Jethwa Jawahar Tulsidas
Orthopaedics Department, Narendra Modi Medical College, Nr. Rambaug, Opp. Fire Station, Maninagar, Ahmedabad, 380 008 India.
135, Nandanbaug Society, Chapter 30 B, 135, Behind Applewoods Township, Shela, Ahmedabad, Gujarat 380058 India.
Indian J Orthop. 2023 Nov 30;57(Suppl 1):260-266. doi: 10.1007/s43465-023-01072-5. eCollection 2023 Dec.
Although it has long been believed that stress has a detrimental effect on health and the risk of disease, little research has been done on the precise mechanisms by which this happens. The literature produced by past workers suggests many possibly intersecting mechanistic pathways that might be useful for future fundamental and clinical study. Exercise has been thoroughly researched as a non-pharmacologic strategy to increase bone mass. Many evidence-based treatment recommendations for patients suffering from osteoporosis-related fractures, potential courses of care, and rehabilitation concur that multidisciplinary therapy would be the most beneficial.
Older and recent articles about musculoskeletal and psychological rehabilitation in the management of osteoporosis published in prominent and reputed journals are reviewed. Important and interesting information from some of the cross-references is also included. Opinions and impressions from the experience of treating osteoporosis are added while describing various aspects of psychological and physical rehabilitation.
The recent evidence, reviewed here, also indicates the possibility of cross-effects between osteoporosis and psychological issues. A multi-factorial and personalised strategy should be explored for improved outcomes in patients under psychological stress, particularly those at increased risk of osteoporosis development. Reviewing current publications, the objectives of rehabilitation are evolving based on the disease's stage. For example, during the initial stage of a vertebral body collapse, the patient is treated with bracing, physical therapy, education, local and systemic analgesics, and a brief period of bed rest. The need to mobilise the patient carefully and safely along with a mix of medical care, dietary supplements, rehabilitation, and instructions to facilitate daily living activities, are endorsed to manage post-fracture osteoporosis.
This chapter is not to make treatment advice, but rather to outline potential connections between psychological stress and low bone density and to emphasise potential multi-system consequences of pharmaceutical therapies. The goal is to enhance activities of daily living, which will increase safety, minimise falls, and maintain bone mass. Osteoporosis and fragility fractures can be prevented and managed with regular medical check-ups, daily exercise and yoga, a healthy diet, fall prevention measures, recreational group activities, supportive medications, control of comorbidities, use of assistive devices, and customised rehabilitation programmes.
尽管长期以来人们一直认为压力会对健康和疾病风险产生不利影响,但对于压力产生这种影响的确切机制却鲜有研究。过去研究人员发表的文献表明,存在许多可能相互交叉的机制途径,这可能对未来的基础研究和临床研究有所帮助。运动作为一种增加骨量的非药物策略,已经得到了充分研究。许多针对骨质疏松相关骨折患者的循证治疗建议、潜在的护理方案和康复措施都一致认为,多学科治疗将最为有益。
回顾了在著名期刊上发表的有关骨质疏松管理中肌肉骨骼和心理康复的近期及早期文章。还纳入了一些交叉参考文献中的重要且有趣的信息。在描述心理和身体康复的各个方面时,补充了治疗骨质疏松经验中的观点和印象。
本文回顾的最新证据也表明骨质疏松与心理问题之间存在交叉影响的可能性。对于处于心理压力下的患者,尤其是那些骨质疏松发病风险增加的患者,应探索多因素和个性化的策略以改善治疗效果。回顾当前的出版物,康复目标正根据疾病阶段不断演变。例如,在椎体塌陷的初始阶段,对患者进行支具治疗、物理治疗、健康教育、局部和全身镇痛,并进行短时间卧床休息。为了管理骨折后骨质疏松,需要谨慎且安全地动员患者,并结合医疗护理、膳食补充剂、康复治疗以及指导以促进日常生活活动。
本章并非提供治疗建议,而是概述心理压力与低骨密度之间的潜在联系,并强调药物治疗可能产生的多系统后果。目标是增强日常生活活动能力,这将提高安全性、减少跌倒并维持骨量。通过定期体检、日常锻炼和瑜伽、健康饮食、预防跌倒措施、娱乐性团体活动、支持性药物治疗、控制合并症、使用辅助设备以及定制康复计划,可以预防和管理骨质疏松及脆性骨折。