Abstract
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 (n = 40) and a standard care control group (n = 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; g2/cm4), total volumetric BMD (vBMDTOT; mg/cm3), and total area (CSATOT; mm2), as well as midtibia (55%) strength–strain index (SSI; mm3), cortical vBMD (vBMDCO; mg/cm3), and ratio of cortical to total area (CSACO/CSATOT) 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, vBMDTOT of the fractured side, and CSATOT of the nonfractured side decreased significantly over time in both groups 0.7% to 3.1% (12 months, p < 0.05). At the midshaft site, CSACO/CSATOT and SSI of both legs, and vBMDCO of the fractured leg, decreased significantly over time in both groups 1.1% to 1.9% (12 months, p < 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. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.
Highlights
IntroductionThe substantial and long-term decline in bone properties that occurs after hip fracture[1,2,3,4,5] markedly increases the risk for a second fracture.[6,7] In the contralateral hip, as measured by DXA, the loss of bone density, structure, and strength over the year after fracture far exceeds the decrements from normal aging, in both men and women.[1,3,4,5] Cross-sectional studies using peripheral 3D-imaging modalities have revealed marked impairments in tibial properties on both the fractured and nonfractured sides.[2,8] These reductions were most evident in bone geometric properties[2,8] and correlated with hip BMD measured by DXA.[8]
Most of the previous studies have, focused on relatively healthy populations, whereas only a few studies have been performed in the frail elderly,(12–14) and even fewer in hip fracture patients.[15,16] the findings from the limited number of trials examining the effects of exercise on bone structure, strength, and volumetric density in older people are conflicting[17,18,19,20,21,22] and no studies involving 3D bone characterization have been conducted in hip fracture patients or subjects comparable to them
No intervention effect was observed in the distal tibia or midtibial bone traits (Supplemental Tables S1 and S2). This 12-month home-based physical rehabilitation program on mobility recovery had no effect on the distal tibia or tibial midshaft bone traits of community-dwelling men and women over age 60 years recovering from a hip fracture
Summary
The substantial and long-term decline in bone properties that occurs after hip fracture[1,2,3,4,5] markedly increases the risk for a second fracture.[6,7] In the contralateral hip, as measured by DXA, the loss of bone density, structure, and strength over the year after fracture far exceeds the decrements from normal aging, in both men and women.[1,3,4,5] Cross-sectional studies using peripheral 3D-imaging modalities have revealed marked impairments in tibial properties on both the fractured and nonfractured sides.[2,8] These reductions were most evident in bone geometric properties[2,8] and correlated with hip BMD measured by DXA.[8]. Most of the previous studies have, focused on relatively healthy populations, whereas only a few studies have been performed in the frail elderly,(12–14) and even fewer in hip fracture patients.[15,16] the findings from the limited number of trials examining the effects of exercise on bone structure, strength, and volumetric density (vBMD) in older people are conflicting[17,18,19,20,21,22] and no studies involving 3D bone characterization have been conducted in hip fracture patients or subjects comparable to them It is currently unclear whether fragile bones, such as those in older hip fracture patients, are able to adapt to increased loading. We hypothesized that a 12-month home-based physical rehabilitation program, including weight-bearing exercises, would be feasible and effective in reducing postfractural losses in tibial bone density, structure, and strength in older people recovering from a recent hip fracture
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