Improving Patients' Outcomes After Osteoporotic Fractures

Rozalia Dimitriou; Giorgio Maria Calori; Peter V Giannoudis


Int J Clin Rheumatol. 2012;7(1):109-124. 

In This Article

Rehabilitation, Long-term Pain Management & Improving Quality of Life After an Osteoporotic Fracture

In addition to fall prevention and treatment of osteoporosis, rehabilitation also improves the functional outcome in patients after an osteoporotic fracture by reducing the level of disability and/or maintaining the level of mobility.[12] Prompt physical therapy in terms of mobilization, muscle strengthening and chest physiotherapy, postoperatively or after conservative management, ensures early recovery, maximizes mobility and reduces complications from prolonged immobilization.[77] Continued physical therapy after discharge from the hospital is also central in order to ensure and retain optimal functional recovery. In osteoporotic patients, long-term mobility and weight-bearing exercises are important to help maintain and improve bone health. The importance of physical exercise is not only that it improves the outcome after a recent fragility fracture, but it also has a positive effect on the rest of the patients' lives.[12]

Particularly for older patients with hip fractures, rehabilitation interventions to improve their recovery and physical and psychosocial functioning have been a topic of intense research as they often result in reduced mobility. Care programs including strategies for mobilization with early weight bearing and gait retraining, exercises and physical training, and even home exercise programs,[114] used at various stages during rehabilitation[115] have been implemented. However, there is insufficient evidence to determine the effectiveness of the various mobilization strategies at enhancing mobility that start either in the early postoperative period or during the later rehabilitation period,[84] and to recommend practice changes.[116] A review on the effects of multidisciplinary rehabilitation for these patients has shown that although there was a tendency to a better overall result when multidisciplinary inpatient rehabilitation was provided in patients, these results were not statistically significant.[117] Similarly, regarding the distal radius fractures, the effects of rehabilitation interventions on outcome in adults after conservative or surgical treatment have been studied, but the current evidence is insufficient to establish their relative effectiveness.[118] Therefore, future trials are needed to establish the effectiveness as well as the cost–effectiveness of different rehabilitation strategies.

In addition to increased morbidity and mortality after an osteoporotic fracture, there is also an associated compromise in various aspects of quality of life, including pain, decreased physical, mental and social well being.[10] Quality of life can be measured in these patients using generic questionnaires such as Short Form (36) Health Survey and European Quality of Life-5 Dynamics or one of the available osteoporotic-specific questionnaires.

Significant loss of quality of life has been reported with hip fractures and with prevalent vertebral fractures, especially with lumbar fractures compared with thoracic ones or with multiple vertebral fractures.[10,119] As quality of life was found to be dependent on comorbidities, mobility, independence of activities of daily life and fracture complaints,[10] it is central to optimize treatment modalities, pain management, rehabilitation strategies and overall patients' medical management to improve outcomes as evaluated by quality of life questionnaires. Recently, it has been demonstrated that osteoporotic fractures also have an impact on quality of life over time,[120] implying that evaluation and management of patients with fragility fractures should be continuing for a better outcome.

Especially after hip fractures, up to 42% of older patients may experience persistent pain 3–4 months postoperatively;[121] and around a quarter of hip-fractured patients continued to experience moderate to very severe pain from 6–12 months after discharge, with a significant impact on their quality of life.[93] Consequently, more attention should be given to ensure continuing adequate pain control strategies when required postoperatively in patients with fragility fractures, to prevent further declines in their outcomes in the long term, such as ambulation, morbidity and return to community.[122]

Finally, modifications of lifestyle factors such as quitting smoking and minimizing alcohol intake can also improve patients' general health and quality of life.[12]