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Erschienen in: Current Osteoporosis Reports 3/2016

04.04.2016 | Imaging (T Lang and F Wehrli, Section Editors)

The Role of Trunk Musculature in Osteoporotic Vertebral Fractures: Implications for Prediction, Prevention, and Management

verfasst von: Hossein Mokhtarzadeh, Dennis E. Anderson

Erschienen in: Current Osteoporosis Reports | Ausgabe 3/2016

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Abstract

This review examines the current evidence for associations between vertebral fractures (VFx), the most common type of fracture in older adults, and trunk muscles, which are intimately tied to spinal loading and function. Individuals with prevalent VFxs have more fat infiltration in the trunk muscles, lower trunk extension strength, and altered muscle activation patterns. However, no longitudinal studies have examined whether assessment of trunk muscle can contribute to prediction of fracture risk. A few studies report that exercise interventions targeting the trunk muscles can reduce the risk of VFx, improve trunk strength and endurance in patients who have had a VFx, and reduce the risk of falling, a common cause of VFx, but the quality of evidence is low. Trunk muscles likely have an important role to play in prediction, prevention, and management of VFx, but additional longitudinal studies and randomized controlled trials are needed to clarify this role.
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Zurück zum Zitat Giangregorio LM, Macintyre NJ, Thabane L, Skidmore CJ, Papaioannou A. Exercise for improving outcomes after osteoporotic vertebral fracture (review). Cochrane Collab. 2013;1–50. A systematic review of the benefits and harms of exercise interventions in post-VFx individuals identified seven randomized controlled trials with 488 participants. Five of the seven directly targeted trunk muscles, and while some trials reported beneficial effects of exercise in VFx patients, variability in outcomes prevented much pooling of results. This review notes that overall quality of evidence is low, and that no studies to date have assessed incident falls, incident VFx, or other adverse events. Thus this strongly supports the need for high quality randomized controlled trials to assess the safety and efficacy of exercise for VFx prevention and management. Giangregorio LM, Macintyre NJ, Thabane L, Skidmore CJ, Papaioannou A. Exercise for improving outcomes after osteoporotic vertebral fracture (review). Cochrane Collab. 2013;1–50. A systematic review of the benefits and harms of exercise interventions in post-VFx individuals identified seven randomized controlled trials with 488 participants. Five of the seven directly targeted trunk muscles, and while some trials reported beneficial effects of exercise in VFx patients, variability in outcomes prevented much pooling of results. This review notes that overall quality of evidence is low, and that no studies to date have assessed incident falls, incident VFx, or other adverse events. Thus this strongly supports the need for high quality randomized controlled trials to assess the safety and efficacy of exercise for VFx prevention and management.
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Zurück zum Zitat Pfeifer M, Kohlwey L, Begerow B, Minne HW. Effects of two newly developed spinal orthoses on trunk muscle strength, posture, and quality-of-life in women with postmenopausal osteoporosis: a randomized trial. Am J Phys Med Rehabil. 2011;90(10):805–15.CrossRefPubMed Pfeifer M, Kohlwey L, Begerow B, Minne HW. Effects of two newly developed spinal orthoses on trunk muscle strength, posture, and quality-of-life in women with postmenopausal osteoporosis: a randomized trial. Am J Phys Med Rehabil. 2011;90(10):805–15.CrossRefPubMed
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84.•
Zurück zum Zitat Barker KL, Javaid MK, Newman M, Minns Lowe C, Stallard N, Campbell H, et al. Physiotherapy rehabilitation for osteoporotic vertebral fracture (PROVE): study protocol for a randomized controlled trial. Trials. 2014;15(1):22. This paper presents the protocol for an ongoing RCT of 600 people with clinically diagnosed VFxs to study the effectiveness of exercise-based physiotherapy (including spine extensor and stabilization exercises), a manual therapy-based physiotherapy, or usual care. The primary outcomes will be Quality of Life and trunk muscle endurance (i.e. TLS) test outcomes at 1 year, and importantly incident VFx and falls will also be assessed, providing needed information on safety and whether these interventions may help in VFx prevention.CrossRefPubMedPubMedCentral Barker KL, Javaid MK, Newman M, Minns Lowe C, Stallard N, Campbell H, et al. Physiotherapy rehabilitation for osteoporotic vertebral fracture (PROVE): study protocol for a randomized controlled trial. Trials. 2014;15(1):22. This paper presents the protocol for an ongoing RCT of 600 people with clinically diagnosed VFxs to study the effectiveness of exercise-based physiotherapy (including spine extensor and stabilization exercises), a manual therapy-based physiotherapy, or usual care. The primary outcomes will be Quality of Life and trunk muscle endurance (i.e. TLS) test outcomes at 1 year, and importantly incident VFx and falls will also be assessed, providing needed information on safety and whether these interventions may help in VFx prevention.CrossRefPubMedPubMedCentral
85.•
Zurück zum Zitat Giangregorio LM, Thabane L, Adachi JD, Ashe MC, Bleakney RR, Braun EA, et al. Build better bones with exercise: protocol for a feasibility study of a multicenter randomized controlled trial of 12 months of home exercise in women with a vertebral fracture. Phys Ther. 2014;94(9):1337–52. This paper presents the protocol for a pilot multicenter RCT recruiting 160 women aged ≥65 years with a prevalent VFx, examining the effect of an exercise intervention group compared with controls receiving equal attention but no exercise advice. The intervention involves personalized and progressive exercises (at least three times a week) targeting lower limb strength, balance, posture, upper extremity strength and endurance Trunk extensor muscle endurance (via TLS test) will be assessed at two study sites. Importantly incident VFx and falls will also be assessed, providing needed information on safety and whether the intervention may help in VFx prevention.CrossRefPubMedPubMedCentral Giangregorio LM, Thabane L, Adachi JD, Ashe MC, Bleakney RR, Braun EA, et al. Build better bones with exercise: protocol for a feasibility study of a multicenter randomized controlled trial of 12 months of home exercise in women with a vertebral fracture. Phys Ther. 2014;94(9):1337–52. This paper presents the protocol for a pilot multicenter RCT recruiting 160 women aged ≥65 years with a prevalent VFx, examining the effect of an exercise intervention group compared with controls receiving equal attention but no exercise advice. The intervention involves personalized and progressive exercises (at least three times a week) targeting lower limb strength, balance, posture, upper extremity strength and endurance Trunk extensor muscle endurance (via TLS test) will be assessed at two study sites. Importantly incident VFx and falls will also be assessed, providing needed information on safety and whether the intervention may help in VFx prevention.CrossRefPubMedPubMedCentral
Metadaten
Titel
The Role of Trunk Musculature in Osteoporotic Vertebral Fractures: Implications for Prediction, Prevention, and Management
verfasst von
Hossein Mokhtarzadeh
Dennis E. Anderson
Publikationsdatum
04.04.2016
Verlag
Springer US
Erschienen in
Current Osteoporosis Reports / Ausgabe 3/2016
Print ISSN: 1544-1873
Elektronische ISSN: 1544-2241
DOI
https://doi.org/10.1007/s11914-016-0305-4

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