Physical Therapist Management of Patients With Suspected or Confirmed Osteoporosis: A Clinical Practice Guideline From the Academy of Geriatric Physical Therapy.

A clinical practice guideline on physical therapist management of patients with suspected or confirmed osteoporosis was developed by a volunteer guideline development group (GDG) that was appointed by the Academy of Geriatric Physical Therapy (APTA Geriatrics). The GDG consisted of an exercise physiologist and 6 physical therapists with clinical and methodological expertise. The guideline was based on a systematic review of existing clinical practice guidelines, followed by application of the ADAPTE methodological process described by Guidelines International Network for adapting guidelines for cultural and professional utility. The recommendations contained in this guideline are derived from the 2021 Scottish Intercollegiate Guideline Network (SIGN) document: Management of Osteoporosis and the Prevention of Fragility Fractures. These guidelines are intended to assist physical therapists practicing in the United States, and implementation in the context of the US health care system is discussed.

Essential Components of Physical Therapist Management of Patients With Osteoporosis: A Delphi Study.

BACKGROUND AND PURPOSE: Osteoporosis is a systemic, metabolic bone disease that affects bone quality, increases susceptibility to low-trauma bone fracture, and has downstream effects on falls and fragility fractures. Osteoporosis is a multifactorial disease process that requires management from multiple health care providers including physicians, nurses, and physical therapists. However, the paucity of information regarding comprehensive physical therapist management for patients with osteoporosis indicated the need for an evidence-based document. The purpose of this document was to provide the best available expert guidance for clinicians in the selection of screening tools, essential tests and measures, treatment goals, and interventions for patients with osteoporosis. METHODS: A Delphi process was used. Thirty-one physical therapists with expertise in the care of patients with osteoporosis participated in a series of 3 sequential surveys designed to build and reach agreement on the management of patients with osteoporosis. The desired survey outcomes were to: (1) identify the range of examination and plan of care components considered important to physical therapists' care for patients with osteoporosis, (2) determine which components should be considered essential, and (3) achieve consensus on the final list of essential components and related operational definitions. RESULTS: A clear consensus on the essential components of examination and interventions was achieved. In general, there were 4 to 6 items across each category of history, tests and measures, education/goals, and treatment. CONCLUSIONS: The prioritization of these management items will better support clinicians working with adults who have osteoporosis.

Physical Therapist Management of Patients With Suspected or Confirmed Osteoporosis: A Clinical Practice Guideline From the Academy of Geriatric Physical Therapy.

A clinical practice guideline on physical therapist management of patients with suspected or confirmed osteoporosis was developed by a volunteer guideline development group (GDG) that was appointed by the Academy of Geriatric Physical Therapy (APTA Geriatrics). The GDG consisted of an exercise physiologist and 6 physical therapists with clinical and methodological expertise. The guideline was based on a systematic review of existing clinical practice guidelines, followed by application of the ADAPTE methodological process described by Guidelines International Network for adapting guidelines for cultural and professional utility. The recommendations contained in this guideline are derived from the 2021 Scottish Intercollegiate Guideline Network (SIGN) document: Management of Osteoporosis and the Prevention of Fragility Fractures. These guidelines are intended to assist physical therapists practicing in the United States, and implementation in the context of the US health care system is discussed.

Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition.

Osteoporosis-related fractures are undertreated, due in part to misinformation about recommended approaches to patient care and discrepancies among treatment guidelines. To help bridge this gap and improve patient outcomes, the American Society for Bone and Mineral Research assembled a multistakeholder coalition to develop clinical recommendations for the optimal prevention of secondary fractureamong people aged 65 years and older with a hip or vertebral fracture. The coalition developed 13 recommendations (7 primary and 6 secondary) strongly supported by the empirical literature. The coalition recommends increased communication with patients regarding fracture risk, mortality and morbidity outcomes, and fracture risk reduction. Risk assessment (including fall history) should occur at regular intervals with referral to physical and/or occupational therapy as appropriate. Oral, intravenous, andsubcutaneous pharmacotherapies are efficaciousandcanreduce risk of future fracture.Patientsneededucation,however, about thebenefitsandrisks of both treatment and not receiving treatment. Oral bisphosphonates alendronate and risedronate are first-line options and are generally well tolerated; otherwise, intravenous zoledronic acid and subcutaneous denosumab can be considered. Anabolic agents are expensive butmay be beneficial for selected patients at high risk.Optimal duration of pharmacotherapy is unknown but because the risk for second fractures is highest in the earlypost-fractureperiod,prompt treatment is recommended.Adequate dietary or supplemental vitaminDand calciumintake shouldbe assured. Individuals beingtreatedfor osteoporosis shouldbe reevaluated for fracture risk routinely, includingvia patienteducationabout osteoporosisandfracturesandmonitoringfor adverse treatment effects.Patients shouldbestronglyencouraged to avoid tobacco, consume alcohol inmoderation atmost, and engage in regular exercise and fall prevention strategies. Finally, referral to endocrinologists or other osteoporosis specialists may be warranted for individuals who experience repeated fracture or bone loss and those with complicating comorbidities (eg, hyperparathyroidism, chronic kidney disease).

Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition.

Osteoporosis-related fractures are undertreated, due in part to misinformation about recommended approaches to patient care and discrepancies among treatment guidelines. To help bridge this gap and improve patient outcomes, the American Society for Bone and Mineral Research assembled a multistakeholder coalition to develop clinical recommendations for the optimal prevention of secondary fracture among people aged 65 years and older with a hip or vertebral fracture. The coalition developed 13 recommendations (7 primary and 6 secondary) strongly supported by the empirical literature. The coalition recommends increased communication with patients regarding fracture risk, mortality and morbidity outcomes, and fracture risk reduction. Risk assessment (including fall history) should occur at regular intervals with referral to physical and/or occupational therapy as appropriate. Oral, intravenous, and subcutaneous pharmacotherapies are efficacious and can reduce risk of future fracture. Patients need education, however, about the benefits and risks of both treatment and not receiving treatment. Oral bisphosphonates alendronate and risedronate are first-line options and are generally well tolerated; otherwise, intravenous zoledronic acid and subcutaneous denosumab can be considered. Anabolic agents are expensive but may be beneficial for selected patients at high risk. Optimal duration of pharmacotherapy is unknown but because the risk for second fractures is highest in the early post-fracture period, prompt treatment is recommended. Adequate dietary or supplemental vitamin D and calcium intake should be assured. Individuals being treated for osteoporosis should be reevaluated for fracture risk routinely, including via patient education about osteoporosis and fractures and monitoring for adverse treatment effects. Patients should be strongly encouraged to avoid tobacco, consume alcohol in moderation at most, and engage in regular exercise and fall prevention strategies. Finally, referral to endocrinologists or other osteoporosis specialists may be warranted for individuals who experience repeated fracture or bone loss and those with complicating comorbidities (eg, hyperparathyroidism, chronic kidney disease). © 2019 American Society for Bone and Mineral Research.

Association of physical performance measures with bone mineral density in postmenopausal women.

OBJECTIVE: To investigate the association between physical performance measures and bone mineral density (BMD) in older women. DESIGN: Cross-sectional analysis. SETTING: University research laboratory. PARTICIPANTS: Healthy postmenopausal women (N=116; mean age +/- standard deviation, 68.3+/-6.8y) in self-reported good health who were not taking medications known to affect bone, including hormone replacement therapy. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Anthropometrics and BMD of the hip, spine, whole body, and forearm. Physical performance measures included normal and brisk 8-m gait speed, normal step length (NSL), brisk step length (BSL), timed 1-leg stance (OLS), timed sit-to-stand (STS), and grip strength. RESULTS: NSL, BSL, normal gait speed, brisk gait speed, OLS, and grip strength correlated significantly with several skeletal sites ( r range, .19-.38; P <.05). In multiple regression models containing body mass index, hours of total activity, total calcium intake, and age of menarche, NSL, BSL, normal and brisk gait speeds, OLS, and grip strength were all significantly associated with BMD of various skeletal sites (adjusted R 2 range, .11-.24; P <.05). Analysis of covariance showed that subjects with longer step lengths and faster normal and brisk gait speeds had higher BMD at the whole body, hip, and spine (brisk speed only). Those with a longer OLS had greater femoral neck BMD, and those with a stronger grip strength had greater BMD in the whole body and forearm ( P <.05). STS was not related to any skeletal site. CONCLUSIONS: Normal and brisk gait speed, NSL, BSL, OLS, and grip strength are all associated with BMD at the whole body, hip, spine, and forearm. Physical performance evaluation may help with osteoporosis prevention and treatment programs for postmenopausal women when bone density scores have not been obtained or are unavailable.