Suominen Tuuli H, Edgren Johanna, Salpakoski Anu, Arkela Marja, Kallinen Mauri, Cervinka Tomas, Rantalainen Timo, Törmäkangas Timo, Heinonen Ari, Sipilä Sarianna
Gerontology Research Center Faculty of Sport and Health Sciences University of Jyväskylä Jyväskylä Finland.
Rehabilitation Center Peurunka Laukaa Finland.
JBMR Plus. 2019 Mar 6;3(6):e10175. doi: 10.1002/jbm4.10175. eCollection 2019 Jun.
Weight-bearing physical activity may decrease or prevent bone deterioration after hip fracture. This study investigated the effects of a home-based physical rehabilitation program on tibial bone traits in older hip fracture patients. A population-based clinical sample of men and women operated for hip fracture (mean age 80 years, 78% women) was randomly assigned into an intervention (= 40) and a standard care control group (= 41) on average 10 weeks postfracture. The intervention group participated in a 12-month home-based rehabilitation intervention, including evaluation and modification of environmental hazards, guidance for safe walking, nonpharmacological pain management, motivational physical activity counseling, and a progressive, weight-bearing home exercise program comprising strengthening exercises for the lower legs, balance training, functional exercises, and stretching. All participants received standard care. Distal tibia (5% proximal to the distal end plate) compressive bone strength index (BSI; g/cm), total volumetric BMD (vBMD; mg/cm), and total area (CSA; mm), as well as midtibia (55%) strength-strain index (SSI; mm), cortical vBMD (vBMD; mg/cm), and ratio of cortical to total area (CSA/CSA were assessed in both legs by pQCT at baseline and at 3, 6, and 12 months. The intervention had no effect (group × time) on either the distal or midtibial bone traits. At the distal site, BSI of both legs, vBMD of the fractured side, and CSA of the nonfractured side decreased significantly over time in both groups 0.7% to 3.1% (12 months, < 0.05). At the midshaft site, CSA/CSA and SSI of both legs, and vBMD of the fractured leg, decreased significantly over time in both groups 1.1% to 1.9% (12 months, < 0.05). Trabecular and cortical bone traits of the tibia on the fractured and the nonfractured side deteriorated throughout follow-up. The home-based physical rehabilitation intervention aimed at promoting mobility recovery was unable to prevent bone deterioration in older people after hip fracture. © 2019 The Authors. published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.
负重体育活动可能会减少或预防髋部骨折后的骨质恶化。本研究调查了一项基于家庭的物理康复计划对老年髋部骨折患者胫骨骨特征的影响。以人群为基础的髋部骨折手术患者（平均年龄80岁，78%为女性）临床样本在骨折后平均10周被随机分为干预组（=40）和标准护理对照组（=41）。干预组参与了一项为期12个月的基于家庭的康复干预，包括评估和修改环境危险因素、安全行走指导、非药物疼痛管理、激励性体育活动咨询，以及一个渐进的负重家庭锻炼计划，包括小腿强化锻炼、平衡训练、功能锻炼和伸展运动。所有参与者均接受标准护理。在基线、3个月、6个月和12个月时，通过外周定量计算机断层扫描（pQCT）评估双腿的胫骨干骺端（远端终板近端5%）抗压骨强度指数（BSI；g/cm）、总体积骨密度（vBMD；mg/cm）和总面积（CSA；mm），以及胫骨中段（55%）的强度应变指数（SSI；mm）、皮质骨vBMD（vBMD；mg/cm）和皮质面积与总面积之比（CSA/CSA）。干预对胫骨干骺端或胫骨中段的骨特征均无影响（组×时间）。在远端部位，两组双腿的BSI、骨折侧的vBMD和非骨折侧的CSA均随时间显著下降0.7%至3.1%（12个月，P<0.05）。在胫骨中段部位，两组双腿的CSA/CSA和SSI以及骨折腿的vBMD均随时间显著下降1.1%至1.9%（12个月，P<0.05）。在整个随访过程中，骨折侧和非骨折侧胫骨的小梁骨和皮质骨特征均恶化。旨在促进活动恢复的基于家庭的物理康复干预无法预防老年人髋部骨折后的骨质恶化。©2019作者。由Wiley Periodicals, Inc.代表美国骨与矿物质研究学会出版。
