacotherapy of osteoporosis diminisched the risk
•of fragility fractures only in 20-50 %
•
•The whole patient with osteoporotic syndrom
•+ frailty syndrom
•+ sarcopenie
•+ osteoarthrosis
•+ other comorbidities
•
•Prevention of falls
•
F koubová 1

•Physiotherapy
Fosa-cvičení


•Medication for osteoporosis
Bisphosphonates
- Alendronate (Fosavance)
- Risedronate (Actonel)
- Ibandronate (Bonviva)
- Zolendronate (Aclasta)
Denosumab (Prolia)
Stroncium ranelate (Protelos)
Parathormon, teriparatid
– synthetic parathormon 1-34 fragment
(Forsteo)
SERM- bazedoxifen
Fosa-páteř

•New agents
Sclerostin antibodies
Sclerostin – inhibitor of osteoblasts
                      produced by osteocytes
Romosozumab
Blosozumab
Inhibitors of katepsin K
- inhibit bone resorption
Odanatocibe
Sclerostin- přirozený negativní regulátor kostní formace
Je produkován osteocyty
Sclerostin stimuluje kostní resorpci přes RANKL
Je inhibitor osteoblastů