Nonpharmacological approaches to improve bone health and reduce osteoporosis.
OBJECTIVE
With an aging population, osteoporosis has become a public health concern and an area of increased awareness among both patients and medical practitioners. Timely screening and pharmacologic treatment of low bone mass effectively reduces fracture risk. Nonpharmacologic interventions, however, deserve equal emphasis both in the prevention and treatment of osteoporosis.


RESULTS
Recent advances in bone biology have established that exercise in the form of short, repetitive mechanical loading leads to the greatest gains in bone strength. As demonstrated by both observational and randomized exercise intervention trials, these gains are best achieved in childhood but can be maintained in adulthood with continued regular weight-bearing exercise. In the later years, evidence supports the implementation of balance training to decrease fall risk, especially in elderly patients with low bone mass. Following an osteoporotic fracture, a multidisciplinary rehabilitation program with an emphasis on early mobilization, fall prevention, use of orthoses, and noninvasive surgical procedures is emerging as a promising approach.


CONCLUSIONS
Clinically, these findings should imply greater emphasis on high impact exercise during skeletal growth and on maintenance of weight bearing and balance training in the later years. Future research should examine the effect of these interventions on fracture prevention.
Schwab
Pascale
P
Division of Arthritis and Rheumatic Diseases, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA. schwabp@ohsu.edu
Klein
Robert F
RF
D000058:Accidental Falls / Q000517:prevention & control; D015519:Bone Density / Q000502:physiology; D015444:Exercise; D005081:Exercise Therapy / Q000379:methods*; D006620:Hip Fractures / Q000517:prevention & control / Q000534:rehabilitation; D006801:Humans; D010024:Osteoporosis / Q000534:rehabilitation* / Q000628:therapy