Winkelmann A, Schilling S, Neuerburg C, Mutschler W, Böcker W, Felsenberg D, Stumpf U
Klinik und Poliklinik für Orthopädie, Physikalische Medizin und Rehabilitation, Osteologisches Schwerpunktzentrum (DVO), Klinikum der LMU, München, Campus Innenstadt, München, Deutschland.
Klinik für Allgemeine, Unfall-, Hand- und Plastische Chirurgie, Osteologisches Schwerpunktzentrum (DVO), Klinikum der LMU München, Campus Innenstadt, Nussbaumstrasse 20, 80336, München, Deutschland.
Unfallchirurg. 2015 Nov;118(11):933-7. doi: 10.1007/s00113-015-0080-1.
In the prevention and treatment of osteoporosis, movement with muscle strengthening and proprioceptive training plays a major role. This was taken into consideration in the guidelines by the governing body on osteoporosis (Dachverband Osteoporose, DVO) from 2014 on prophylaxis, diagnosis and treatment of osteoporosis and in the DVO guidelines from 2008 on physiotherapy and exercise therapy for osteoporosis. Increases in lumbar bone density of between 0.5 % and 2.5 % can be achieved in women by strengthening exercises with high resistance. With this combination and strengthening of the quadriceps muscle a reduction of falls and hence the fracture risk could also be achieved. In traumatology, training for muscle strengthening is not always possible, especially for elderly patients. Practically relevant alternatives are regular walking and aquatraining, which may also lead to a significant increase in bone mineral density. Furthermore, large effects can be achieved with alternating side whole-body vibration (WBV) training with whole body vibration plates with only 3 days of training per week and with short training periods (15-20 min). Rates of increase in leg strength between 20 % and almost 40 % and in bone density between 0.5 % and 4 % in 6 months have been described. Whether and with what intensity whole body vibration therapy could be used for e.g. more rapid healing of fractures, is currently unclear. Initial positive results have been described in animal models.
在骨质疏松症的预防和治疗中，肌肉强化和本体感觉训练的运动起着主要作用。2014年骨质疏松症防治机构（德国骨质疏松症协会，DVO）关于骨质疏松症预防、诊断和治疗的指南以及2008年DVO关于骨质疏松症物理治疗和运动疗法的指南都考虑到了这一点。通过高强度抗阻运动，女性腰椎骨密度可提高0.5%至2.5%。通过这种组合以及股四头肌的强化，还可以降低跌倒风险，从而降低骨折风险。在创伤学中，尤其是对老年患者而言，并非总能进行肌肉强化训练。实际可行的替代方法是定期散步和水中训练，这也可能导致骨矿物质密度显著增加。此外，每周仅进行3天训练且训练时间较短（15 - 20分钟）的交替侧全身振动（WBV）训练，使用全身振动板，也能取得显著效果。已有报道称，6个月内腿部力量增加20%至近40%，骨密度增加0.5%至4%。目前尚不清楚全身振动疗法是否以及以何种强度可用于例如骨折的更快愈合。动物模型中已报道了初步的积极结果。
