The importance of physical function to people with osteoporosis

Abstract

SummaryThere is increasing need to understand patient outcomes in osteoporosis. This article discusses that fracture in osteoporosis can lead to a cycle of impairment, driven by complex psychosocial factors, having a profound impact on physical function/activity which accumulates over time. More information is required on how treatments impact physical function.IntroductionThere is increasing need to understand patient-centred outcomes in osteoporosis (OP) clinical research and management. This multi-method paper provides insight on the effect of OP on patients’ physical function and everyday activity.MethodsData were collected from three sources: (1) targeted literature review on OP and physical function, conducted in MEDLINE, Embase and PsycINFO; (2) secondary thematic analysis of transcripts from patient interviews, conducted to develop a patient-reported outcome instrument. Transcripts were re-coded to focus on OP impact on daily activities and physical function for those with and without fracture history; and (3) discussions of the literature review and secondary qualitative analysis results with three clinical experts to review and interpret the importance and implications of the findings.ResultsResults suggest that OP, particularly with fracture, can have profound impacts on physical function/activity. These impacts accumulate over time through a cycle of impairment, as fracture leads to longer term detriments in physical function, including loss of muscle, activity avoidance and reduced physical capacity, which in turn leads to greater risk of fracture and potential for further physical restrictions. The cycle of impairment is complex, as other physical, psychosocial and treatment-related factors, such as comorbidities, fears and beliefs about physical activity and fracture risk influence physical function and everyday activity.ConclusionMore information on how treatments impact physical function would benefit healthcare professionals and persons with OP in making treatment decisions and improving treatment compliance/persistence, as these impacts may be more salient to patients than fracture incidence.Electronic supplementary materialThe online version of this article (doi:10.1007/s00198-017-3911-9) contains supplementary material, which is available to authorized users.

Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition

“…• Strongly consider referring patients to physical and/or occupational therapists or a physiatrist for evaluation and interventions to improve impairments in mobility, gait, and balance and to reduce fall risk. (60) Because front-line clinicians are often already overextended and are not generally trained in exercise modalities, (61) the coalition recommends that they consider referring patients at potential high risk for falls to physical or occupational therapists or to physiatrists for evaluation and intervention. Although the association between fall risk and FRIDs is clear and it would seem logical that minimizing FRID use would reduce falls and therefore fractures, the evidence demonstrating this effect is not robust.…”

“…(103) Clinical guidelines are also united with respect to the importance of recommending exercise for patients with osteoporosis. (21,61) For example, activities that involve forward spine flexion and rotation, side bending, or heavy weights should be approached cautiously because they generate compressive and torsional forces on vertebrae that can result in fracture. (105)(106)(107)(108)(109) Exercises that focus on balance and trunk muscle strength may be even more effective at preventing falls.…”

“…(104) Regular weight-bearing and strength-training exercise can lead to improvements in bone mineral density and also decrease the risk of falls. (20,61) Although available clinical guidelines are well aligned in terms of types of exercise they advise, they often do not include information about exercise dosage, progression, or contraindications. (20) Exercise recommendations must be tailored to the individual patient, considering their needs, limitations, and preferences, among other factors, including safety.…”

Osteoporosis School in Primary Health Care-A Pilot Study

“…Osteoporosis and fracture may have a profound impact on physical function and everyday activity. Thus, healthcare professionals and persons with osteoporosis would benefit from more information on how treatments impact patients' physical function and everyday activity, to optimise treatment decisions and to improve compliance and persistence with treatment to prevent future fractures [52].…”

Novel calcitonin gene‐related peptide/chitosan‐strontium‐calcium phosphate cement: Enhanced proliferation of human umbilical vein endothelial cells in vitro

“…An environment with a poor blood supply, poor bone quality, slow bone repair as well as other adverse factors is observed in most patients with osteoporosis. Currently, bone cement, often a synthetic polymer (commonly polymethyl methacrylate [PMMA]), is used in clinical treatment for such severe bone injury . However, there remain some shortcomings with bone cement, including slow degradation and lack of biological activity, which greatly weakens its clinical application.…”