RSNA2023 Leading Through Change
Daily Bulletin

Understanding Musculoskeletal Manifestations of Aging

Thursday, Nov. 30, 2023

The increasing elderly population poses significant challenges and opportunities for physicians across various specialties. As primary care physicians are grappling with the management of elderly patients with multiple comorbidities, radiologists are, in turn, seeing a surge in ordered imaging.



"Several topics pertaining to aging, such as osteoarthritis, osteoporosis and sarcopenia are fundamental in the realm of radiology," said Catalina Flores, MD, a PGY-4 diagnostic radiology resident at Creighton University Arizona Health Education Alliance in Phoenix. "It's important to have an in-depth understanding of these diseases as it's highly applicable to our day-to-day practice."

Dr. Flores' education exhibit highlights key teaching points related to the aging processes in the musculoskeletal system, with a particular focus on biochemical aspects and radiologic manifestations.

"The primary purpose of the exhibit is to serve as a useful resource for attendees, offering a dual function of refreshing fundamental biochemistry concepts with easy-to-follow visual diagrams that I created, and providing an overview of the key topics related to aging of the musculoskeletal system," Dr. Flores said. "It is designed to be a comprehensive guide and overview that attendees can use to delve deeper into the information they find most relevant to their needs."

Dr. Flores' exhibit begins with an overview of the biochemical processes of aging and includes information about conditions arising from changes in bone homeostasis, including osteoporosis, Paget's Disease and fragility and insufficiency fractures.

Sharing details about architectural changes in muscle, cartilage and tendon composition, Dr. Flores offers information about imaging techniques and manifestations for conditions including sarcopenia, osteoarthritis, tendinopathy and tendon tears.

Additional topics covered include metabolic derangements and genomic instability resulting from acquired oxidative damage and decreased cellular repair mechanisms.

Challenges to Imaging Elderly Patients

According to Dr. Flores, imaging patients who are elderly presents some inherent challenges. "The elderly often have decreased tolerance for lengthy procedures and scans, which can make it difficult balancing the benefit and cost of diagnostic work-ups and treatments," she said. "Predisposing conditions can also make it difficult to identify pathology compared to younger patients, for instance fractures in a severely osteopenic patient."

Dr. Flores added that high-quality scans may also be difficult to achieve if patients are cognitively impaired, have difficulty with positioning, or have disabilities that impair following directions. "All of these factors pose potential hurdles, therefore it is important to carefully balance the benefits and risks for this patient demographic," she said.

In addition to providing her with a unique opportunity to refresh her knowledge of cell biology and biochemistry concepts, Dr. Flores noted that her research is a blend of her educational background and clinical training that heightened her appreciation of the imaging findings radiologists observe. "I would also like to extend my heartfelt appreciation to my mentor, Dr. Jimmy Saade, for his invaluable guidance and mentorship while creating the exhibit," she said.

"The ability to distinguish between normal age-related changes and pathologic conditions is of paramount importance, and where we can bring value in the eyes of the referring physicians," Dr. Flores said. "In this way we can avoid unnecessary interventions and diagnostic work-up, while facilitating more efficient use of imaging resources."

Access the education exhibit, "The Musculoskeletal Manifestations of Aging: What the Radiologist Needs to Know in Caring for Our Growing Elderly Population," (MKEE67) at