Osteoporosis, which includes prevention; Treatment and Rehabilitation Requires Skills Taking medication alone is not helpful in treating osteoporosis in all patients. One of the problems caused by osteoporosis is dysfunction, and functional improvement is one of the main goals of physical medicine and rehabilitation. An important goal in the field of physical medicine and rehabilitation is to improve the quality of life by improving one’s work.
Improving performance and quality of life is related to prevention, treatment and rehabilitation approaches. Therefore, physical medicine and rehabilitation specialists in all three fields work together with other specialists related to osteoporosis management. In addition, the rehabilitation approach, in addition to the above, anticipates patient care and provides the necessary services in this field, which is considered in community-based rehabilitation. And its goal is maximum participation of the individual in the society. The purpose of this article; The rehabilitation needs of people with osteoporosis are at different levels of prevention, treatment, rehabilitation and community involvement.
Age, on the other hand, is the most important risk factor for osteoporosis and is associated with osteoporosis independently of BMD. Considering the treatment of elderly patients in rehabilitation services, concomitant treatment of osteoporosis should be considered. Other patients who are widely treated in the rehabilitation service and need attention for osteoporosis include stroke, spinal cord injury, MS, and Parkinson’s.
Of course, almost all patients need some level of rehabilitation services, and many have concomitant osteoporosis. With the increasing expansion of the field of rehabilitation medicine in our society and the referral of patients, attention to osteoporosis should be considered in all cases.
In physical medicine and rehabilitation, dealing with osteoporosis is divided into six stages. Prevention, evaluation of risk factors and their change, other studies, especially in terms of performance and quality of life, diagnosis and treatment of drugs and non-drugs, improving performance and increasing individual participation, social support and participation in decision making.
Primary prevention involves improving health through training and personal management to improve bone health and reduce the risk of osteoporosis. Based on scientific evidence, osteoporosis prevention and personal management training have been an effective intervention in the prevention of osteoporosis in women over the age of 40 in society.
Exercise is one of the most important interventions of physical medicine and rehabilitation specialists to prevent osteoporosis. Exercise reduces the risk of osteoporosis by increasing bone mass in young adults, maintaining bone mass in adults, and reducing bone loss in postmenopausal women. A systematic review has shown that high-impact activity and high endurance exercise in premenopausal women increase bone density in the spine and thighs.
And high-pressure exercises that are done periodically and briefly only affect the bone density of the thigh. Bone pressure sites, especially in postmenopausal women, have increased bone density following exercise. Based on a systematic review, Whole-Body Vibration has been used as a new exercise method with significant changes in tibial and spinal bone density in the hip joint in postmenopausal women.
Assessing risk factors and changing them:
The first step in managing osteoporosis is to evaluate the absolute risk of osteoporosis fractures. This is done by assessing BMD and FRAX. Falling is most associated with the risk of fracture. Falling more than once a year is twice as important as other risk factors. Therefore, the risk factors for falls should be identified and the necessary intervention should be done.
In one study, 67% of people with osteoporosis had administrative incontinence. Effective rehabilitation interventions for these individuals in physical medicine include biofeedback, functional electrical stimulation, pelvic floor exercises, and the use of vaginal cones. Using two or more methods will produce excellent performance results.
A recent study on cognitive rehabilitation has shown that this method can be effective in reducing the risk of falls. Exercise, in addition to reducing osteoporosis, also reduces the risk of falls. Exercise training at home has been effective in reducing the risk of falling. Tai-Chi exercise has also been shown to be effective in Cochrane study, but a systematic review published later did not show the effect of tai-chi on reducing the risk of falling. Be used.
In people with osteoporosis, body posture control is also impaired. Balance exercises and muscle strengthening, walking exercises and muscle coordination improve moderation in balance. A new study has shown that in the elderly with osteoporosis, insole use can be associated with reduced pain and disability and increased balance. Proprioceptive exercise in extension has reduced the risk of falls in the elderly with spinal kyphosis.
The use of Whole body vibration has not reduced the risk of falls in the elderly. But it may affect balance and mobility. It also increases the strength of the lower limb muscles. A meta-analysis showed a reduced risk of fracture with exercise.
Treatment of chronic spinal pain in osteoporosis
- Correct the improper position of the spine, use weighted
- kypho-orthosis Biofeedback
- Use physical modalities such as ultrasound, massage or electrical stimulation
- If spinal deviation is not correctable, the use of supportive lumbar orthosis is recommended
- Advise not to do activities that cause high vertical pressure on the vertebrae or are accompanied by excessive bending of the body forward
Prescribe specific therapeutic exercises for the problem that caused the pain. Not corrected The use of lumbar orthosis is recommended. It is recommended not to perform activities that cause high vertical pressure on the vertebrae or are accompanied by excessive bending of the body forward.
Sleep disturbance is another risk factor for falls that exercise can improve sleep but has not been directly proven in research. Using a hip protector reduces the risk of fractures but has no effect on reducing the risk of falling. Research has shown that hip protection has a small but significant effect on reducing fractures in the elderly who are cared for in a nursing home but has no effect on other elderly people in the community.
Kyphosis is the most common deformity caused by osteoporosis and the most common cause of osteoporosis-related psychological damage. In this case, the relative weakness of the extensor muscles relative to the flexor or body weight is involved, and increases the risk of fractures of the spine. Spinal kyphosis also increases the risk of falling.
Other physical medicine evaluations:
- Check the performance status
- Performance appraisal is essential in physical medicine and rehabilitation and includes mobility assessment.
Coordination is positional control and the ability to perform physical activities. Ability to perform physical activity includes gait analysis, ability to walk backwards, gait speed test, standing excellence test, ability to stand while sitting in a chair, and Berg balance criteria.
Quality of life assessment: Fractures of the thighs and spine impair the quality of life. Recent research shows that osteoporosis alone or fractures other than the spine and thighs affect quality of life. Therefore, one of the goals of osteoporosis rehabilitation is to evaluate the quality of life and try to improve it. One of the questionnaires that is also standardized in Persian is SF36 that can be used for these people.
Drug treatment: Explained in previous topics.
Improve performance and increase social participation:
Unfortunately, many people come to us with osteoporosis who have severe functional impairments and problems with social participation due to fear of movement. Many people who see a physical therapist are concerned about becoming addicted and looking for a way to prevent or treat it. Following careful patient evaluation, appropriate approaches should be designed to improve patient performance and participation.
Physical fitness exercises, moving around in bed, indoors and outdoors, walking and daily living activities should be designed and taught for the individual. Use appropriate aids such as crutches, walkers and wheelchairs. For example, a short cane increases kyphosis and fractures of the spine, and a long cane increases the risk of falling from behind. The use of other aids to improve balance is another rehabilitation measure. Treating accompanying problems such as pain, or edema that interferes with a person’s movement are other measures that can help improve performance and increase participation.
Participation in planning:
With the spread of aging and its complications and the role of rehabilitation medicine in disease management, physical medicine and rehabilitation specialists should have a consensus in planning, especially in terms of community-based rehabilitation in the health system.