Skip to main content

Advertisement

Springer Nature Link
Log in

Effects of therapeutic exercise for persons with osteoporotic vertebral fractures: a systematic review

  • Review
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

Summary

A systematic literature review was conducted and revealed nine studies investigating the effects of therapeutic exercise for persons with osteoporotic vertebral fractures. Although modest improvements were noted in strength and balance, results were inconsistent in supporting therapeutic exercise as effective in improving outcomes such as pain and quality of life (QOL).

Introduction

The purpose of this systematic review was to investigate the effects of therapeutic exercise as an intervention for patients over age 45 years with one or more osteoporotic vertebral fractures. The effects of the intervention on the following outcomes are summarized in this review: pain/analgesic use, QOL, function, strength, balance, range of motion, bone mineral density, and incidence of future fractures.

Methods

A systematic literature review of therapeutic exercise as a treatment for persons with osteoporotic vertebral fractures was conducted. Studies were retrieved from six databases, screened for inclusion, and assessed for methodological quality. Results were analyzed qualitatively based on levels of evidence, methodological rigor, and consistency of findings across studies within each of the eight health-related outcomes.

Results

Due to inconsistent results across the nine studies included in the review, there is only limited or inconsistent evidence for the effectiveness of therapeutic exercise on each of the outcomes investigated.

Conclusions

Due to lack of high-quality, consistent research on the effects of exercise for persons with vertebral fractures, no definitive conclusions can be drawn from this systematic review. Positive trends were identified with regard to improvements in strength and balance, with no increase in pain following exercise protocols. Future research is needed in this area.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+
from $39.99 /Month
  • Starting from 10 chapters or articles per month
  • Access and download chapters and articles from more than 300k books and 2,500 journals
  • Cancel anytime
View plans

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Explore related subjects

Discover the latest articles, books and news in related subjects, suggested using machine learning.

References

  1. Anonymous (2009) World Health Organization definitions for osteoporosis. The Bone Wellness Centre. http://www.bonewellness.com/world_health_organization_osteoporosis.php. Accessed 30 July 2010

  2. Glaser DL, Kaplan FS (1997) Osteoporosis: definition and clinical presentation. Spine 22:12S–16S

    Article  CAS  PubMed  Google Scholar 

  3. Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporosis Int 17:1726–1733

    Article  CAS  Google Scholar 

  4. Kanis JA (2002) Diagnosis of osteoporosis and assessment of fracture risk. Lancet 359:1929–1936

    Article  PubMed  Google Scholar 

  5. Gueldner SH, Newman ED, Grabo TN (2007) Osteoporosis: clinical guidelines for prevention, diagnosis, and management. Springer, Binghamton

    Google Scholar 

  6. Haczynski J, Jakimiuk A (2001) Vertebral fractures: a hidden problem of osteoporosis. Med Sci Monit 7:1108–1117

    CAS  PubMed  Google Scholar 

  7. Lindsay R, Silverman SL, Cooper C, Hanley DA, Barton I, Broy SB, Licata A, Benhamou L, Geusens P, Flowers K, Stracke H, Seeman E (2001) Risk of new vertebral fracture in the year following a fracture. JAMA 285:320–323

    Article  CAS  PubMed  Google Scholar 

  8. Cummings SR, Karpf DB, Harris F, Genant HK, Ensrud K, LaCroix AZ, Black DM (2002) Improvement in spine bone density and reduction in risk of vertebral fractures during treatment with antiresorptive drugs. Am J Med 112:281–289

    Article  CAS  PubMed  Google Scholar 

  9. Legroux-Gerot I, Lormeau C, Boutry N, Cotten A, Duquesnoy B, Cortet B (2004) Long-term follow-up of vertebral osteoporotic fractures treated by percutaneous vertebroplasty. Clin Rheumatol 23:310–317

    Article  PubMed  Google Scholar 

  10. Liu-Ambrose TY, Khan KM, Eng JJ, Lord SR, Lentle B, McKay HA (2005) Both resistance and agility training reduce back pain and improve health-related quality of life in older women with low bone mass. Osteoporos Int 16:1321–1329

    Article  PubMed  Google Scholar 

  11. Dean E (1997) Oxygen transport deficits in systematic disease and implications for physical therapy. Phys Ther 77:187–202

    CAS  PubMed  Google Scholar 

  12. Bennell KL, Matthews B, Greig A, Briggs A, Kelly A, Sherburn M, Larsen J, Wark J (2010) Effects of an exercise and manual therapy program on physical impairments, function and quality-of-life in people with osteoporotic vertebral fracture: a randomised, single-blind controlled pilot trial. BMC Musculoskelet Disord 11:36

    Article  PubMed  Google Scholar 

  13. Smith AA, Summers GD, Baxendale A, Butterly RJ (1998) A randomized controlled trial of the effects of weight-bearing exercise and resistance training on risk factors for fracture in women with osteoporosis. In: Ring EFJ, Elvins DM, Bhalla AK (eds) Current research in osteoporosis and bone mineral measurement V. British Institute of Radiology, London, p 128

    Google Scholar 

  14. van Tulder M, Furlan A, Bombardier C, Bouter L, Editorial Board of the Cochrane Collaboration Back Review Group (2003) Updated method guidelines for systematic reviews in the Cochrane collaboration back review group. Spine 28:1290–1299

    Article  PubMed  Google Scholar 

  15. de Kam D, Smulders E, Weerdesteyn V, Smits-Engelman BCM (2009) Exercise interventions to reduce fall-related fractures and their risk factors in individuals with low bone density: a systematic review of randomized controlled trials. Osteoporos Int 20:2111–2125

    Article  PubMed  Google Scholar 

  16. Bautmans I, Van Arken J, Van Mackelenberg M, Mets T (2010) Rehabilitation using manual mobilization for thoracic kyphosis in elderly postmenopausal patients with osteoporosis. J Rehabil Med 42:129–135

    Article  PubMed  Google Scholar 

  17. Gold DT, Shipp KM, Pieper CF, Duncan PW, Martinez S, Lyles KW (2004) Group treatment improves trunk strength and psychological status in older women with vertebral fractures: results of a randomized, clinical trial. J Am Geriatr Soc 52:1471–1478

    Article  PubMed  Google Scholar 

  18. Hongo M, Itoi E, Sinaki M, Miyakoshi N, Shimada Y, Maekawa S, Okada K, Mizutani Y (2007) Effect of low-intensity back exercise on quality of life and back extensor strength in patients with osteoporosis: a randomized controlled trial. Osteoporos Int 18:1389–1395

    Article  CAS  PubMed  Google Scholar 

  19. Malmros B, Mortensen L, Jensen MB, Charles P (1998) Positive effects of physiotherapy on chronic pain and performance in osteoporosis. Osteoporos Int 8:215–221

    Article  CAS  PubMed  Google Scholar 

  20. Papaioannou A, Adachi JD, Winegard K, Ferko N, Parkinson W, Cook RJ, Webber C, McCartney N (2003) Efficacy of home-based exercise for improving quality of life among elderly women with symptomatic osteoporosis-related vertebral fractures. Osteoporos Int 14:677–682

    Article  CAS  PubMed  Google Scholar 

  21. Yang L, He C, Lei Z, Xie W, Lan Q (2007) Effect of pain-free exercises on female osteoporosis patients with spinal compressive fracture. J Clin Rehab Tis Eng Res 11:9108–9111

    Google Scholar 

  22. Sinaki M, Mikkelsen BA (1984) Postmenopausal spinal osteoporosis: flexion versus extension exercises. Arch Phys Med Rehabil 65:593–596

    CAS  PubMed  Google Scholar 

  23. Cameron ID, Handoll HH, Finnegan TP, Madhok R, Langhorne P (2009) WITHDRAWN: co-ordinated multidisciplinary approaches for inpatient rehabilitation of older patients with proximal femoral fractures. Cochrane Database Syst Rev Oct 7(4):CD000106

    Google Scholar 

  24. Chilov MN, Cameron ID, March LM, Health AN, Council MR (2003) Evidence-based guidelines for fixing broken hips: an update. Med J Aust 179:489–493

    PubMed  Google Scholar 

  25. Beaupre LA, Jones CA, Saunders LD, Johnston DW, Buckingham J, Majumdar SR (2005) Best practices for elderly hip fracture patients. A systematic overview of the evidence. J Gen Intern Med 20:1019–1025

    Article  PubMed  Google Scholar 

  26. Toussant EM, Kohia M (2005) A critical review of literature regarding the effectiveness of physical therapy management of hip fracture in elderly persons. J Gerontol Series A Biol Sci Med Sci 60:1285–1291

    Google Scholar 

  27. Halbert J, Crotty M, Whitehead C, Cameron I, Kurrle S, Graham S, Handoll H, Finnegan T, Jones T, Foley A, Shanahan M, Hip Fracture Rehabilitation Trial Collaborative Group (2007) Multi-disciplinary rehabilitation after hip fracture is associated with improved outcome: a systematic review. J Rehabil Med 39:507–512

    Article  PubMed  Google Scholar 

  28. Handoll HH, Sherrington C, Parker MJ (2004) Mobilisation strategies after hip fracture surgery in adults. Cochrane Database Syst Rev Oct 18(4):CD001704

    Google Scholar 

  29. Chudyk AM, Jutai JW, Petrella RJ, Speechley M (2009) Systematic review of hip fracture rehabilitation practices in the elderly. Arch Phys Med Rehabil 90:246–262

    Article  PubMed  Google Scholar 

  30. Scottish Intercollegiate Guidelines Network (2009) Management of hip fracture in older people: a national clinical guideline. SIGN, Edinburgh

    Google Scholar 

  31. Smith TO, Davies L (2006) Do exercises improve outcome following fixation of ankle fractures? A systematic review. Int J Ther Rehabil 13:273–281

    Google Scholar 

  32. Lin CW, Moseley AM, Refshauge KM (2008) Rehabilitation for ankle fractures in adults. Cochrane Database Syst Rev Jul 16(3):CD005595

    Google Scholar 

  33. Handoll HH, Gibson JN, Madhok R (2003) Interventions for treating proximal humeral fractures in adults. Cochrane Database Syst Rev (4):CD000434

  34. Handoll HH, Madhok R, Howe TE (2006) Rehabilitation for distal radial fractures in adults. Cochrane Database Syst Rev Jul 19;3:CD003324

    Google Scholar 

  35. Heinonen A, Kannus P, Sievanen H, Oja P, Pasanen M, Rinne M, Uusi-Rasi K, Vuori I (1996) Randomised controlled trial of effect of high-impact exercise on selected risk factors for osteoporotic fractures. Lancet 348:1343–1347

    Article  CAS  PubMed  Google Scholar 

  36. Paganini-Hill A, Chao A, Ross RK, Henderson BE (1991) Exercise and other factors in the prevention of hip fracture: the leisure world study. Epidemiology 2:16–25

    Article  CAS  PubMed  Google Scholar 

  37. Nelson ME, Fiatarone MA, Morganti CM, Trice I, Greenberg RA, Evans WJ (1994) Effects of high-intensity strength training on multiple risk factors for osteoporotic fractures. A randomized controlled trial. JAMA 272:1909–1914

    Article  CAS  PubMed  Google Scholar 

  38. Rutherford OM (1999) Is there a role for exercise in the prevention of osteoporotic fractures? Br J Sports Med 33:378–386

    Article  CAS  PubMed  Google Scholar 

  39. Chesnut CH 3rd, Silverman S, Andriano K, Genant H, Gimona A, Harris S, Kiel D, LeBoff M, Maricic M, Miller P, Moniz C, Peacock M, Richardson P, Watts N, Baylink D, PROOF Study Group (2000) A randomized trial of nasal spray salmon calcitonin in postmenopausal women with established osteoporosis: the prevent recurrence of osteoporotic fractures study. Am J Med 109:267–276

    Article  CAS  PubMed  Google Scholar 

  40. Ettinger B, Black DM, Mitlak BH, Knickerbocker RK, Nickelsen T, Genant HK, Christiansen C, Delmas PD, Zanchetta JR, Stakkestad J, Gluer CC, Krueger K, Cohen FJ, Eckert S, Ensrud KE, Avioli LV, Lips P, Cummings SR, Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators (1999) Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. JAMA 282:637–645

    Article  CAS  PubMed  Google Scholar 

  41. Neer RM, Arnaud CD, Zanchetta JR, Prince R, Gaich GA, Reginster JY, Hodsman AB, Eriksen EF, Ish-Shalom S, Genant HK, Wang O, Mitlak BH (2001) Effect of parathyroid hormone (1–34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med 344:1434–1441

    Article  CAS  PubMed  Google Scholar 

  42. Hulme PA, Krebs J, Ferguson SJ, Berlemann U (2006) Vertebroplasty and kyphoplasty: a systematic review of 69 clinical studies. Spine 31:1983–2001

    Article  PubMed  Google Scholar 

  43. Gill JB, Kuper M, Chin PC, Zhang Y, Schutt R Jr (2007) Comparing pain reduction following kyphoplasty and vertebroplasty for osteoporotic vertebral compression fractures. Pain Physician 10:583–590

    PubMed  Google Scholar 

  44. McGirt MJ, Parker SL, Wolinsky JP, Witham TF, Bydon A, Gokaslan ZL (2009) Vertebroplasty and kyphoplasty for the treatment of vertebral compression fractures: an evidenced-based review of the literature. Spine J 9:501–508

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study was funded in part by a Canadian Institutes of Health Research (CIHR) Knowledge Synthesis Grant (FRN 86244); Principal Investigator: Susan R. Harris. We wish to acknowledge Drs. Kim Bennell and Greg Summers for their personal communications and for provision of their unpublished work. We would also like to thank Dr. Linda Li for her assistance with data abstraction and Tony Hong for help with translation. Lastly, we wish to thank Charlotte Beck for her guidance with our search strategy.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Physical Therapy, University of British Columbia, 212 Friedman Building, 2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada

    K. Dusdal, J. Grundmanis, K. Luttin, P. Ritchie, C. Rompre, R. Sidhu & S. R. Harris

Authors
  1. K. Dusdal
    View author publications

    Search author on:PubMed Google Scholar

  2. J. Grundmanis
    View author publications

    Search author on:PubMed Google Scholar

  3. K. Luttin
    View author publications

    Search author on:PubMed Google Scholar

  4. P. Ritchie
    View author publications

    Search author on:PubMed Google Scholar

  5. C. Rompre
    View author publications

    Search author on:PubMed Google Scholar

  6. R. Sidhu
    View author publications

    Search author on:PubMed Google Scholar

  7. S. R. Harris
    View author publications

    Search author on:PubMed Google Scholar

Corresponding author

Correspondence to S. R. Harris.

Appendix A

Appendix A

Table 3 Search strategy on MEDLINE
Full size table

Rights and permissions

Reprints and permissions

About this article

Cite this article

Dusdal, K., Grundmanis, J., Luttin, K. et al. Effects of therapeutic exercise for persons with osteoporotic vertebral fractures: a systematic review. Osteoporos Int 22, 755–769 (2011). https://doi.org/10.1007/s00198-010-1497-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-010-1497-6

Keywords