Physical Rehabilitation of the Osteoporotic Patient
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0092-861 5/97 Copyright 0 1997 Drug Informarion Association Inc.
PHYSICAL REHABILITATION OF THE OSTEOPOROTIC PATIENT AMYFITZSIMMONS, MD Assistant Residency Director. Physical Medicine and Rehabilitation, Graduate Hospital, Philadelphia, Pennsylvania
Osteoporosis is a national epidemic. This paper provides an overview of osteoporosis, then details a physical rehabilitation program which uses a team approach to help patients prevent the disease for patients at risk and enhancefirnction, decrease pain, and reduce or eliminate disability for those with osteoporosis. Key Words: Osteoporosis; Rehabilitation medicine; Team approach
OSTEOPOROSIS IS A NATIONAL epidemic. It leads to 1.5 million fractures annually at a cost of $10 billion dollars. It effects more than 25 million people, who either have it or are at risk for it due to low bone mass. More than 80% of these people are women. Hip fractures alone increase the mortality 12-20% over and above age-matched controls. Fifteen to twenty percent of those who fracture a hip will be institutionalized at one year. Twenty-five to thirty-five percent will be dependent on an assistive device or another person. It is important to remember that osteoporosis is not necessarily a disease of low bone mass. It is a disease marked by fractures and the disability and frailty that ensue. The three most common types of fracture seen in osteoporosis include hip fractures, vertebral fractures, and wrist (Colle’s) fractures. Although vertebral fractures are not typically caused by a fall, hip and wrist fractures are. There-
fore, anything that can be done to augment bone mass and/or to decrease the fall rates would help to diminish the risk of fracturing. Rehabilitation medicine utilizes a team approach which has proven to be especially helpful in the treatment of patients with osteoporosis. The team consists of many physicians including primary care doctors and specialists, nurses, therapists, dietitians, social workers, and educators in the community. Whether pharmaceuticals, supplementations, and/or change in life style or habits is indicated the team can address and implement these. Through the team approach the expertise of all of those professionals can be pooled to provide the absolutely best care for the patient. The physiatrist aids the team in assessing and educating the patient regarding the appropriate duration, intensity, and frequency of exercise. This is applicable to patients who are presenting at the time when they are concerned about preventing the disease, those who have sustained a fracture, and those who Presented at the DIA Workshop “Curriculum Develop- are in chronic pain from an existing fracture. ment in Osteoporosis,” March 11-12. San Francisco, Some form of exercising is always approCalifornia. priate for all of these patients. It is known Reprint address: Amy Fitzsimmons, MD, Assistant that exercise must be weight-bearing in order Residency Director, Physical Medicine and Rehabilitation, Graduate Hospital, One Graduate Plaza, 1800 to build bone density. The i
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