The Role of Exercise in the Prevention and Treatment of Compression Fractures

Abstract

To the Editor: We read with interest the excellent review article on osteoporosis by Mauck and Clarke1Mauck KF Clarke BL Diagnosis, screening, prevention, and treatment of Oosteoporosis.Mayo Clin Proc. 2006; 81: 662-672Abstract Full Text Full Text PDF PubMed Scopus (119) Google Scholar in the May 2006 issue of Mayo Clinic Proceedings, which summarized current strategies for the diagnosis, screening, prevention, and treatment of this disorder. However, we found one area that we believe deserves further elaboration—the role of exercise in the prevention and treatment of osteoporotic compression fractures. In their article, Mauck and Clarke reported that “weight-bearing exercise appears to be effective in maintaining or increasing bone density at the lumbar spine and hip in postmenopausal women, but currently, no evidence suggests that it decreases fractures.” They referenced the report by Bonaiuti et al2Bonaiuti D Shea B Iovine R et al.Exercise for preventing and treating osteoporosis in postmenopausal women?.Cochrane Database Syst Rev. 2002; 3 (CD000333)PubMed Google Scholar in the 2002 Cochrane Database of Systematic Reviews, which included studies up to 2000. However, since that time evidence has accumulated that substantiates the use of targeted back extensor-strengthening (BES) exercise to reduce the risk of vertebral compression fractures in the postmenopausal population. For example, in 2002, Sinaki et al3Sinaki M Itoi E Wahner HW et al.Stronger back muscles reduce the incidence of vertebral fractures: a prospective 10 year follow-up of postmenopausal women.Bone. 2002; 30: 836-841Abstract Full Text Full Text PDF PubMed Scopus (312) Google Scholar published the results of a prospective 10-year follow-up study showing a statistically significant reduction in vertebral compression fractures in a group of women who had participated in BES exercises compared to a control group of women who did not participate in such an exercise program (Figure 1). Stronger back extensors reduced the risk of vertebral fractures by 3-fold with no specific pharmacotherapy. In 2003, Turner and Robling4Turner CH Robling AG Designing exercise regimens to increase bone strength.Exerc Sport Sci Rev. 2003; 31: 45-50Crossref PubMed Scopus (336) Google Scholar noted that regular exercise can “effectively reduce fracture risk” while increasing bone strength. Pfeifer et al5Pfeifer M Sinaki M Geusens P Boonen S Preisinger E Minne HW ASBMR Working Group on Musculoskeletal Rehabilitation Musculoskeletal rehabilitation in osteoporosis: a review.J Bone Miner Res. 2004 Aug; 19 (Epub 2004 May 10.): 1208-1214Crossref PubMed Scopus (103) Google Scholar reviewed the literature in 2004 and concluded that exercise was associated with reduced risk of hip fracture. In a recent pilot study of the effects of BES exercise and refracture rates after vertebroplasty, we found not only a decreased refracture rate but an increased fracture-free interval when BES exercise was included.6Schmidt C Huntoon E Sinaki M Strategies to decrease risk of vertebral refracture with and without vertebroplasty through rehabilitation [abstract].Osteoporos Int. 2006; 17 (Abstract P196.): S47-S48Google Scholar Bone mineral density accounts for less than 50% of fracture risk; the remaining risk depends on other factors such as muscle strength and risk of falls. Thus, given the safety of an appropriately designed exercise program in this population, we believe that targeted BES exercise should be considered for fracture prevention and as a treatment option for all osteoporotic individuals. The Role of Exercise in the Prevention and Treatment of Compression Fractures–Reply–IMayo Clinic ProceedingsVol. 81Issue 10PreviewWe thank Drs Huntoon and Sinaki for their comments regarding the statement about weight-bearing exercise in our recent article in the Proceedings. We agree that it is important to address muscle strength and fall risk in osteoporotic individuals and just as important to consider an appropriate exercise program for such patients. Intuitively, targeted BES exercises would increase balance and decrease the risk of falls, thereby potentially decreasing the incidence of subsequent fractures. However, the data that Huntoon and Sinaki present may not be substantial enough to recommend that all osteoporotic individuals participate in a program of targeted BES exercises for the purpose of fracture prevention. Full-Text PDF