Non-pharmacological management of osteoporosis: a consensus of the Belgian Bone Club

Abstract

This consensus article reviews the various aspects of the non-pharmacological management of osteoporosis, including the effects of nutriments, physical exercise, lifestyle, fall prevention, and hip protectors. Vertebroplasty is also briefly reviewed. Non-pharmacological management of osteoporosis is a broad concept. It must be viewed as an essential part of the prevention of fractures from childhood through adulthood and the old age. The topic also includes surgical procedures for the treatment of peripheral and vertebral fractures and the post-fracture rehabilitation. The present document is the result of a consensus, based on a systematic review and a critical appraisal of the literature. Diets deficient in calcium, proteins or vitamin D impair skeletal integrity. The effect of other nutriments is less clear, although an excessive consumption of sodium, caffeine, or fibres exerts negative effects on calcium balance. The deleterious effects of tobacco, excessive alcohol consumption and a low BMI are well accepted. Physical activity is of primary importance to reach optimal peak bone mass but, if numerous studies have shown the beneficial effects of various types of exercise on bone mass, fracture data as an endpoint are scanty. Fall prevention strategies are especially efficient in the community setting, but less evidence is available about their effectiveness in preventing fall-related injuries and fractures. The efficacy of hip protectors remains controversial. This is also true for vertebroplasty and kyphoplasty. Several randomized controlled studies had reported a short-term advantage of vertebroplasty over medical treatment for pain relief, but these findings have been questioned by recent sham-controlled randomized clinical studies.

Adherence to a Mediterranean diet and risk of fractures in French older persons

“…The prevention of fractures by modifiable factors including falls prevention and lifestyle, such as 29 physical activity and nutrition, has been well documented in older persons [5][6]. Among dietary 30 factors, much attention has been focused on the beneficial effects of calcium and vitamin D on bone 31 metabolism [7][8].…”

Health Benefits of Exercise

“…Bireyin yaşı ve fonksiyonel kapasitesine uygun vücut ağırlığı ile yapılan aerobik egzersizler, kas kuvvetlendirme egzersizleri (progresif dirençli egzersizler), germe, postüral ve denge egzersizleri başlıca önerilen egzersizlerdir. Egzersizlerin haftada 2-3 kez yapılması ve 15-60 dk aerobik egzersizleri ve 1 set dirençli egzersizleri içerme-si, egzersiz şiddetinin de fonksiyonel kapasitenin veya maksimal gücün %70-80'inde olması önerilmektedir (56).…”

“…Osteoporozlu hastalara dirençli egzersizler özellikle bölge spesifik hedef alanlara; kalça, kuadriseps, el bilek ekstansörleri ve sırt ekstansörleri önerilir. Tüm hastalarda egzersiz programlarına kolay seviyeden başlanmalı ve şiddet ve darbe düzeyi arttırılmalıdır (56).…”

Male osteoporosis: A review

“…Falls are a major risk factor in patients with osteoporosis. In relation to this, fall prevention programs have also proved to be very effective [101][102][103][104][105][106] .…”