Exercise for Improving Outcomes After Osteoporotic Vertebral Fracture

Throughout life old bone is replaced by new bone in similar quantities but in someone with osteoporosis this is not the case. Old bone is removed faster than new bone being created making the persons bones weaker and more likely to break. These breaks can be traumatic with minimal force which are called fragility fractures or silent which are often called insufficiency fractures and can occur during normal activity without trauma. The most common sites for fragility fractures are the wrist, hip and vertebrae and symptoms include impaired mobility, pain, deformity, sleep disturbance, depression and fear of falling and partaking in normal activity.

The management of osteoporosis involves medication, lifestyle changes and exercise. We know exercise helps preserve bone density and improves mobility and quality of life but for vertebral fractures the emphasis is on postural correction and modified trunk and lower extremity muscle strengthening exercises with the goal of regaining or maintaining normal spine curvatures, increasing spine stability and improving functional movement and mobility while avoiding postures and physical activities that may increase the risk of fracture.

That being said the evidence based clinical practice guidelines for exercise prescription for people with osteoporotic vertebral fractures are lacking. A systematic review in 2010 demonstrated this lack of evidence and since then new trials have been published therefore this new Cochrane review was performed to identify new gaps in knowledge and update clinical practice guidelines.

Implications for Practice

Overall there was low quality in the body of evidence and the RCTs included (n=7) were diverse in their aims and outcomes including some contradictory findings so definitive conclusions cannot be made and therefore caution needs to be taken when applying findings to clinical settings. There appears to be a consensus that back extensor weakness is an impairment worth targeting in exercise training along with lower limb strengthening. Individual trials did show some improvements in pain, physical function and quality of life.

It is not appropriate to generalise results of exercise studies across the topic of vertebral fractures as there can be numerous causes and this can be easily seen in postmenopausal populations vs frail elderly populations; exercise intensity and safety will differ greatly. Therefore in future cohorting this patients in research may be a suitable options to consider. What is clearly evident from this systematic review is that large RCTs are required to ascertain any certainties.