Weight-bearing exercise key to reducing risk, severity of falls

Exercise combined with calcium and vitamin D supplements may be ideal prevention approach.

Issue: Issue 6 2006

TORONTO — Weight-bearing exercise is a vital step in physical rehabilitation after a fall and a means to prevent further falls, according to research presented at the World Congress on Osteoporosis.

“If you perform training in the long run, you will get a reduction in fracture rate [in postmenopausal women],” said Michael Pfeifer, MD, at the Institute of Clinical Osteology Gustav Pommer in Bad Pyrmont, Germany.

Indeed, one study by Sinaki and colleagues published in Bone showed postmenopausal women aged 58 to 75 years who participated in back muscle strengthening for 2 years had fewer vertebral fractures (11%) 10 years later compared to controls (30%) who did not perform strengthening exercises, Pfeifer said.

In another trial of elderly patients who received a hip replacement, those who were involved in exercise therapy were better able to perform their daily activities postoperatively than those who were not. The study by Hauer and colleagues appeared in the January 2002 issue of Aging.

Benefits of weight-bearing

Normal daily activities like walking or climbing stairs maintain bone strength. To improve their strength, bones have to carry a greater load than in normal activities, Pfeifer said.

Bone mineral density (BMD) gains are also seen in adolescence. Pfeifer noted that a 1997 study appearing in Journal of Bone and Mineral Research of 148 premenarcheal girls showed the most physically active gained 40% more bone mass than the least active.

Because it is more difficult to improve BMD after puberty, most exercises are geared to maintaining BMD in young adults and premenopausal women, he said. However, small increases in BMD can significantly decrease the potential for fracture in later life.

Pfeifer said diet as well as exercise could help minimize the risk of falls in the elderly.

In his presentation, Pfeifer said that calcium and vitamin D supplements resulted in a significant decrease in falls as well as “stable” muscle function in men and women aged 70 years and older. Falls were recorded every 2 months; muscle function every 4 months.

Pfeifer said the optimal dosage levels for the patients seemed to be 400 to 1,200 IU per day of vitamin D and 800 to 1,500 mg per day of calcium.

Spinal orthoses

Pfeifer also conducted research on patients who received spinal orthoses for vertebral fracture. In a 2004 study published in American Journal of Physical Medicine and Rehabilitation, 110 patients who had a kyphosis angle of 60° or greater and wore either the Spinomed (medi-Bayreuth, Germany) device, the Spinomed active device, or no device showed that the orthoses improved patients’ posture, trunk muscle strength and quality of life.

“The device holds the subject stable, so [the patients] are forced to use their other muscles and not put any pressure on their spine,” he said.

For more information:
Pfeifer M. Physical rehabilitation and prevention of falls. Presented at the IOF World Congress on Osteoporosis. June 2-6, 2006. Toronto.