Efficacy of group-adapted physical exercises in reducing back pain in women with postmenopausal osteoporosis.

PURPOSE: The clinical effects of osteoporosis include pain, fractures, and physical disability, causing a loss of independence and necessitating long-term care. Whereas the effects of exercise therapy in decreasing body mass index and preventing fractures are well established, there is no consensus on back pain and quality of life in women with osteoporosis. The aim of this study was to determine the efficacy of a brief course of rehabilitation, comprising group-adapted physical exercises, with regard to back pain, disability, and quality of life in women with postmenopausal osteoporosis who had no evidence of fractures. METHODS: The enrolled patients were randomized into two groups: the treatment group underwent ten sessions of rehabilitative exercises, and the control group received an instructional booklet with descriptions and figures of exercises that were to be performed at home. RESULTS: Sixty patients completed the trial and assessments, including a 6-month follow-up. The treatment was effective versus the control group, significantly improving pain (Visual Analogue Scale: p < 0.001 at the end of the treatment and at the follow-up; McGill Pain Questionnaire: p = 0.018 at the follow-up), disability (Oswestry Disability Questionnaire: p < 0.001 at the end and follow-up), and quality of life (Shortened Osteoporosis Quality of Life Questionnaire: p = 0.021 at the end of treatment; p = 0.005 at follow-up). CONCLUSIONS: Our results suggest that group rehabilitation reduces back pain and improves functional status and quality of life in women with postmenopausal osteoporosis, maintaining these outcomes for 6 months. The use of physical exercises might strengthen the habit to training.

Impact of clinical fractures on health-related quality of life is dependent on time of assessment since fracture: results from the FREEDOM trial.

UNLABELLED: In the Fracture Reduction Evaluation of Denosumab in Osteoporosis Every 6 Months (FREEDOM) study, women with incident clinical fractures reported significant declines in health-related quality of life (HRQoL). The largest declines were observed when the assessment was <3 months post fracture. The largest impact of incident clinical fractures was on physical function, and that of incident clinical vertebral fractures was on back pain. INTRODUCTION: In the FREEDOM trial, denosumab significantly reduced the risk of new vertebral, hip, and nonvertebral fractures. We evaluated the effect of denosumab on HRQoL and the association between incident clinical fractures and HRQoL. METHODS: The FREEDOM trial enrolled 7,868 women aged 60-90 years with a total hip and/or lumbar spine BMD T-score <-2.5 and not <-4.0 at either site. Women were randomized to receive denosumab 60 mg or placebo every 6 months, in addition to daily calcium and vitamin D. HRQoL was assessed with the Osteoporosis Assessment Questionnaire-Short Version (OPAQ-SV) at baseline and every 6 months for 36 months. The OPAQ-SV assesses physical function, emotional status, and back pain. Higher scores indicate better health status. RESULTS: No statistically significant differences in mean change in HRQoL from baseline to end of study were found when comparing treatment groups. Compared with women without any incident fractures during the study, women with incident clinical fractures reported significant declines in physical function (-4.0 vs. -0.5) and emotional status (-5.0 vs. -0.8) at month 36 (P < 0.001 for both). Importantly, time-dependent covariate analyses demonstrated that the largest declines were observed when the assessment was <3 months post fracture. The largest impact of incident clinical fractures was on physical function, and that of incident clinical vertebral fractures was on back pain. CONCLUSIONS: These findings not only demonstrate that incident clinical fractures impact HRQoL but also contribute new information regarding the impact of these fracture events on HRQoL over time.

A survey of screening and practice patterns used for patients with osteoporosis in a sample of physical therapists from Illinois.

BACKGROUND: Physical therapists provide care for many patients who are at risk or have been diagnosed with osteoporosis. Currently, little information exists about what physical therapists know about osteoporosis, how they screen for the condition, and how they manage patients with osteoporosis. PURPOSE: This study assessed knowledge and confidence of physical therapists in screening, examining, and planning interventions for persons diagnosed or at risk for osteoporosis. METHODS: A survey was mailed to 250 randomly selected members of the Illinois Physical Therapy Association. A follow-up mailing was sent to those who had not replied within 3 months. Survey items focused knowledge and confidence with screening and developing interventions for persons with osteoporosis. Response rate was 41% with a final sample of 83, 3 respondents meeting the inclusion criterion (working with women age 40-90). RESULTS: The majority of respondents were confident (35%) or somewhat confident (47%) in their ability to recognize risk factors for osteoporosis. The majority correctly identified female gender (68%), history of fracture (88%), and family history of osteoporosis (80%) as risk factors for osteoporosis, and identified changes in height (86%), and changes in posture (90%) as indicators for screening. Only 35% would often or always identify Asian American individuals as appropriate for screening for osteoporosis. Respondents appropriately prescribed log rolling for bed mobility (82%), rest in a supine position (45%), "hip hinge" as a method for sit to stand (48%), and wall slides (52%). Although more than 55% reported never prescribing high-risk exercises such as toe touches, abdominal machines, or abdominal crunches, 33% would prescribe high-risk exercises such as rest in a sitting position (37%) and a "nose over toes" method of sit-stand (36%). CONCLUSION: It appears physical therapists correctly screen and identify some risk factors for osteoporosis; more education is needed in certain areas of screening and interventions for those with osteoporosis.

Dose-response effect of 40 weeks of resistance training on bone mineral density in older adults.

UNLABELLED: Resistance training is becoming popular for maintaining bone health. Previous studies examined high intensity exercise; we compared high and low intensity resistance training performed 2 or 3 days per week in older adults. We found positive bone density responses for the hip and spine for all types of resistance training. INTRODUCTION: This study determined the dose-response effect of resistance training on lumbar spine, proximal femur, and total body bone mineral density (BMD) in older men and women (55-74 years). METHODS: Subjects included 45 men and 79 women who were assigned to one of the following training groups: 1-high intensity (80% 1RM), 2 days/week (2HI); 2-low intensity (40% 1RM), 2 days/week (2LI); 3-high intensity (80% 1RM), 3 days/week (3HI); and 4-low intensity (40% 1RM), 3 days/week (3LI). Bone scans (dual energy X-ray absorptiometry) were performed at baseline and after 40 weeks of training. Muscular strength (1-repetition maximum) was assessed every 5 weeks. RESULTS: There were significant trial (p < 0.05) effects but no significant trial × training group interactions for the BMD sites. Spine, trochanter, and total hip BMD increased from baseline to 40 weeks; however, the total body BMD site decreased in the 3LI group. Men and women exhibited similar improvements for the trochanter and total hip sites but the percent change in the spine tended (p = 0.054) to be higher for men (1.8%) than women (0.4%). CONCLUSIONS: The resistance training programs, regardless of intensity and frequency, were effective in improving BMD of the proximal femur and lumbar spine but not the total body. Both men and women responded similarly for the hip sites but men show a greater response at the lumbar spine than women.

Rehabilitation using manual mobilization for thoracic kyphosis in elderly postmenopausal patients with osteoporosis.

OBJECTIVE: To explore the feasibility and effects of rehabilitation using manual mobilization of the thoracic spine in elderly female patients with osteoporosis. METHODS: Forty-eight postmenopausal patients with osteoporosis (age 76 -/+ 7 years) were randomly assigned to 3 months rehabilitation (18 sessions including manual mobilization, taping and exercises, n = 29) or control (wait-list, n = 19). The primary outcome was thoracic kyphosis degree (Spinal-Mouse). Secondary outcomes were back pain (visual analogue scale) and quality of life (Qualeffo-41). Explanatory outcomes were compliance with rehabilitation, complications, and patients' and therapists' perceptions regarding the rehabilitation programme. RESULTS: Thoracic kyphosis improved significantly following rehabilitation compared with controls (intention-to-treat analysis, p = 0.017); and in patients who were compliant with rehabilitation (n = 15) compared with those who were non-compliant (p = 0.002) and controls (p = 0.001). Mental health worsened slightly in the rehabilitation group (p = 0.029), but not significantly compared with controls. Neither patients nor physical therapists reported serious adverse effects. CONCLUSION: Three months of rehabilitation with manual mobilization can attenuate thoracic kyphosis in elderly patients with osteoporosis. Its impact on back pain and quality of life remains unclear and needs further investigation.

La conducta del ortopedista en la prevención, diagnóstico y tratamiento de la osteoporosis en mujeres posmenopáusicas con fractura de cadera en cuatro hospitales de Bogotá - Colombia, 2001-2003 / The conduct of the orthopedist in the prevention, diagnosis and treatment of osteoporosis in postmenopausal women with hip fracture at four hospitals of Bogotá - Colombia, 2001-2003

Las publicaciones internacionales han mostrado que el ortopedista juega un papel de “reparador” de las fracturas y muy poco en la prevención de las mismas. Se realizó un estudio observacional descriptivo tipo serie de casos para estudiar el comportamiento del ortopedista en las mujeres posmenopáusicas con fractura de cadera por osteoporosis en cuatro centros hospitalarios de Bogotá. Resultados: No había información en el 82% de las historias clínicas sobre los antecedentes médicos, familiares y factores de riesgo para osteoporosis. Se reportaban medidas de prevención en el 35% de los casos. Estudios con DEXA o Ultrasonido: 1% Tratamiento y Prevención: El 1% con Estrógenos, Bifosfonatos o Calcitonina. El 31% con Calcio. Conclusiones: Los resultados hablan del bajo interés y el escaso conocimiento que tenemos de la osteoporosis y del papel que tenemos como “reparadores” de las fracturas y muy poco en su prevención.

Positive effects of physiotherapy on chronic pain and performance in osteoporosis.

The aim of this placebo-controlled, randomized, single-masked study was to establish the effects of a 10-week ambulatory exercise programme for osteoporotic patients on pain, use of analgesics, functional status, quality of life, balance and muscle strength. Fifty-three ambulatory postmenopausal women with at least one spinal crush fracture and pains within the last 3 years were randomized for physiotherapeutic training twice a week for 10 weeks or no training. The training included general training of balance and muscle strength, with stabilization of the lumbar spine. The participants were tested at baseline, week 5 and week 10 with a balance test, muscle strength test and questionnaires on pain, use of analgesics, functional status and quality of life. Twelve weeks after the supervised training had finished (week 22) they answered the same questionnaires. The study groups were comparable at baseline. The training group had a significant reduction in use of analgesics (p = 0.02) and pain level (p = 0.01) during the training period. Distribution of functional score improved; the improvement was reduced at week 22. Quality of life score improved significantly throughout the study (p = 0.0008), even after week 22. Balance improved non-significantly (p = 0.08). Quadriceps muscle strength improved significantly after 5 weeks (p = 0.04). Back extensor muscle strength improved almost significantly (p = 0.09). In conclusion, this training programme for osteoporotic patients improved balance and level of daily function and decreased experience of pain and use of analgesics. Quality of life was improved even beyond the active training period.

Terapéutica hormonal de reemplazo, estudio prospectivo: 17 beta estradiol transdermal, efectos sobre las lipoproteínas LDL y HDL del colesterol plasmático y modificaciones en la sintomatología climatérica sistematizada / Hormone replacement therapy, prospective study: estradiol 17b, effects above the lipoproteins LDL and HDL of the plasmatic cholesterol and modifications in the climateric symptomatology

Se investigaron los resultados de estrogenoterapia transdermal sostenida, durante un año y medio, en una población homogeneizada. No solo la edad, ausencia de patología asociada, talla, peso, antigüedad en la menopausia, sino fundamentalmente el programa dietético y de ejercitación física, en el grupo tratado THR, 35 casos y el grupo control PHD, 56 casos, fuesen semejantes. Se enfatizó la motivación para el cumplimiento en 18 meses del programa higiénico dietético. Con respecto a las lipoproteínas del colesterol, el análisis de varianza anidado evidenció una curva descendente significativamente más pronunciada, en el grupo THR, que la pendiente descendente del grupo PHD. Interacción p < 1 por ciento. En lo que atañe al HDL colesterol, la franca curva ascendente del grupo tratado difiere muy significativamente, de la curva muy levemente descendente, del grupo control. Interacción p < 1 por ciento. En la sintomatología se observó un impacto favorable general. Se realizó test no paramétrico de Wilcoxon y Wilcox comparando las observaciones con la basal y para comparar la THR el test U de Mann-Withney, que demostró diferencias significativas en orden decrecientes, para ostealgias, desinterés sexual, depresión y tuforadas