[Nonpharmacological treatments for osteoporosis].
OBJECTIVE
Study the effectiveness of nonpharmacological treatments for osteoporosis.


METHODS
Review and qualitative analysis of the literature concerning the effectiveness of nonpharmacological treatments: physical exercise, rehabilitation aiming to prevent falls, spinal orthosis, and vertebro- and kyphoplasty.


RESULTS
The level of evidence of the effectiveness of nonpharmacological treatment is unequal on the basis of randomized study. The practice of physical exercise by the ambulatory elderly people and home rehabilitation for those who have previously fallen prevent the occurrence of falls. For institutionalized people, the prevention of falls is achieved by multidisciplinary programs. The use of hip protectors to prevent fracture is controversial. Physical exercises prevent bone loss after menopause and during postmenopausaul and corticosteroid osteoporosis. The effectiveness of mobilization after fracture is not documented. Only one study concerning the use of spinal orthosis after vertebral fracture reports interesting results for pain and disability. No randomized study concerning vertebroplasty or kyphoplasty for osteoporotic vertebral fracture is described.


CONCLUSIONS
The nonpharmacological treatments of osteoporosis are considered therapeutic means of key importance. They aim at the prevention of falls and bone loss and the reduction of disability after fracture. Only physical exercise and rehabilitation have been shown to be effective in preventing falls or bone loss. Their ability to reduce the incidence of fractures remains to be evaluated.
Beaudreuil
J
J
Fédération de rhumatologie, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France. johann.beaudreuil@lrb.ap-hop-paris.fr
D000058:Accidental Falls / Q000517:prevention & control / Q000706:statistics & numerical data; D000305:Adrenal Cortex Hormones / Q000009:adverse effects; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D015444:Exercise; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D008297:Male; D008593:Menopause; D015201:Meta-Analysis as Topic; D008875:Middle Aged; D009989:Orthotic Devices; D010024:Osteoporosis / Q000139:chemically induced / Q000150:complications / Q000628:therapy*; D017698:Postmenopause; D003668:Pressure Ulcer / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D012737:Sex Factors; D016103:Spinal Fractures / Q000209:etiology / Q000517:prevention & control / Q000601:surgery; D013123:Spinal Fusion; D013177:Sports; D013997:Time Factors
D000305:Adrenal Cortex Hormones