Aging Begins at 30

Collar Bone Injury Leads to Mysterious Aches

I fell a few weeks ago running for a bus in Ayr, Scotland. The pain in my shoulder was moderate but persistent enough to warrant a shoulder x-ray. I found I had broken my collar bone or clavicle. The clavicle (Latin for a little key) keys the shoulder blade to the breast bone. The orthopedists no longer think bandaging helps. "Just wait it out. It will heal. We’ve hardly ever seen an ununited clavicular fracture." "That’s all right. I can wait," I said, but I told my wife, "I do feel a bit miserable".

I noticed each morning that my shoulder ached but so did other muscles remote from the injury site. I said to my wife, "There must be a generalized inflammation of muscles, I’m going to look up myositis associated with injury." I did and found nothing. That same day, surprisingly, my copy of the Journal of the American Geriatric Society arrived with an article by a group of investigators in Florence and Padova in Italy and from Vermont, Durham, Memphis, Bethesda, and Iowa City, called "IL 6 and Disability in Older Persons." IL 6 is a blood protein signaling between cells (a cytokine) that is raised after inflammation or acute injury such as fractures. IL 6 also is known to increase with age. Elevations of such messengers, especially IL6, cause muscle wasting. The authors set out to prove that high levels of IL 6 might predict disability from loss of muscle size and strength (sarcopenia) in older persons.

Geriatricians have hypothesized that an accumulation of diseases such as stroke, arthritis, heart failure, dementia, and so on could lead to debility directly or maybe by a common pathway weakening muscle and producing disability. IL6 will rise with inflammation or injury, such as an inflamed colon (diverticulitis), periodontal disease, inflammation associated with hardening of the arteries, or increased belly fat; but would these add up? Sustained over a long period would they act through elevated IL6 to destroy muscle fibers and weaken the elderly person? There are some other blood protein reactants like C Reactive Protein (CRP) first studied in 1930 in pneumonia. Could either of these tests predict future disability and senile weakness? If raised levels could be found and reduced by treatment of, for example, chronic diverticulitis, would disability be less? As one author put it, "Can the graying of the immune system be reversed?"

IL6 was measured in 280 test subjects with disability and 350 random control subjects from the same population. Follow up four years later found that patients within the highest third of IL6 values, were 1.8 times more likely to develop mobility-disability problems and 1.6 times more likely to lose the ability to perform the activities of daily living (ADL) than persons within the lowest third of IL6 values. Those with problems were older, less educated and had lower mental status scores.

Multiple unrelated diseases are common in old age. They may well be tied together by a global marker of inflammation like IL 6. Could inflammatory activity thus detected be diagnosed and treated to prevent or reduce weakness and disability? This seems a good question.

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See related Patient Topics Bones, Joints and Muscles, Injuries and Wounds or Shoulder Injuries and Disorders.

See related Provider Topics Bones, Joints and Muscles, Injuries and Wounds or Shoulder Injuries and Disorders.

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