Abstract
Falls and fractures are multifactorial; therefore, multifaceted approaches are required to prevent and manage them. Reducing sedative pharmacotherapy decreases iatrogenically affected alertness and falls in the geriatric population. Axial strength and stability are of primary importance. Muscle and bone loss, along with age-related disequilibrium, falls, and fractures, require innovative approaches for management. Imbalance and postural sway are two important risk factors for falls. Strengthening lower extremity muscles can decrease the risk of falls. Prevention of falls is the primary objective of a rehabilitation course. Factors contributing to the risk of falls could be intrinsic or extrinsic to the body.
A spinal extensor strengthening program can be performed with progressively resistive exercises, as tolerated. The combination of reducing kyphosis, increasing back strength, and reorienting the facet joints for proper upright posture would be of help. Rib fractures are not uncommon in older adults with osteoporosis and are very painful, and some options for management are discussed. Emergency care is indicated if there is shortness of breath, especially if it is worsening. The most life-threatening fracture in osteoporosis, the hip fracture, is covered in detail here. In this chapter, other fractures such as the forearm, tibial shaft, ankle and sacral insufficiency fractures, or stress fracture and soft tissue injuries will be mentioned as well. Prevention of vertebral wedging and compression fracture requires special rehabilitative measures as reflected throughout the book.
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References
National Osteoporosis Foundation: Clinician’s guide to prevention and treatment of osteoporosis, Washington, 2013, National Osteoporosis Foundation. Available at: http://nof.org/.
Sinaki M, Mikkelsen BA. Postmenopausal spinal osteoporosis: flexion vs extension exercises. Arch Phys Med Rehabil. 1984;65:593–6.
Sinaki M. Prevention and Treatment of Osteoporosis. Chapter 41. In: Braddom R, Buschbacher R, Dumitru D, Johnson E, Matthews D, Sinaki M, editors. Physical Medicine and Rehabilitation. 2nd ed. Philadelphia: W. B. Saunders; 2000. p. 894–912.
Lindsay R, Silverman SL, et al. Risk of new vertebralfracture in the year following a fracture. JAMA. 2001;285(3):320–3. doi:10.1001/jama.285.3.320.
Sinaki M. Prevention of hip fracture: physical activity. In: Ringe JD, Meunier JP, editors. Osteoporotic fractures in the elderly: clinical management and prevention. Stuttgart: Georg Thieme; 1996. p. 99–115.
Sinaki M. Falls, fractures, and hip pads. Curr Osteoporos Rep. 2004;2(4):131–7.
Nichols FC (expert opinion). Mayo Clinic, Rochester, Minn. July 12, 2012.
Hui SL, Slemenda CW, Johnston Jr CC. Age and bone mass as predictors of fracture in a prospective study. J Clin Invest. 1988;81:1804–9.
Lofman O, Berglund K, Larsson L, Toss G. Changes in hip fracture epidemiology: redistribution between ages, genders and fracture types. Osteoporos Int. 2002;13(1):18–25.
Handoll HHG, Cameron ID, Mak JCS, Finnegan TP. Multidisciplinary rehabilitation for older people with hip fractures. Cochrane Database Syst Rev. 2009;(4):CD007125.
Handoll HHG, Sherrington C, Mak JCS. Interventions for improving mobility after hip fracture surgery in adults. Cochrane Database Syst Rev. 2011;(3):CD001704.
American College of Sports Medicine. Position stand: progression models in resistance training for healthy adults. Med Sci Sports Exerc. 2002;34:364–80.
Cronin JB, Henderson ME. Maximal strength and power assessment in novice weight trainers. J Strength Cond Res. 2004;18:48–52.
Sinaki M, Canvin JC, Phillips BE, et al. Site specificity of regular health club exercise on muscle strength, fitness, and bone density in women aged 29 to 45 years. Mayo Clin Proc. 2004;79:639–44.
Nachemson A. Lumbar intradiskal pressure: experimental studies on post-mortem material. Acta Orthop Scand. 1960;43(Suppl):1–104.
Sinaki M, Brey R, Hughes C, Larson D, Kaufman K. Balance disorder and increased risk of falls in osteoporosis and kyphosis: significance of kyphotic posture and muscle strength. Osteoporos Int. 2004;16(8):1004–10. doi:10.1007/s00198-004.
Kaplan RS, Sinaki M, Hameister M. Effect of back supports on back strength in patients with osteoporosis: controlled trial. A pilot study. Mayo Clin Proc. 1996;71:235–41.
Tinetti ME, Baker DI, Gottschalk M, et al. Home-based multicomponent rehabilitation program for older persons after hip fracture: a randomized trial. Arch Phys Med Rehabil. 1999;80:916–22.
Sinaki M. Osteoporosis, Chapter 34. In Braddom’s Physical medicine and rehabilitation. 5th edn. Amsterdam: Elsevier; 2016. p. 747–68.
Pfeifer M, Begerow B, Minne HW. Effects of a new spinal orthosis on posture, trunk strength, and quality of life in women with postmenopausal osteoporosis: a randomized trial. Am J Phys Med Rehabil. 2004;83(3):61–6.
Sinaki M, Itoi E, Wahner H, Wollan P, Gelzcer R, Mullan B, Collins D, Hodgson S. Stronger back muscles reduce the incidence of vertebral fracture: a prospective 10-year follow-up of postmenopausal women. Bone. 2002;30(6):836–41.
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Sinaki, M. (2017). Management of Fractures in Osteoporosis: Role of Rehabilitative Measures. In: Sinaki, M., Pfeifer, M. (eds) Non-Pharmacological Management of Osteoporosis. Springer, Cham. https://doi.org/10.1007/978-3-319-54016-0_8
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DOI: https://doi.org/10.1007/978-3-319-54016-0_8
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