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Would the first fragility fracture be the last one - a physiotherapeutic perspective

Ann-Charlotte Grahn Kronhed

RehabVäst Vadstena, Local Health Care Services in the West of Östergötland, Sweden

Social Medicine and Public Health Science, Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, Sweden

E-mail : bhuvaneswari.bibleraaj@uhsm.nhs.uk

DOI: 10.15761/PMRR.1000143

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Osteoporosis and fragility fractures are major world-wide public health problems [1]. Osteoporosis is defined as “a disease characterized by low bone mass and microarchitectural deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risk” [2]. Osteoporosis is known as the silent disease because there are no apparent early symptoms. For most people, the first indication that they have osteoporosis is a fracture or maybe severe back pain caused by a vertebral compression fracture [3]. An osteoporotic fracture is usually caused by a mild to moderate trauma such as a fall from standing height or less. However, osteoporotic vertebral compression fractures may also occur after lifting an object or bending forward [4]. The International Osteoporosis Foundation (IOF) believes that the prevention of a secondary fracture is the single most important thing that can be done to directly improve patient care and reduce increasing fracture related healthcare costs worldwide. IOF:s Capture the Fracture® (http://capturethefracture.org/) is a global campaign to facilitate the implementation of coordinated, multi-disciplinary models of care for secondary fracture prevention. Fracture Liaison Services (FLS) are these coordinator-based secondary fracture prevention services implemented by health care systems for the treatment of osteoporotic patients [5].

The 10-year fracture probability of a hip or a major osteoporotic fracture in persons aged 40-90 years may be calculated by the FRAX® tool (https://www.shef.ac.uk/FRAX/), which integrates the weight of patient-derived clinical risk factors, with or without the inclusion of femoral neck bone mineral density (BMD). The introduction of FRAX® into physiotherapist practice is a rather new activity that should be highlighted. A prior clinical low-energy vertebral fracture or a hip fracture is an especially strong risk factor for achieving another osteoporotic fracture. Women with preexisting vertebral fractures have approximately four times greater risk of subsequent vertebral fractures than those without prior fractures and the risk increases with the number of prior vertebral fractures [3]. However, fracture probability may be underestimated as the FRAX questionnaire asks for any previous fracture in adult life. Fracture probability is also underestimated with multiple fractures. Other fracture risk factors such as physical inactivity, propensity to fall and height loss since young adulthood (severe height loss may indicate vertebral fractures) are not either included in the FRAX algorithm model and thus should be asked for by the physiotherapist [6]. A fall is defined by the Prevention of Falls Network Europe (ProFaNE) as an unexpected event in which a person comes to rest on the ground, floor, or lower level. A person should be asked, ‘‘In the past month, have you had any fall including a slip or trip in which you lost your balance and landed on the floor or ground or lower level?” [7]. Balance performance, in specific the ability to stand on one leg with the eyes open, is age-related and deteriorates after the age of 60 years [8]. Elderly women who did not manage to stand 10 seconds on one leg with the eyes open had an almost three-fold higher age-adjusted risk of hip fracture compared to those who managed this [9]. Women with osteoporosis often have weak back extensor muscles and also increased thoracic kyphosis that may influence balance performance [10]. The presence of osteoporotic vertebral fracture usually means worse health-related quality of life and pain [11,12].

Supervised individually tailored multicomponent exercise training program with progressive resistance training for all major muscle groups at least two times per week combined with 15-20 min daily balance exercises should be included in training programs for people with osteoporosis or osteoporotic fractures to prevent future falls and fractures [13,14]. Advice on fall prevention measures should also be communicated by the physiotherapist [15].

References

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  2. (1991) Consensus development conference: prophylaxis and treatment of osteoporosis. Am J Med 90: 107-110. [Crossref]
  3. Klotzbuecher CM, Ross PD, Landsman PB, Abbott III TA, Berge M (2000) Patients with prior fractures have an increased risk of future fractures: A summary of the literature and statistical synthesis. J Bone Miner Res 15: 721-739. [Crossref]
  4. Mundy G (1998) Bone remodeling and mechanisms of bone loss in osteoporosis. In: Meunier P (Ed.), Osteoporosis: diagnosis and management. London: Martin Dunitz Ltd; 17-35.
  5. Javaid MK, Kyer C, Mitchell PJ, Chana J, Moss C, et al. (2015) Effective secondary fracture prevention: implementation of a global benchmarking of clinical quality using the IOF Capture the Fracture® Best Practice Framework tool. Osteoporos Int 26: 2573-2578. [Crossref]
  6. Perry S, Downey PA (2012) Fracture risk and prevention: a multidimensional approach. Phys Ther 92: 164-178. [Crossref]
  7. Lamb S, Jørstad-Stien E, Hauer K, Becker C on behalf of the Prevention Falls Network Europe and Outcomes Consensus Group (2005) Development of a common outcome data set for fall injury prevention trials: the Prevention of Falls Network Europe consensus. J Am Geriatr Soc 53: 1618-1622. [Crossref]
  8. Bohannon RW (2006) Single limb stance times: a descriptive meta-analysis of data from individuals at least 60 years of age. Topics Ger Rehab 22: 70–77.
  9. Lundin H, Sääf M, Strender LE, Nyren S, Johansson SE, et al. (2014) One-leg standing time and hip-fracture prediction. Osteoporos Int 25: 1305-1311. [Crossref]
  10. Sinaki M, Brey RH, Hughes CA, Larson DR, Kaufman KR (2005) Balance disorder and increased risk of falls in osteoporosis and kyphosis: significance of kyphotic posture and muscle strength. Osteoporos Int 16: 1004-1010. [Crossref]
  11. Oleksik A, Lips P, Dawson A, Minshall ME, Shen W, et al. (2000) Health-related quality of life in postmenopausal women with low BMD with or without prevalent vertebral fractures. J Bone Miner Res 15: 1384-1392. [Crossref]
  12. Francis R, Aspray TJ, Hide G, Sutcliffe AM, Wilkinson P (2008) Back pain in osteoporotic vertebral fractures. Osteoporos Int 19: 895-903.
  13. Giangregorio LM, Papaioannou A, MacIntyre NJ, Ashe MC, Heinonen A, et al. (2014) Too fit to fracture: exercise recommendations for individuals with osteoporosis or osteoporotic vertebral fracture. Osteoporos Int 25: 821-835. [Crossref]
  14. Grahn Kronhed A (2017) Effects of physical activity in postmenopausal women with primary osteoporosis: a review. In: Advances in Osteoporosis. Hyderabad. Avid Science.
  15. Karlsson MK, Magnusson H, von Schewelov T, Rosengren BE (2013) Prevention of falls in the elderly--a review. Osteoporos Int 24: 747-762. [Crossref]

Editorial Information

Editor-in-Chief

Martin Grabois
Baylor College of Medicine

Article Type

Editorial

Publication history

Received date: April 24, 2017
Accepted date: May 18, 2017
Published date: May 22, 2017

Copyright

© 2017 Grahn Kronhed AC. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Citation

Grahn Kronhed AC (2017) Would the first fragility fracture be the last one - a physiotherapeutic perspective. Phys Med Rehabil Res 2: DOI: 10.15761/PMRR.1000143

Corresponding author

Ann-Charlotte Grahn Kronhed

Social Medicine and Public Health Science, Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, Sweden

E-mail : bhuvaneswari.bibleraaj@uhsm.nhs.uk

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