Effect of resistance exercises on function in older adults with osteoporosis or osteopenia: a systematic review. Effect of exercise on mobility, balance, and health-related quality of life in osteoporotic women with a history of vertebral fracture: a randomized, controlled trial Efficacy of a short multidisciplinary falls prevention program for elderly persons with osteoporosis and a fall history: a randomized controlled trial. [Optimization of calcium intake for the prevention of osteoporosis and osteoporotic fractures: a review of the evidence]. Effects of physical therapy on quality of life in osteoporosis patients - a randomized clinical trial UK clinical guideline for the prevention and treatment of osteoporosis Health-related quality of life (HRQOL) in Japanese osteoporotic patients and its improvement by elcatonin treatment Progressive load training for the quadriceps muscle associated with proprioception exercises for the prevention of falls in postmenopausal women with osteoporosis: a randomized controlled trial Impact of osteoporosis in dental implants: A systematic review. Effects of Pilates exercises on pain, functional status and quality of life in women with postmenopausal osteoporosis. The burden of prevalent fractures on health-related quality of life in postmenopausal women with osteoporosis: the IMOF study. Efficacy of group-adapted physical exercises in reducing back pain in women with postmenopausal osteoporosis Effectiveness of a community-based osteoporosis education and self-management course: a wait list controlled trial Tailored Interventions to Enhance Osteoporosis Prevention in Women Proactive pharmaceutical care interventions decrease patients’ nonadherence to osteoporosis medication The risk of osteoporosis in oral steroid treatment for nasal polyposis: a systematic review. Structural Model for Osteoporosis Preventing Behavior in Postmenopausal Women The effect of exercise and education on fear of falling in elderly women with osteoporosis and a history of vertebral fracture: results of a randomized controlled trial Patient preferences for osteoporosis in Spain: a discrete choice experiment Interventions to reduce dependency in personal activities of daily living in community-dwelling adults who use homecare services: protocol for a systematic review Postural Control in Elderly Persons with Osteoporosis: Efficacy of an Intervention Program to Improve Balance and Muscle Strength: A Randomized Controlled Trial Pharmacologic Treatment of Low Bone Density or Osteoporosis to Prevent Fractures: A Clinical Practice Guideline from the American College of Physicians Effect of low-intensity back exercise on quality of life and back extensor strength in patients with osteoporosis: a randomized controlled trial Estimating the Horizon of Articles to Decide When to Stop Searching in Systematic Reviews: An Example Using a Systematic Review of RCTs Evaluating Osteoporosis Clinical Decision Support Tools A randomized study of two different information-based interventions on the management of osteoporosis in minimal and moderate trauma fractures
PURPOSE To examine the effect of resistance exercises on self-reported physical function and activities of daily living ( ADL ) in older adults with osteoporosis or osteopenia . METHODS A search of available literature was conducted using PubMed , CINAHL , SPORTD iscus , PEDro , ProQuest Nursing and Allied Health Source , and Cochrane Controlled Trials Register . Studies were included if they involved ( 1 ) r and omized controlled trials ; ( 2 ) participants with osteoporosis or osteopenia ; ( 3 ) resistance exercise as an intervention ;  and ( 4 ) self-report of physical function or ADL . Articles were independently review ed for quality by two authors using the Physiotherapy Evidence Data base ( PEDro ) scale . Cohen 's d effect size was calculated by dividing st and ardized mean differences by the st and ard deviation to determine treatment effect in terms of physical function or ADL . RESULTS Five full-text articles were selected for inclusion . PEDro scores ranged from 5 to 7 ( out of 10 ) . Effect size mean differences as a result of resistance intervention ranged from 0.08 to 1.74 , suggesting " trivial " to " large " effects on self-reported physical function and ADL . CONCLUSION RESULTS suggest that interventions using resistance training have a beneficial impact on the domains of physical function and ADL in participants with osteoporosis or osteopenia . More high- quality studies are needed to lend further validity to this supposition Summary The aim of this r and omized controlled trial was to evaluate the effect of a 3-month course of exercises on mobility , balance , disease-specific , and generic health-related quality of life ( HRQOL ) for women with osteoporosis and a history of vertebral fractures . Our results showed that exercises improved their mobility , balance , and HRQOL . Introduction The aim was to evaluate the effect of a 3-month course of circuit exercises plus a 3-h lesson on how to cope with osteoporosis on mobility , balance , and the HRQOL for postmenopausal women ( 60–84 years ) with osteoporosis and a history of vertebral fracture . Our hypothesis was that a 3-month course would have a significantly positive effect on the women 's mobility and balance as well as on their HRQOL . Methods The participants ( 89 ) were r and omized to an intervention group ( IT ) or a control group ( CT )  and assessed at baseline at 3 months and at 12 months with measurement of maximum walking speed ( MWS ) , Timed Up and GO ( TUG ) , Functional Reach ( FR ) , the Quality of Life Question naire issued by the European Foundation for Osteoporosis ( ‘ QUALEFFO-41 ’ ) and the General Health Question naire ( GHQ-20 ) . The sample size was calculated with reference to walking speed ( primary outcome ) , and the statistical approaches used were Student 's t test or the chi-square test . Results At 3 months , better results were registered on the primary outcome , MWS as well as TUG , FR , sum score of GHQ-20 , and “ QUALEFFO-41 : mental function ” in the IT compared with the CT . At 12 months , those in the IT had a better result on the primary outcome , MWS as well as TUG , “ QUALEFFO-41 : total score ” “ QUALEFFO-41 : mental function ” , “ QUALEFFO-41 : physical function ” , and “ QULEFFO-41 : pain ” compared with CT . Conclusion Circuit exercises will improve mobility and health-related quality of life of elderly women with osteoporosis and a history of vertebral fractures OBJECTIVE To evaluate the efficacy of the Nijmegen Falls Prevention Program ( NFPP ) for persons with osteoporosis and a fall history in a r and omized controlled trial . Persons with osteoporosis are at risk for fall-related fractures because of decreased bone strength . A decrease in the number of falls therefore is expected to be particularly beneficial for these persons . DESIGN R and omized controlled trial . SETTING Hospital . PARTICIPANTS Persons with osteoporosis and a fall history ( N=96 ; mean ± SD age , 71.0±4.7y ; 90 women ) . INTERVENTION After baseline assessment , participants were r and omly assigned to the exercise ( n=50 ; participated in the NFPP for persons with osteoporosis [ 5.5wk ] ) or control group ( n=46 ; usual care ) . MAIN OUTCOME MEASURES Primary outcome measure was fall rate , measured by using monthly fall calendars for 1 year . Secondary outcomes were balance confidence ( Activity-specific Balance Confidence Scale ) , quality of life ( QOL ; Quality of Life Question naire of the European Foundation for Osteoporosis ) , and activity level ( LASA Physical Activity Question naire , pedometer ) , assessed posttreatment subsequent to the program and after 1 year of follow-up . RESULTS The fall rate in the exercise group was 39 % lower than for the control group ( .72 vs 1.18 falls/person-year ; risk ratio , .61 ; 95 % confidence interval , .40-.94 ) . Balance confidence in the exercise group increased by 13.9 % ( P=.001 ) . No group differences were observed in QOL and activity levels . CONCLUSION The NFPP for persons with osteoporosis was effective in decreasing the number of falls and improving balance confidence . Therefore , it is a valuable new tool to improve mobility and independence of persons with osteoporosis One of the main focuses of lifestyle modification for the prevention of osteoporosis and osteoporotic fractures  in Japan is improvement in dietary calcium intake . However , virtually no r and omized controlled trial to assess the preventive effects of administration of calcium on the risk of fractures has been conducted in Japan . In this study , we review ed all the scientific papers currently available from medical literature data bases to propose evidence -based recommendations on the preventive procedures for osteoporosis . The result of the present systematic review gives the evidence showing that calcium supplementation or optimal dietary calcium intake increases bone density in childhood and adolescence and reduces the risk of fracture due to osteoporosis in the elderly people regardless of the gender . The evidence also supports the current health policy guiding the elderly to increase their dietary calcium intake in daily life Summary The aim of this prospect i ve r and omized single-center study was to investigate whether sling exercise therapy is superior to conventional exercises in osteoporosis patients . Background Patients with osteoporosis frequently experience fractures of the vertebral body , which may cause chronic back pain  and other symptoms . These , in turn , may lead to immobilization , muscular atrophy , and restrictions in activities of daily living . The situation can be improved with specific medication and physiotherapy . We explored the effects of a variety of physical treatments on activities of daily living in patients with osteoporosis . Method Fifty patients were r and omly allocated to two treatment groups . Group A received traditional physiotherapy ( PT ) while group B underwent sling exercise therapy ( ST ) . Both treatments were given twice a week for three months . The results of the treatment were registered on the quality of life question naire ( Qualeffo-41 ) devised by the International Osteoporosis Foundation . After a further three months with no specific exercise treatment , we again tested all patients in order to draw conclusions about the long-term effects of both types of exercise . Results Forty-four patients ( 88 % ) completed the study . Patients were assigned to small groups ( a maximum of 5 patients in each group ) and thus received individual attention and motivation . Quality of life was improved in both groups ; a significantly greater improvement was registered in patients who performed sling exercises ( Global score Qualeffo : p = 0.002 ) . Conclusion The test results confirm the known positive effects of physical therapy on the quality of life of osteoporosis patients , as well as the fact that sling exercises are a sound alternative treatment for this condition Introduction In 2008 , the UK National Osteoporosis Guideline Group ( NOGG ) produced a guideline on the prevention and treatment of osteoporosis , with an up date in 2013 . This paper presents a major up date of the guideline , the scope of which is to review the assessment and management of osteoporosis and the prevention of fragility fractures in postmenopausal women and men age 50 years or over . Methods Where available , systematic review s , meta-analyses and r and omised controlled trials were used to provide the evidence base . Conclusions and recommendations were systematic ally grade d according to the strength of the available evidence . Results Review of the evidence and recommendations are provided for the diagnosis of osteoporosis , fracture-risk assessment , lifestyle measures and pharmacological interventions , duration and monitoring of bisphosphonate therapy , glucocorticoid-induced osteoporosis , osteoporosis in men , postfracture care and intervention thresholds . Conclusion The guideline , which has received accreditation from the National Institute of Health and Care Excellence ( NICE ) , provides a comprehensive overview of the assessment and management of osteoporosis for all healthcare professionals who are involved in its management Health-related quality of life ( HRQOL ; “ QOL ” hereafter ) was evaluated in Japanese osteoporotic patients using three question naires ; the SF-36 ( MOS 36-Item Short-Form Health Survey ; generic , profile-type ) , the EQ-5D ( Euro Qol-5 Dimensions ; generic , preference-based ) , and the JOQOL ( Japanese Osteoporosis Quality of Life 1999 ; disease-targeted ) . The eight subscales and two summary scores of the SF-36 were impaired in these patients even after correction for age and sex . The scores on the EQ-5D and JOQOL correlated well with the subscales of the SF-36 that represent the physical aspects of physical function and bodily pain , which suggests that physical aspects are important determinants of overall QOL status in osteoporotic patients . Although the QOL scores did not correlate with bone mineral density , they were markedly influenced by the presence of vertebral fractures . In particular , the presence of two or more vertebral fractures greatly decreased the QOL scores . We then evaluated the QOL scores before and after treatment . The patients were either given calcium supplementation alone or calcium plus once-weekly elcatonin ( Elcitonin , Asahi Kasei Pharma , Tokyo , Japan ) injection . Elcatonin treatment markedly improved diverse aspects of the QOL , whereas calcium alone did not . The current data suggest that osteoporosis , especially in the presence of vertebral fracture , is associated with compromised QOL , and therapeutic intervention for osteoporosis should be evaluated in terms of QOL , as well as in terms of increases in bone mineral density and fracture prevention Summary This study aims to evaluate the effect of 18-week progressive muscular strength and proprioception training program on the muscle strength of the quadriceps , in prevention of falls in postmenopausal women with osteoporosis . The incidence of falls in the intervention group was significantly lower than in the control group ( incidence rate ratio ( IRR ) = 0.263 , 95 % CI 0.10–0.68 ) . Introduction This study aims to evaluate the effect of a progressive muscular strength and proprioception training program on the muscle strength of the quadriceps , balance , quality of life , and reduction in the risk of falls in postmenopausal women with osteoporosis . Methods One hundred sedentary postmenopausal women with osteoporosis , ages ranging from 55 to 75 , were selected and r and omized into two groups : the intervention group comprised of 50 patients who underwent a 18-week of progressive load training for the quadriceps muscle ( 50 % up to 80 % of 1-RM — one maximum repetition ) and proprioception training associated to a drug treatment of osteoporosis and the  control group that included 50 patients who only underwent a drug treatment of osteoporosis .  The muscular strength , balance , functional mobility , and quality of life were evaluated in the beginning and end of the research . The number of falls was evaluated 24 weeks post-treatment . Results Eighty-five patients concluded the research . The program promoted a significant difference among the groups for SF-36 in the eight sub-scales ( p ≤ 0.0018 ) , Timed Up & Go Test ( p < 0.0001 ) , 1-RM test ( p < 0.0001 ) , Berg Balance Scale ( p < 0.0001 ) and also a decrease in the number of falls in the intervention group compared to control ( IRR = 0.263 , 95 % CI 0.10–0.68 , p = 0.0064 ) . Conclusion The association of progressive strength training for the quadriceps and the proprioceptive training is effective for the prevention of falls , increasing the muscle power , the static and dynamic balance and increasing the speed of the motor responses , therefore improving the performance of daily activities AIM To assess the failure and bone-to-implant contact rate of  dental implants placed on osteoporotic subjects . METHODS Extensive examination strategies were created to classify studies for this systematic review . MEDLINE ( via PubMed ) and EMBASE data base were examined for studies in English up to and including May 2014 . The examination presented a combination of the MeSH words described as follow : " osteoporosis " or " osteopenia " or " estrogen deficiency " AND " implant " or " dental implant " or " osseointegration " . Assessment of clinical and /or histological peri-implant conditions in osteoporosis subjects treated with titanium dental implants . The examination included a combination of the MeSH terms described as follow : " osteoporosis " or " osteopenia " or " estrogen deficiency " AND " implant " or " dental implant " or " osseointegration " . RESULTS Of 943 potentially eligible articles , 12 were included in the study . A total of 133 subjects with osteoporosis , 73 subjects diagnosed with osteopenia and 708 healthy subjects were assessed in this systematic review . In these subjects were installed 367 , 205 , 2981 dental implants in osteoporotic , osteopenic and healthy subjects , respectively . The failure rate of dental implant was 10.9 % in osteoporotic subjects , 8.29 % in osteopenic and 11.43 % in healthy ones . Bone-to-implant contact obtained from retrieved implants ranged between 49.96 % to 47.84 % , for osteoporosis and non-osteoporotic subjects . CONCLUSION Osteoporotic subjects presented higher rates of implant loss , however , there is a lower evidence to strengthen or refute the hypothesis that osteoporosis may have detrimental effects on bone healing . Consequently , final conclusions regarding the effect of osteoporosis in dental implant therapy can not be made at this time . There are no r and omized clinical trial accessible for evaluation and the retrospective nature of the evaluated studies shall be taken in account when interpreting this study OBJECTIVE The present study aim ed to evaluate the effects of Pilates exercise program on pain , functional status and quality of life in women with postmenopausal osteoporosis . DESIGN The study was performed as a r and omized , prospect i ve , controlled and single-blind trial . PARTICIPATIONS : Seventy women ( age range , 45 - 65 years ) with the diagnosis of postmenopausal osteoporosis were included . METHODS AND INTERVENTIONS Patients were r and omly allocated into two groups ( home and Pilates exercise groups ) . Patients in the Pilates exercise group underwent a supervised Pilates exercise program twice a week for one year . Patients in the home exercise group were asked to perform a home exercise program consisting of thoracic extension exercises . Patients were evaluated at baseline and after one year of participation in the exercise programs . MAIN OUTCOME MEASUREMENTS Visual Analog Scale for pain , six-minute walking and sit-to-st and tests for functional status , and the Qualeffo-41 Question naire and the Short Form-36 ( SF-36 ) for quality of life . Patients were also asked to report the number of falls during the intervention . RESULTS At the end of the study , the results of 60 patients were analyzed . A significant improvement was noted in all evaluation parameters at the end of the exercise program in the Pilates exercise group . Except for Qualeffo- Leisure Time Activities , SF-36 physical role limitation and emotional role limitation subscales , a significant improvement was noted in all other evaluation parameters at the end of the exercise program in the home exercise group . Improvement was significantly greater in the Pilates exercise group compared to the home exercise group in all parameters . CONCLUSION Pilates exercises may be a safe and an effective treatment alternative for the quality of life in patients with postmenopausal osteoporosis OBJECTIVE Vertebral fractures are a common complication of osteoporosis and may have a negative effect on health-related quality of life ( HRQOL ) . We investigated the effect of prevalent vertebral fractures on HRQOL in patients with osteoporosis . METHODS A cross-sectional multicenter study was carried out among postmenopausal women with primary osteoporosis attending primary care centers and hospital outpatient clinics : 234 women with vertebral fractures and 244 asymptomatic women . Women with secondary osteoporosis or taking medications that affect bone metabolism were excluded . All patients were question ed using the  mini-Osteoporosis Quality of Life Question naire ( mini-OQLQ ) , Medical Outcomes Study Short Form-36 ( SF-36 )  , and the  EuroQuol-5D  , after assessment of all clinical variables and anthropometric data . To assess comorbidity we used the Self-Administered Comorbidity Question naire ( SCQ ) . Diagnosis of osteoporosis was confirmed in all patients by bone mineral density using dual energy x-ray absorptiometry . Radiographic evaluation was performed by a musculoskeletal radiologist . A total of 483 postmenopausal women , r and omly matched for age out of 1579 healthy controls , were chosen to compare the SF-36 scores with respect to patients with and without vertebral fractures due to osteoporosis . A multivariable regression analysis was conducted to identify the strongest determinant for low HRQOL , adjusted for potential confounding variables such as comorbid conditions , education level , and psychosocial status . RESULTS The vertebral fracture group had significantly lower scores than patients without fractures and controls in all domains of the generic and specific question naires . Women with only 1 prevalent fracture had statistically significantly lower HRQOL scores than those without fractures on SF-36 measures of bodily pain , physical functioning , and role function physical ( all p < 0.01 ) . HRQOL scores were lower in women with lumbar fractures compared with women with thoracic fractures only when the physical functioning and bodily pain dimensions approached statistical significance . Based on the multivariate analysis , the strongest determinant for low HRQOL was physical functioning ( explained by number of vertebral fractures ) followed by comorbidity score and age . Adjusted R2 in the final model was 35.9 % . Using the SF-36 summary scales , comorbid conditions predominantly affected either mental or physical health ( p < 0.0001 ) . A significant correlation ( p < 0.0001 ) was found between total score on the mini-OQLQ and the mean SCQ comorbidity score . CONCLUSION Our results confirm previous findings that HRQOL , assessed by generic and osteoporosis-specific instruments , is decreased in patients with vertebral fractures due to osteoporosis as a function of the number of vertebral fractures , presence of comorbid conditions , and age Purpose The clinical effects of osteoporosis include pain , fractures , and physical disability , causing a loss of independence and necessitating long-term care . Whereas the effects of exercise therapy in decreasing body mass index and preventing fractures are well established , there is no consensus on back pain and quality of life in women with osteoporosis . The aim of this study was to determine the efficacy of a brief course of rehabilitation , comprising group-adapted physical exercises , with regard to back pain , disability , and quality of life in women with postmenopausal osteoporosis who had no evidence of fractures . Methods The enrolled patients were r and omized into two groups : the treatment group underwent ten sessions of rehabilitative exercises , and the control group received an instructional booklet with descriptions and figures of exercises that were to be performed at home . Results Sixty patients completed the trial and assessment s , including a 6-month follow-up . The treatment was effective versus the control group , significantly improving pain ( Visual Analogue Scale : p < 0.001 at the end of the treatment and at the follow-up ; McGill Pain Question naire : p = 0.018 at the follow-up ) , disability ( Oswestry Disability Question naire : p < 0.001 at the end and follow-up ) , and quality of life ( Shortened Osteoporosis Quality of Life Question naire : p = 0.021 at the end of treatment ; p = 0.005 at follow-up ) . Conclusions Our results suggest that group rehabilitation reduces back pain and improves functional status and quality of life in women with postmenopausal osteoporosis , maintaining these outcomes for 6 months . The use of physical exercises might strengthen the habit to training Summary Osteoporosis is an increasing burden on individuals and health re sources . The Osteoporosis Prevention and Self-Management Course ( OPSMC ) was design ed to assist individuals to prevent and manage osteoporosis ; however , it had not been evaluated in an Australian setting . This r and omised controlled trial showed that the course increased osteoporosis knowledge . Introduction and hypothesisOsteoporosis is a major and growing public health concern . An OPSMC was design ed to provide individuals with information and skills to prevent or manage osteoporosis , but its effectiveness has not previously been evaluated . This study aim ed to determine whether OPSMC attendance improved osteoporosis knowledge , self-efficacy , self-management skills or behaviour . Material s and methods Using a wait list r and omised controlled trial design , 198 people ( 92 % female ) recruited from the community and aged over 40 ( mean age = 63 ) were r and omised into control ( n = 95 ) and intervention ( n = 103 ) groups . The OPSMC consists of four weekly sessions which run for 2 h and are led by two facilitators . The primary outcome were osteoporosis knowledge , health-directed behaviour , self-monitoring and insight and self-efficacy . Results The groups were comparable at baseline . At 6-week follow-up , the intervention group showed a significant increase in osteoporosis knowledge compared with the control group ; mean change 3.5 ( p < 0.001 ) on a measure of 0–20 . The intervention group also demonstrated a larger increase in health-directed behaviour , mean change 0.16 ( p < 0.05 ) , on a measure of 0–6 . Conclusion The results indicate that the OPSMC is an effective intervention for improving underst and ing of osteoporosis and some aspects of behaviour in the short term PURPOSE The purpose of this pilot study was to determine if tailored nursing interventions based on personal knowledge of bone mineral density from a dual-energy x-ray absorptiometry cause increases in knowledge of osteoporosis , health beliefs , or osteoporosis-prevention behaviors in postmenopausal women 50–65 years of age , 6 months after the intervention . METHOD The design for this pilot study was a two group quasi-experimental design . The treatment group received a tailored intervention ; the control group did not . Outcome data were gathered at 6 months after dual-energy x-ray absorptiometry . The tailored intervention was design ed and given to each woman via telephone using her dual-energy x-ray absorptiometry results and osteoporosis question naire data that addressed her knowledge of osteoporosis and osteoporosis-prevention behaviors of calcium intake , exercise , smoking , and alcohol use . A written mailed copy of the intervention followed the telephone interview . Six months after the intervention , the women were mailed another osteoporosis question naire to determine if the tailored intervention made a difference in the outcome variables . SAMPLE A total 124 women between the ages of 50 and 65 ( 101 control , 23 treatment ) comprised the sample . RESULTS There was no difference in knowledge between groups . On the average , there were significantly more perceived barriers to calcium in the tailored group ( mean = 13.48 ) than in the nontailored group ( mean = 11.55 ) ( t = 2.147 ; df = 122 ; p = .034 ) . There were significantly more perceived barriers to exercise in the tailored group ( mean = 14.39 ) than in the nontailored group ( mean = 12.21 ) ( t = .144 ; df = 122 ; p = .034 ) . Daily calcium intake increased in both the tailored and the nontailored groups . The tailored intervention increased women 's daily calcium intake from 614.28 to 1039.10 mg ( t = −2.896 ; df = 22 ; p = .008 ) . The nontailored group daily calcium intake increased from 587.91 to 916.30 mg ( t = −3.541 ; df = 100 ; p = .001 ) ; there was no significant difference between the groups . Weight-bearing exercise behaviors decreased from 96.04 minutes to 59.2 minutes in the tailored group but increased slightly in the nontailored group from 81.47 to 87.26 minutes of exercise . CONCLUSION Tailored interventions  increased women 's perceived barriers to calcium and exercise . Both groups increased calcium intake . The mixed findings of increased perception of barriers to calcium and exercise and decreased exercise behaviors indicate the need for further study . This important intervention has implication s for orthopaedic nurses and healthcare professionals involved in health promotion and prevention of osteoporosis Summary Using a protocol led intervention program , pharmacists can decrease nonadherence to osteoporosis medication , by continuous monitoring and tailored counseling sessions , starting at treatment initiation . In the usual care group , 32.8 % of patients initiating osteoporosis medication discontinued or were nonadherent , compared to 19.0 % of patients in the intervention group . Purpose While community pharmacies have been shown to offer a promising platform for osteoporosis management in patients with osteoporosis , more research is needed to determine pharmacists ’ effects on improving adherence . The aim of this study was to determine the effects of a community pharmacists ’ intervention program on the 1-year discontinuation and nonadherence rates of patients initiating osteoporosis medication . Methods This intervention study included 937 patients , recruited from 13 Dutch community pharmacies , initiating osteoporosis medication . The intervention group ( N = 495 ) , received the Medication Monitoring and Optimization ( MeMO ) intervention , comprising of continuous monitoring of patients ’ adherence to their osteoporosis medication and tailored counseling sessions with nonadherent patients . Results were compared to an internal ( n = 442 ) reference group , receiving usual pharmacy care . Primary study outcomes were therapy discontinuation and nonadherence ; results were adjusted for potential confounders using Cox proportional hazard analysis . Secondary outcome was patients ’ satisfaction . Results In the usual care group , 32.8 % of patients initiating osteoporosis medication discontinued or were nonadherent , compared to 19.0 % of patients in the intervention group ( P < 0.001 ) . Ninety-three percent of the respondents were satisfied with the pharmacies ’ services provided . Notably , 31 % mentioned that the pharmacy was the only place where they received information on various aspects of administration and acting of their medication . Conclusion Pharmacists can decrease nonadherence and discontinuation with osteoporosis medication by providing tailored counseling sessions and continuous monitoring of drug use . Pharmaceutical care programs , such as MeMO , contribute to more optimal use of osteoporosis medication BACKGROUND Systemic glucocorticoids are often used in the treatment of chronic rhinosinusitis with nasal polyps ( CRSwNP ) , and osteoporosis is a well-known complication to steroid treatment , associated with significant morbidity . Nevertheless , the burden of steroid induced osteoporosis is unknown in patients with CRSwNP . We aim ed to assess the risk of acquiring osteoporosis caused by oral steroids in patients with CRSwNP , and provide recommendations on future research and guidelines . METHODOLOGY Cochrane Review Data base , EMBASE , Ovid Medline , and PubMed were search ed for studies including adult patients with CRSwNP treated with oral steroids .  Outcomes were Bone Mineral Density ( BMD ) and prevalence of fractures in relation to dose and duration of oral steroids . In addition , we review ed general guidelines for treatment with oral steroids . RESULTS We identified two studies ( n=243 ) that met the inclusion criteria . Doses and duration s of oral steroids were over 5 mg/day for more than 3 months and 1 mg/kg body weight/day for 6 to 10 days for 4 or more courses/year . The prevalence of low bone mass was 39 % and 61 % , respectively . It was not possible to quantify the overall risk of osteoporosis induced by oral steroids from the studies . No studies evaluated prevalence of fracture . CONCLUSIONS Registry studies and r and omized controlled trials would be needed to assess the risk of osteoporosis in CRSwNP patients and future guidelines should include recommendations regarding preventive treatment and recommendations on doses and duration s of oral steroids Background : Osteoporosis prevention behaviors ( OPBs ) can prevent and delay bone deterioration ; dual-energy X-ray absorptiometry ( DXA ) scan can identify osteoporosis and provide personal osteoporosis risk information that may promote prevention behaviors . Objectives : This study was design ed to estimate relationships between receiving personal knowledge of bone mineral density ( gained through DXA scan ) , general knowledge of osteoporosis , health beliefs , and the two OPBs of calcium intake and weight-bearing exercise in healthy postmenopausal women 50 to 65 years . Methods : In this longitudinal , r and omized clinical trial ( including covariates ) , receipt of personal DXA information was manipulated by r and om assignment to the experimental or control group . The remaining antecedent and outcome variable measures were collected by question naire at three time points ( initial [ T1 ; pre-DXA ] , 6 months [ T2 ] , 12 months [ T3 ] ) and by bone density assessment from 203 women over an 18-month period in 2001 - 2003 . Results : The experimental manipulation ( DXA results ) had a direct positive effect ( & bgr ; = .23 , p < .05 ) on calcium intake at T2 , and indirectly at T3 through T2 . Women in the experimental group who were informed they had osteopenia or osteoporosis had a greater T1-T2 change in daily calcium intake than those with normal bone density ( & bgr ; = .23 , p < .05 ) . However , providing DXA results did not relate to change in exercise . Health beliefs and general osteoporosis knowledge predicted initial calcium and exercise levels ; there was tentative evidence that susceptibility beliefs partially mediate between DXA results and change in calcium intake . Discussion : Personal knowledge of DXA results was related significantly to increases in calcium intake in postmenopausal women , but not to exercise . Directions for further study are discussed Summary This article explores the effect of a group-based exercise program and an educational session on the fear of falling among 89 women with osteoporosis and a history of vertebral fracture . This r and omized clinical trial showed that the intervention had a positive and durable effect on the fear of falling . Introduction The aim of this study was to evaluate the effect of an intervention on fear of falling in women with osteoporosis and a history of vertebral fracture . Methods The study was a parallel-group r and omized clinical trial with a blinded assessor . The participants were 89 community-dwelling elderly women with osteoporosis and a history of vertebral fracture . The intervention group ( IT , n = 47 ) received a 3-month group-based circuit exercise program combined with a 3-h educational session focusing on the reduction of the risk of falls and challenges specific to osteoporosis and vertebral fractures . The control group ( CT , n = 42 ) continued with their usual activities . Clinical outcomes were assessed at baseline , postintervention and 12 months after r and omization . This article reports on the secondary outcome Falls Efficacy Scale — International ( FES-I ) from a previously reported trial . Results We found a significantly better result for the IT group compared with the CT group , both at 3 months ( p = 0.004 ) and 12 months ( p < 0.001 ) follow-up . The effect size at 3 months was small ( 0.4 ) and at 12 months moderate ( 0.7 ) . Multiple regression analysis confirmed the effect of the intervention . Conclusion The intervention had a positive and durable effect on fear of falling as measured with the Summary In Spain , various treatments are available to prevent osteoporotic fractures . A discrete choice experiment ( DCE ) was used to investigate the importance of different treatment aspects and its influence on patients ’ preferences . All attributes included as type and place of drug administration as well as costs showed to be significant predictors of choice . Spanish osteoporosis patients have well-defined preferences and accept trade-offs among attributes . Introduction This study was design ed to identify patient preferences for different aspects of osteoporosis treatments in Spain . Methods Main attributes of severe osteoporosis treatments were determined by literature review and consultations with nurses . The discrete choice experiment included three attributes : type of drug administration , place of administration , plus a cost attribute in order to estimate willingness to pay for improvements in attribute levels . A pilot study with 50 patients was performed to identify the areas of misunderst and ing . One hundred sixty-six patients with a diagnosis of osteoporosis and severe osteoporosis were presented with pairs of hypothetical treatment profiles with different type of administration levels , places of administration and costs . Questions to collect socio-demographic and disease-related treatment data were also included . Data were analysed using a r and om effects probit model . Results All attributes had the expected polarity and were significant predictors of choice . Patients were willing to pay 183 € /month to have a subcutaneous injection once per day rather than an intravenous injection once per year . Patients with osteoporosis were willing to pay 121 € /month to have medical support when administering the drug treatment at home rather than being admitted several hours to a hospital for drug administration . ConclusionS panish osteoporosis patients have well-defined preferences among treatment attributes and are willing to accept trade-offs among attributes . Participants indicated that they are willing to accept self medication with medical support rather than being hospitalised for several hours . The perspective of the patients should be taken into account when making treatment decisions Background There is a growing dem and for services whereby individuals receive assistance from care workers for personal care within the home . This has led to the development of re-ablement or restorative homecare services that provide time-limited input aim ed at reducing dependency in personal activities of daily living , and preventing or delaying the need for further homecare support . However , little is currently known about how such interventions are configured , or how they may affect individuals ’ ability to carry out personal care independently . Methods / Design We will seek to identify studies that compare an intervention design ed to reduce dependency in personal activities of daily living with routine input or usual care as the control . We will include r and omised controlled trials , nonr and omised controlled trials , and controlled before and after studies . We will also include interrupted time series studies .We shall search electronic data bases in addition to search ing for ongoing and unpublished studies , and where appropriate will contact key authors . Two review ers will independently screen articles for inclusion ; will assess risk of bias using quality assessment tools ; and will carry out data extraction using pre-prepared forms . Any disagreements , at any stage , will be resolved by discussion and the involvement of a third review er if needed . We will produce a narrative summary of the results . A meta- analysis will be conducted if sufficient data are available of appropriate quality and comparability . Discussion The findings from this review will inform future practice within homecare re-ablement services ; will inform policy decisions about the structure , organisation and content of such services ; and will identify areas where further research is warranted . Systematic review registration This review protocol has been registered on the PROSPERO data base ( CRD42013004163 ) Burke TN , França FJR , de Meneses SRF , Cardoso VI , Marques AP : Postural control in elderly persons with osteoporosis : Efficacy of an intervention program to improve balance and muscle strength : A r and omized controlled trial . Objective : To assess the efficacy of an exercise program aim ing to improve balance and muscular strength , for postural control and muscular strength of women with osteoporosis . Design : Sample consisted of 33 women with osteoporosis , r and omized into one of two groups : intervention group , in which exercises for balance and improvement of muscular strength of the inferior members were performed for 8 wks ( n = 17 , age 72.8 ± 3.6 yrs ) ;  control  group , which was women not practicing exercises ( n = 16 , age 74.4 ± 3.7 yrs ) . At baseline and after 8 wks of treatment , postural control was assessed using a force plate ( Balance Master , Neurocom ) , and muscular strength during ankle dorsiflexion , knee extension , and flexion was assessed by dynamometry . Results : Adherence to the program was 82 % . When compared with the control group , individuals in the intervention group significantly improved the center of pressure velocity ( P = 0.02 ) in the modified clinical test of sensory interaction for balance test , center of pressure velocity ( P < 0.01 ) , and directional control ( P < 0.01 ) in limits of stability test , isometric force during ankle dorsiflexion ( P = 0.01 ) , knee extension ( P < 0.01 ) , and knee flexion ( P < 0.01 ) . Conclusions : Balance and strength exercises are effective in improving postural control and lower-limb strength in elderly women with osteoporosis The National Institutes of Health 's consensus conference ( 1 ) defined osteoporosis as a skeletal disorder characterized by compromised bone strength predisposing to an increased risk for fracture . Bone strength reflects the integration of two main features : bone density and bone quality .Bone quality refers to architecture , turnover , damage accumulation ( e.g. , microfractures ) , and mineralization . Although osteoporosis can affect any bone , the hip , spine , and wrist are most likely to be affected . Osteoporosis affects an estimated 44 million Americans or 55 % of people 50 years of age or older . Another 34 million Americans are estimated to have low bone mass , meaning that they are at an increased risk for osteoporosis . Osteoporosis can be diagnosed by the occurrence of fragility fracture . In patients without fragility fracture , osteoporosis is often diagnosed by low bone density .  Dual x-ray absorptiometry ( DXA ) is the current gold st and ard test for diagnosing osteoporosis in people without an osteoporotic fracture .  Dual x-ray absorptiometry results are scored as st and ard deviations ( SDs ) from a young healthy norm ( usually female ) and reported as T-scores . For example , a T-score of 2 indicates a bone mineral density that is 2 SDs below the comparative norm . The international reference st and ard for the description of osteoporosis in postmenopausal women and in men age 50 years or older is a femoral neck bone mineral density of 2.5 SD or more below the young female adult mean ( 2 ) . Low bone density , as measured by DXA , is an imperfect predictor of fracture risk , identifying fewer than half the people who go on to have an osteoporotic fracture . Screening guidelines for women are well established ( 3 ) , and the American College of Physicians ( ACP ) recently published guidelines on screening for men ( 4 ) . This guideline presents the available evidence on various pharmacologic treatments to prevent fractures in men and women with low bone density or osteoporosis . Medications used to treat osteoporosis may affect different parts of the skeletal system differently , and efficacy for vertebral fractures does not necessarily imply efficacy for nonvertebral fractures . The target audience for this guideline is all clinicians and the target patient population is all adult men and women with low bone density or osteoporosis . These recommendations are based on the systematic evidence review by MacLean and colleagues ( 5 ) and the Agency for Healthcare Research and Quality sponsored Southern California Evidence -Based Practice Center evidence report ( 6 ) . The drugs currently approved for prevention of osteoporosis include alendronate , ib and ronate , risedronate , zoledronic acid , estrogen , and raloxifene . The drugs currently approved for treatment of osteoporosis include alendronate , ib and ronate , risedronate , calcitonin , teriparatide , zoledronic acid ( in postmenopausal women ) , and raloxifene . Testosterone , pamidronate , and etidronate are not approved by the U.S. Food and Drug Administration for the treatment or prevention of osteoporosis . Methods The literature search done by MacLean and colleagues for the systematic review ( 5 ) included studies from MEDLINE ( 1966 to December 2006 ) , the ACP Journal Club data base , the Cochrane Central Register of Controlled Trials ( no date limits ) , the Cochrane Data base of Systematic Review s ( no date limits ) , Web sites of the United Kingdom National Institute of Health and Clinical Excellence ( no date limits ) , and the United Kingdom Health Technology Assessment Program ( January 1998 to December 2006 ) . The review ers limited their search to English- language publications and human studies . They derived evidence for comparative benefits of various treatments exclusively from r and omized , controlled trials , whereas they included evidence from other types of studies for short- and long-term harms . Two physicians independently abstract ed data about study population s , interventions , follow-up , and outcome ascertainment by using a structured form . For each group within a r and omized trial , a statistician extracted the sample size and number of persons reporting fractures . Two review ers , under the supervision of the statistician , independently abstract ed information about adverse events . The statistician or the principal investigator resolved disagreements . This guideline is based on an evaluation of 76 r and omized , controlled trials , 4 of which were identified in the up date d search , and 24 meta-analyses that were included in the efficacy analyses . The analyses of adverse events included 491 articles , representing 417 r and omized trials , 25 other controlled clinical trials , 11 open-label trials , 31 large observational studies , and 9 case reports of osteonecrosis among bisphosphonate users . MacLean and colleagues ' background article ( 5 ) includes details about the methods used for the systematic evidence review . The ACP rates the evidence and recommendations by using the Grading of Recommendations , Assessment , Development , and Evaluation ( GRADE ) system with minor modifications ( Table 1 ) . In addition , the evidence review ers used predefined criteria to assess the quality of systematic review s and r and omized trials , based on internal and external validity assessment s detailed in the Quality of Reporting of Meta-Analyses ( QUOROM ) statement ( 7 ) . Table 1 . The American College of Physicians ' Guideline Grading System The objective of this guideline is to synthesize the evidence for the following questions : What are the comparative benefits in fracture reduction among and also within the following treatments for low bone density :  bisphosphonates , specifically alendronate , risedronate , etidronate , ib and ronate , pamidronate , and zoledronic acid ; calcitonin ; estrogen for women ; teriparatide ; selective estrogen receptor modulators ( SERMs ) , specifically raloxifene and tamoxifen ; testosterone for men ; vitamins and minerals , specifically vitamin D and calcium ; and the combination of calcium plus vitamin D ? How does fracture reduction result ing from treatments vary among individuals with different risks for fracture as determined by bone mineral density ( borderline , low , or severe ) , previous fractures ( prevention vs. treatment ) , age , sex , glucocorticoid use , and other factors ( such as community-dwelling vs. institutionalized or vitamin Ddeficient vs. not ) ? What are the short- and long-term harms ( adverse effects ) of these therapies , and do these vary by specific sub population s ? Comparative Benefits of Drugs versus Placebo in Fracture Reduction Evidence from 24 meta-analyses ( 830 ) and 35 additional r and omized trials published after the meta-analyses ( 3165 ) described the effect of 9 of the 14 agents ( alendronate , etidronate , risedronate , calcitonin , estrogen , teriparatide , raloxifene , calcium , and vitamin D ) on fracture incidence . For 4 agents ( ib and ronate , pamidronate , zoledronic acid , and tamoxifen ) , the review ers found no meta-analyses and instead gathered the evidence from 14 r and omized trials ( 6679 ) . No studies were found that reported fracture rates for testosterone . Three r and omized trials ( 35 , 80 , 81 ) and 1 meta- analysis ( 82 ) evaluated the combination of calcium plus vitamin D  on fractures .  Bisphosphonates Good- quality evidence showed that alendronate , etidronate , ib and ronate , and risedronate prevent vertebral fractures . In addition , evidence from good- quality studies demonstrated that both alendronate and risedronate prevent nonvertebral and hip fractures . Two large r and omized trials showed that zoledronic acid prevents vertebral and nonvertebral fractures in high-risk population s and reduces the risk for hip fracture ( 67 , 74 ) . Ib and ronate has not been shown to reduce nonvertebral fractures ( 68 ) . Of the 6 fairly small trials that looked at vertebral fractures , 1 demonstrated a statistically significant reduction in fractures with pamidronate relative to placebo ( 0.14 [ 95 % CI , 0.03 to 0.72 ] ) ( 73 ) . However , after these data were pooled , the pooled risk estimate for fractures for pamidronate relative to placebo was not significant ( 0.52 [ CI , 0.21 to 1.24 ] ) ( 6 ) . Calcitonin Fair- quality evidence shows that calcitonin reduces vertebral fractures ( 83 , 84 ) . Good- quality evidence indicates that calcitonin does not reduce nonvertebral fractures ( 13 , 16 ) . Estrogen Good- quality evidence shows that estrogen reduces the incidence of vertebral ( 29 , 85 ) , nonvertebral ( 86 ) , and hip fractures ( 85 ) . Teriparatide Good- quality evidence shows that teriparatide prevents vertebral fractures . The evidence related to teriparatide preventing nonvertebral fractures is mixed ; 1 large r and omized trial showed a reduction in nonvertebral fractures ( 34 ) but 2 small trials did not ( 87 , 88 ) . SERMs Good- quality evidence shows that raloxifene prevents vertebral fractures , but that tamoxifen has no effect on vertebral fractures ( 8991 ) . In addition , both raloxifene and tamoxifen had no effect on hip fractures ( 91 ) . Tamoxifen is not approved by the U.S. Food and Drug Administration for the treatment or prevention of osteoporosis . Testosterone No studies reported fracture rates for testosterone . Calcium and Vitamin D In the studies evaluated by MacLean and colleagues ( 5 ) , the evidence for the effect of calcium alone on reduction of fractures is complex . Most studies of pharmacologic agents for osteoporosis include calcium and vitamin D as part of the treatment regimen . Evidence from 1 meta- analysis ( 27 ) and several r and omized trials ( 35 , 48 , 51 , 92 ) showed no significant difference between calcium and placebo in preventing vertebral , nonvertebral , and hip fractures in postmenopausal women . However , nonadherence to therapy may influence this result , and 1 trial with a prespecified analysis of adherent patients found a reduction in fracture risk ( 48 ) . A recent meta- analysis ( 82 ) concluded that the relative risk ( RR ) for fracture with calcium alone was 0.90 ( CI , 0.80 to 1.00 ) , but it did not include a modestly large trial with negative results ( 35 ) . MacLean and colleagues ( 5 ) Summary R and omized controlled study in 80 postmenopausal women with osteoporosis was conducted to investigate the effect of a home-based , simple , low-intensity exercise . Low-intensity back-strengthening exercise was effective in improving the quality of life and back extensor strength . Introduction and hypothesisBack-strengthening exercise is effective in increasing back extensor strength and decreasing risk of vertebral fractures . We hypothesized that a home-based , simple , low-intensity exercise could enhance back extensor strength and improve the quality of life and /or spinal range of motion in postmenopausal women in a short-term follow-up . Methods Eighty postmenopausal women with osteoporosis were r and omly assigned to a  control group ( n = 38 ) or an exercise group ( n = 42 ) . Subjects were instructed to lift their upper trunk from a prone position antigravity and maintain the neutral position . Isometric back extensor strength , spinal range of motion , and scores for quality of life were evaluated at baseline and 4 months . Results Back extensor strength significantly increased both in the exercise group ( 26 % ) and in the control group ( 11 % ) . Scores for quality of life increased in the exercise group ( 7 % ) , whereas it remained unchanged in the control group ( 0 % ) . There was a significant difference in quality of life score between the groups ( p = 0.012 ) . Conclusions Low-intensity back-strengthening exercise was effective in improving the quality of life and back extensor strength in patients with osteoporosis Research ers conducting systematic review s need to search multiple bibliographic data bases such as MEDLINE and EMBASE . However , research ers have no rational search stopping rule when looking for potentially-relevant articles . We empirically tested a stopping rule based on the concept of  capture-mark-recapture ( CMR ) , which was first pioneered in ecology . The principles of CMR can be adapted to systematic review s and meta-analyses to estimate the Horizon of articles in the literature with its confidence interval . We retrospectively tested this Horizon Estimation using a systematic review of r and omized controlled trials ( RCTs ) that evaluated clinical decision support tools for osteoporosis disease management . The Horizon Estimation was calculated based on 4 bibliographic data bases that were included as the main data sources for the review in the following order : MEDLINE , EMBASE , CINAHL , and EBM Review s. The systematic review captured 68 % of known articles from the 4 data sources , which represented 592 articles that were estimated as missing from the Horizon Introduction Despite the high risk for subsequent fracture following an initial osteoporotic fracture , the majority of subjects with minimal trauma fractures receive no treatment for osteoporosis . The primary aim of this investigation was to determine whether an information-based intervention could change post-fracture management of osteoporosis . A secondary aim was to define participant- and doctor-related barriers to osteoporosis management . Methods Consecutive fracture patients ( n=254 ) from the outpatient fracture clinic at St Vincent ’s Hospital , Sydney were interviewed over a 15-month period ( February 2002–July 2003 ) . Fracture risk factors , prior investigation and treatment for osteoporosis were collected at baseline . Participants were initially contacted after 3 months to ascertain follow-up management . All those not investigated or treated by their primary care physician were then r and omized to either a personalized letter or the same letter plus an offer of a free bone mineral density ( BMD ) test . Participants were contacted after 9 months to record further investigations or treatment for osteoporosis . Results Less than 20 % of the participants had a primary care physician follow-up 3 months after the fracture , leaving 159 who were r and omized to a personalized letter ( n=79 ) and a personalized letter plus the offer of a free BMD test ( n=80 ) . There was a significant increase in the number of people investigated for osteoporosis in the group receiving the letter plus BMD offer [ 38 % ( letter + BMD ) vs. 7 % ( letter only ) ; p=0.001 ) . A high proportion of those tested had low BMD ( 49 % osteopenia and 17 % osteoporosis ) . However , the rates of treatment in both groups were very low ( 6 % ) . Furthermore , even among the few individuals ( 23 % ) who contacted their primary care physician , only 25 % were recommended treatment . The belief that the fracture was osteoporotic was an independent predictor of having a BMD test , a primary care physician follow-up and treatment . Other independent predictors were age over 50 years for a primary care physician follow-up , female sex for having a BMD test and having had a BMD test for treatment . Conclusion This study demonstrates that an information-based intervention led to a modest increase in the proportion of people investigated for osteoporosis ; however . there was no significant effect on treatment rates . The offer of a free BMD assessment was associated with a significantly higher rate of investigation than a personalized letter alone ( odds ratio : 8.5 ; 95 % confidence interval : 3.1–24.5 ) , but this investigation did not affect treatment rate . The low uptake of either a BMD or a visit to a primary care physician together with low rates of treatment recommendation even among people who contacted their primary care physician reflects significant participant and doctor-related barriers to osteoporosis management
Conclusions A multicomponent exercise program of high-speed training combined with simulated functional tasks is promising to enhance functional outcomes .
Due to substantial clinical heterogeneity of the target groups and specific dem and s of exercise modes , it is unclear which exercise program is optimal
Summary Osteoporosis affects many aspects of daily life .
The aim of this systematic review was to assess the effects of exercise interventions on functional outcomes in persons with osteoporosis , in comparison with controls .