Effects of Osteoporosis Specific Standardized Physical Therapy on Functional Capacity, Bone Mineral Density and Bone Metabolism – a 2-Year Prospective and Randomized Study

 

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Abstract

Purpose: Patients with osteoporosis inherit a high risk for pathologic fractures as consequence from falling due to deficits in coordination, balance, muscle strength and endurance. It is believed that a specific training can avoid these complications. Therefore the effects of osteoporosis specific physiotherapy (OSP) on functional capacity, bone mineral density (BMD) and bone metabolism were evaluated in a real-life long-term setting.

Methods: 42 patients with manifest osteoporosis receiving adequate calcium and vitamin D supplementation and bisphosphonate therapy were included. 25 patients underwent OSP once a week (exercise group – EG) and were compared to 17 patients without OSP (control group – CG). Outcome parameters at baseline and after 1 and 2 years included assessments of functional capacity and pain as well as BMD and specific markers of bone metabolism (serum osteocalcin and crosslaps).

Results: Functional capacities improved significantly only in the EG, a significant pain reduction occurred only in the EG as well. Furthermore the EG demonstrated a significant increase in BMD of the right femur after 2 years (0.84±0.10 g/cm²) as compared to baseline (0.81±0.12 g/cm²) (p<0.02). Moreover a significant amelioration of bone metabolism could be demonstrated only in the EG.

Conclusions: This is the first study to show that standardized osteoporosis-specific physiotherapy once weekly results in significant protective effects on functional capacity, bone mineral density and bone metabolism, which is accompanied by a reduced risk of falling in patients with osteoporosis under adequate osteoprotective medical treatment. It needs to be emphasized that even a once-weekly exercise is sufficient to sustain these positive effects.

Zusammenfassung

Fragestellung: Patienten mit Osteoporose unterliegen einem erhöhen Risiko für pathologische Frakturen nach Sturzereignis aufgrund von Einschränkungen in Koordination, Balance, Muskelkraft und Ausdauervermögen. Es wird vermutet, dass ein spezifisches Training zur Vermeidung dieser Komplikationen beitragen kann. In der vorliegenden Studie wurden daher die Auswirkungen einer osteoporosespezifischen Physiotherapie (OSP) auf funktionelle Parameter, die Knochenmineraldichte (BMD) und den Knochenstoffwechsel untersucht.

Material und Methoden: Eingeschlossen wurden 42 Patienten mit manifester Osteoporose unter adäquater Kalzium- und Vitamin D-Supplementation, sowie Bisphosphonat-Therapie. 25 Patienten erhielten 1 × wöchentlich eine OSP (exercise group – EG) und wurden mit 17 Patienten ohne OSP (control group – CG) verglichen. Die Outcome-Parameter wurden zu Beginn der Studie, sowie nach einem und 2 Jahren erhoben und beinhalteten Assessments zur funktionalen Kapazität, Messung der Knochendichte und Bestimmung spezifischer laborchemischer Marker des Knochenstoffwechsels (Serum-Osteocalcin und CrossLaps).

Ergebnisse: Eine signifikante Verbesserung der Funktionsparameter und eine signifikante Schmerzreduktion zeigte sich nur in der EG. Ferner konnte in der EG ein signifikanter Anstieg der BMD nach 2 Jahren (0.84±0.10 g/cm²) im Vergleich zu Baseline (0.81±0.12 g/cm²) (p<0.02) objektiviert werden. Eine positive Beeinflussung des Knochenstoffwechsels in Richtung Knochenaufbau konnte ebenfalls nur für die EG belegt werden.

Diskussion und Schlussfolgerung: Die vorliegende Arbeit zeigt erstmalig, dass eine standardisierte osteoporosespezifische Physiotherapie bei Patienten mit manifester Osteoporose unter adäquater osteoprotektiver medikamentöser Therapie zu signifikanten Verbesserungen der funktionellen Parameter, der Knochendichte und des Knochenstoffwechsels führt, was mit einem verminderten Sturz- und Frakturrisiko einhergeht. Hierbei muss besonders betont werden, dass ein lediglich 1x wöchentlich durchgeführtes Trainingsprogramm ausreicht, um diese positiven Effekte zu induzieren.

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