Preventing Fragility Fractures The Role of Exercise Physiology

Heightened fall risk leads to fractures, fear of falling, loss of confidence, and subsequent self-restricted activities.1-3. Those fractures that occur from standing height or less are often referred to as fragility fractures.

A number of studies show how interventions in the exercise physiology scope of practice lower fear of falling, decrease fall risk, and improve quality of life. Moreover, studies further show that interventions can decrease the fracture risk, specifically.

Therapeutic Exercise and Fracture Risk: Collectively, studies have shown a robust and long-lasting correlation between exercise intervention and lowered fracture risk (not just lowered fall risk).

In one study, the incidence of fractures was 38% lower in the exercise group at a seven-year follow-up.4

Osteoporosis and Aerobic Activity: Aerobic exercise interventions have been shown to create significant improvements in bone mineral density, in both weightbearing bones and in non -weightbearing bones such as the radius.5 Patients at risk of fragility fractures often resist activity recommendations due to fear of self-injury. Professional guidance in a customised exercise plan gives patients greater confidence in adopting activity recommendations.

Urinary Incontinence (UI): The presence of UI among elderly patients increases the risk of an accidental fall by 56%. The association is further increased based on volume of urine loss, pain in bladder, pain on micturition, and the presence of physical limitations.6 Exercise physiology can teach pelvic-floor muscle training and behavioural training to mitigate UI symptoms.

Mobility Aids: In their prospective cohort study, “Understanding the Relationship Between Walking Aids and Falls in Older Adults,” Mettelinge and Cambrier conclude with a recommendation for “extensive” training periods and appropriate instructions on the proper use of walking aids in terms of adequate and safe gait patterns.7

Vitamin D with Calcium: Supplementation of vitamin D with calcium significantly reduces fracture rates.8 Exercise physiologists can screen for nutritional status and provide guidance to patients about supplementation.

At Advanced Physiotherapy, we can evaluate the need for walking aids, help order them, help fit them, and help train patients in their effective use over repeated visits. Vitamin D with Calcium: Supplementation of vitamin D with calcium significantly reduces fracture rates.8 Exercise physiologists can screen for nutritional status and provide guidance to patients about supplementation.

When to Refer: Authorities recommend these three questions as part of any senior exam:

Have you fallen in the past year?
Do you feel unsteady when standing or walking?
Do you worry about falling?

A yes answer to any of these prompts a more thorough exam. Deficits in walking speed, foot height during gait, leg strength, balance, use or implementation of mobility equipment, etc. can prompt a referral.

References

1. Foley A, Loharuka S, Barrett J, et al. Association between the geriatric giants of urinary incontinence and falls in older people using data from the Leicestershire MRC incontinence study. Age and Ageing. 2012; 41: 35-40.

2. Chiarelli P, Mackenzie L, Osmotherly P. Urinary incontinence is associated with an increase in falls: a systematic review. Australian Journal of Physiotherapy. 2009; 55: 89-95.

3. Liddle J, Gilleard C. The emotional consequences of falls for patients and their families. Age Ageing. 1994; 23 (supp 4): 17.

4. Zhao R, Feng F, Wang X. Exercise interventions and prevention of fall-related fractures in older people: a meta-analysis of randomized controlled trials. International Journal of Epidemiology. 2017 Feb 1;46(1):149-61.

5. Meléndez-Ortega A. Osteoporosis, falls and exercise. European Review of Aging and Physical Activity. 2007 Oct;4:61-70.

6. Foley A, Loharuka S, Barrett J, et al. Association between the geriatric giants of urinary incontinence and falls in older people using data from the Leicestershire MRC incontinence study. Age and Ageing. 2012; 41: 35-40.

7. de Mettelinge TR, Cambier D. Understanding the relationship between walking aids and falls in older adults: a prospective cohort study. Journal of Geriatric Physical Therapy. 2015 Jul 1;38 (3):127-32.

8. Chakhtoura M, Chamoun N, Rahme M, Fuleihan GE. Impact of vitamin D supplementation on falls and fractures—A critical appraisal of the quality of the evidence and an overview of the available guidelines. Bone. 2020 Feb 1;131:115112