David Hamerman

The structure of the lining cells at the surface of the synovial membrane facing the joint cavity has been studied by electron microscopy. The long cytoplasmic processes of these cells appear to be oriented toward the surface of the membrane, where they overlap and intertwine. The matrix of the lining cells contains dense material but no fibers with the periodicity of collagen. The lining cells are divided into two cell types or states of activity on the basis of their cytoplasmic contents. Type A is more numerous and contains a prominent Golgi apparatus, numerous vacuoles (0.4 to 1.5 microns in diameter) containing varying amounts of a dense granular material, many filopodia, mitochondria, intracellular fibrils, and micropinocytotic-like vesicles. Type B contains large amounts of ergastoplasm with fewer large vacuoles, micropinocytotic-like vesicles, and mitochondria. The probable functions of these cells are discussed in the light of current knowledge of the metabolism and function of the synovial membrane.

Medical Writings1 June 1999Toward an Understanding of FrailtyDavid Hamerman, MDDavid Hamerman, MDAlbert Einstein College of Medicine; Bronx, NY 10467 (Hamerman)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-130-11-199906010-00022 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Health care providers who serve an aging population inherently associate the word frailty with patients whom they perceive as frail. Although frailty is not confined to elderly persons, it is more frequently observed in persons older than 85 years of age (the "oldest old") (1). This is because limitations and diseases associated with aging are an inseparable part of frailty (2-5). As a result, frailty remains more a constellation of many conditions than a discrete clinical entity, and it certainly does not have a precise scientific meaning (6). Frailty is often identified by words that express a similar state, such ...References1. Suzman RM, Manton KG, Willis DP. Introducing the oldest old.. In: Suzman RM, Willis DP, Manton KC, eds. The Oldest Old. New York: Oxford Univ Pr; 1992:3-14. Google Scholar2. Fried LP. Frailty. In: Hazzard WR, Bierman EL, Blass JP, Ettinger WH Jr, Halter JB, eds. Principles of Geriatric Medicine and Gerontology. 3d ed. New York: McGraw-Hill; 1994:1149-55. Google Scholar3. Powell C. Frailty: help or hindrance? J R Soc Med. 1997;90 Suppl 23-36. CrossrefMedlineGoogle Scholar4. van Weel C, Michels J. Dying, not old age, to blame for costs of health care. Lancet. 1997;350:1159-60. CrossrefMedlineGoogle Scholar5. Fried LP, Williamson JD, Kaspar J. The epidemiology of frailty: scope of the problem.. In: Perry HM 3d, Morley JE, Coe RM, eds. Aging and Musculoskeletal Disorders: Concepts, Diagnosis, and Treatment. New York: Springer; 1993:3-15. Google Scholar6. Buchner DM, Wagner EH. Preventing frail health. 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OSTEOARTHRITIS, "an almost inevitable consequence of aging,"1 is second only to cardiovascular diseases in producing severe chronic disability, and it affects nearly 10 percent of the population over the age of 60.2 This prevalence and its costs — billions of dollars in medications, surgery, and days lost from work3 — account for the growing interest in uncovering the basic mechanisms by which this disease affects human joints.4 5 6 7 8 9 Osteoarthritis can involve axial, or spinal, as well as peripheral joints — those that bear weight (such as the hips and knees) as well as those that do not (such as the distal . . .

Osteoporosis and atherosclerosis are both widely prevalent in an ageing population, and induce serious morbidities and death. There is growing evidence that in addition to their relationship to ageing, osteoporosis and atherosclerosis are also linked by biological associations. This article reviews their clinical interrelations, discusses the basic biology of bone and the arterial wall, and presents five examples that illustrate their biological linkages. Current therapeutic approaches emerging from these linkages, including statins, bisphosphonates, and the thiazolidinediones, have dual effects on bone and the vasculature. Additional therapies derived from experimental studies that enhance bone density and reduce atherogenesis hold further promise to diminish the morbidity and mortality of osteoporosis and atherosclerosis, with attendant benefits to society.