Effectiveness of Rehabilitative Intervention on Pain, Postural Balance, and Quality of Life in Women with Multiple Vertebral Fragility Fractures: A Prospective Cohort Study.

Giovanni Iolascon,Antimo Moretti,Francesco Martines,Dalila Scaturro,Valeria Sanfilippo,Giuseppe Messina,Giulia Letizia Mauro,Daniele Cuntrera,Serena Rizzo,Valerio Giustino,Vincenzo Falco

doi:10.3390/jfmk6010024

Abstract

Patients with vertebral fragility fractures often experience chronic pain, postural and balance disorders, and poor quality of life (QoL). Although several studies have investigated the role of rehabilitation in severe osteoporosis, the effectiveness of this intervention in patients with multiple vertebral fractures is poorly known. The aim of our longitudinal cohort study is to evaluate the effectiveness of rehabilitation, including postural training, resistance exercises, and visual stabilization exercises, for a 7-week period, on the pain, postural balance, and QoL of subjects with at least two vertebral fragility fractures receiving denosumab and vitamin D. We investigated, before (T0) and after (T1, at 7 weeks) rehabilitation, the following outcome measures on 28 patients: pain (Numerical Rating Scale (NRS)), self-perceived QoL (36-Item Short Form Survey (SF-36) and Mini-Osteoporosis Quality of Life Questionnaire (Mini-OQOL)), dizziness (Dizziness Handicap Inventory (DHI-I)), mobility (Timed-Up and Go (TUG) test), and instrumental posturographic assessment (FreeMed posturography system). At the end of the treatment, improvements of pain and QoL were recorded. Pain relief was highly obtained in patients with more than two vertebral fractures. Moreover, a significant functional improvement (TUG test) was found in those with two vertebral fractures, without any statistically significant change reported for other outcomes. Our findings suggest that combined intervention, including anti-osteoporotic drugs and postural rehabilitation, should be proposed to osteoporotic patients with multiple vertebral fractures.

Highlights

Osteoporosis is a systemic disease characterized by poor bone quality, reduced bone mass, and an increased risk of fragility fractures [1,2,3,4]
The main clinical complaints associated with these fractures include chronic pain, limited social participation, along with poor quality of life (QoL) [3], less than one-third of patients with vertebral fragility fractures come to medical attention [5]
The aim of our study is to evaluate the effectiveness of rehabilitative intervention on pain, postural balance, and quality of life in postmenopausal women with at least two vertebral fragility fractures being treated with denosumab

Summary

Introduction

Osteoporosis is a systemic disease characterized by poor bone quality, reduced bone mass, and an increased risk of fragility fractures [1,2,3,4]. The main clinical complaints associated with these fractures include chronic pain, limited social participation, along with poor quality of life (QoL) [3], less than one-third of patients with vertebral fragility fractures come to medical attention [5]. These fractures can impair mobility even when asymptomatic [6]

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