Effect of Exercises on Quality of Life in Patients with Postmenopausal Osteoporosis - Randomized Trial

Effect of adding diaphragmatic breathing to corrective exercises on kyphotic angle and diaphragmatic excursion in postmenopausal kyphotic women: A randomized controlled trial

BACKGROUND

Age-related thoracic kyphosis can impair posture, diaphragmatic excursion, respiratory function, and overall quality of life (QoL).

PURPOSE

This randomized controlled trial aimed to compare the effects of corrective exercises alone versus combined with diaphragmatic breathing exercises on thoracic kyphosis, diaphragmatic excursion, thoracic pain, and QoL in postmenopausal kyphotic women.

METHODS

Forty postmenopausal women diagnosed with thoracic kyphosis were randomly divided into two groups. Group A received corrective exercises for 12 weeks (n = 20), while Group B received both diaphragmatic breathing exercises and corrective exercises for the same duration (n = 20). Primary outcome measures were thoracic kyphosis angle and diaphragmatic excursion, while secondary outcome measures were thoracic pain and QoL. Both groups were assessed pre- and post-intervention using a flexible curve ruler for the thoracic kyphosis angle, ultrasonography for the diaphragmatic excursion, the visual analog scale for thoracic pain, and the Arabic version of the QoL Questionnaire of the European Foundation for Osteoporosis for QoL.

RESULTS

Both groups showed significant within-group improvements in all measures post-intervention (p < 0.05). Between-group comparisons post-intervention revealed no significant differences (p > 0.05) except for diaphragmatic excursion, where Group B showed significantly greater improvement (p < 0.05).

CONCLUSIONS

A 12-week program of corrective exercises alone or combined with diaphragmatic breathing exercises significantly improved kyphosis angle, thoracic pain, and QoL in postmenopausal kyphotic women. The addition of diaphragmatic breathing exercises provided further benefits by increasing diaphragmatic excursion to a greater degree compared with corrective exercises alone.

Dietary Behaviors, Serum 25(OH)D Levels and Quality of Life in Women with Osteoporotic Disorders

Data obtained in recent years clearly demonstrate the aging process of European populations. Consequently, the incidence of osteoporosis has been rising. The aim of this study is to assess the quality of life (QoL) of women with osteoporosis. A total of 260 women participated in this study. The patient group consisted of 170 women with osteoporotic disorders. The control group consisted of 90 healthy women. Participants' quality of life was measured with the Qualeffo-41 Questionnaire. The total 25(OH)D concentration level was assessed with an assay using the chemiluminescent immunoassay. To assess the pain level, the Visual Analogue Scale (VAS) was used. To assess dietary behaviors, data were obtained by a 13-item Food Frequency Questionnaire. To assess the nutrition knowledge of participants, the Beliefs and Eating Habits Questionnaire was used. Based on the frequency of food intake, participants were classified into three patterns of behavior, i.e., Prudent, Western, and Not Prudent-Not Western. The patients assessed their quality of life as average (36.6 ± 19.9 points). The most favorable scores were obtained in the domains of "Ability to do jobs around the house" and "Mobility". The worst rated domain among the respondents was "Mental function". There were significant differences identified in quality of life depending on diet, nutritional knowledge, comorbidities and occurrence of fractures in the subjects. The individuals in the "Prudent" group reported a significantly higher quality of life as compared to the "Not Prudent-Not Western" and "Western" groups and those with high nutritional knowledge as compared to those with moderate and low. Lower quality of life was also observed among women with comorbidities and with bone fractures. Depending on serum 25(OH)D levels, poorer quality of life was characterized women with vitamin D deficiency. Patient education, implementation of effective methods aimed at alleviating pain and maintaining the optimal concentration of vitamin D can help improve the quality of life in patients with osteoporotic disorders.

Assessment of the importance of physical activity and quality of life for patients diagnosed with osteoporosis during the COVID-19 pandemic

Introduction. Osteoporosis is one of the most important ten diseases worldwide, still causing extreme suffering to patients and huge costs to the health system. The rapid increase of the population 's aging was involved in many aspects of human health, and, among these ones, osteoporosis was one of the main public health issues. The aim of the study was to assess the importance of physical activity and the quality of life in patients diagnosed with osteoporosis during the COVID-19 pandemic. Material and methods. The study is longitudinal, it was conducted in an outpatient setting for a period of 1 year and it included 20 patients diagnosed with osteoporosis. The demographic variables (age, living environment, body mass index) were assessed, and as parameters: pain (VAS scale), fracture risk (FRAX score), quality of life (Qualeffo-41 questionnaire), bone mineral density at the spine and at the femur (DEXA). The patients received pharmacological treatment such as bisphosphonates and underwent physiotherapy for pains: low frequency currents (TENS), ultrasound and physical therapy. Results and discussions. In all the studied cases, it was considered that the pain decreased following the use of the medicinal and physiotherapeutic treatment. This is an expected result given that other studies have shown this. Postmenopausal women in Romania with osteoporosis have a lower HRQoL than healthy controls, measured with the SF-36 instrument and the total QUALEFFO-41 score. Conclusions. The obtained data point out the correlation between bone mineral density, fracture risks and exercises in patients diagnosed with osteoporosis. The FRAX score is useful to identify patients who need the combination of drug therapy and exercises to prevent vertebral and non-vertebral fractures in the next 10 years. Keywords: osteoporosis, physical activity, quality of life, COVID-19,

An Up-Date of the Muscle Strengthening Exercise Effectiveness in Postmenopausal Women with Osteoporosis: A Qualitative Systematic Review

BACKGROUND

Osteoporosis (OP) is a systemic disease that is characterized by decreased bone density and quality. Purpose: The purpose of this systematic review was to determine the effects of muscle strengthening exercise in postmenopausal women with OP. Methods: A literature search was conducted systematically in MEDLINE, CINAHL, EMBASE databases for human studies up to 31 March 2021. Two researchers screened the articles against predefined inclusion criteria; a third resolved discrepancies. Articles were included if they assessed the effects of muscle strengthening exercise in postmenopausal women with OP. The protocol for this systematic review was registered on PROSPERO (CRD42021207917) and a qualitative systematic review was carried out following the PRISMA statement. Methodological quality was evaluated through the scientific validity scales PEDro. Finally, RTCs and NRCTs risk of bias was assessed with the Cochrane risk of bias tool (Risk of Bias-ROB 2.0) and ROBINS-1, respectively. Results: A total of 16 studies (1028 subjects) that met the different eligibility criteria previously established were selected. There is evidence of good methodological quality and a low to moderate risk of bias that supports that muscle strengthening exercise alone or in combination with other therapeutic modalities improves BMD (9, n = 401) in proximal femur and lumbar vertebra body, muscle strength (10, n = 558), balance (4, n = 159), functionality (7, n = 617), and quality of life (5, n = 291).

CONCLUSIONS

Exercise programs focused on muscle strengthening have benefits for all variables studied in postmenopausal women with OP.

Progressive Resistance Training for Improving Health-Related Outcomes in People at Risk of Fracture: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

OBJECTIVE

Osteoporosis clinical practice guidelines recommend exercise to prevent fractures, but the efficacy of exercise depends on the exercise types, population studied, or outcomes of interest. The purpose of this systematic review was to assess the effects of progressive resistance training (PRT) on health-related outcomes in people at risk of fracture.

METHODS

Multiple databases were searched in October 2019. Eligible articles were randomized controlled trials of PRT interventions in men and women ≥50 years with low bone mineral density (BMD) or fracture history. Descriptive information and mean difference (MD) and SD were directly extracted for included trials. A total of 53 studies were included.

RESULTS

The effects of PRT on the total number of falls (incidence rate ratio [IRR] = 1.05; 95% CI = 0.91 - 1.21; 7 studies) and on the risk of falling (risk ratio [RR] = 1.23; 95% CI = 1.00 - 1.51; 5 studies) are uncertain. PRT improved performance on the Timed "Up and Go" test (MD = -0.89 seconds; 95% CI = -1.01 to -0.78; 13 studies) and health-related quality of life (standardized MD = 0.32; 95% CI = 0.22-0.42; 20 studies). PRT may increase femoral neck (MD = 0.02 g/cm2; 95% CI = 0.01-0.03; 521 participants, 5 studies) but not lumbar spine BMD (MD = 0.02 g/cm2; 95% CI = -0.01-0.05; 4 studies), whereas the effects on total hip BMD are uncertain (MD = 0.00 g/cm2; 95% CI = 0.00-0.01; 435 participants, 4 studies). PRT reduced pain (standardized MD = -0.26; 95% CI = -0.37 to -0.16; 17 studies). Sensitivity analyses, including PRT-only studies, confirmed these findings.

CONCLUSION

Individuals at risk of fractures should be encouraged to perform PRT, as it may improve femoral neck BMD, health-related quality of life, and physical functioning. PRT also reduced pain; however, whether PRT increases or decreases the risk of falls, the number of people experiencing a fall, or the risk of fall-related injuries is uncertain.

IMPACT

Individuals at risk of fractures should be encouraged to perform PRT, as it may have positive effects on femoral neck BMD, health-related quality of life, physical functioning, and pain, and adverse events are rare.

LAY SUMMARY

Exercise is recommended for people at risk of osteoporotic fractures. Our study showed that progressive resistance training improves physical functioning, quality of life, and reduces pain. The effects of progressive resistance training on the risk of falling are unclear. Adverse events are rare, and often minor (eg, soreness, pain, musculoskeletal injury). Considering the benefits and safety, people at risk of fractures should engage in progressive resistance training interventions.

MiR-21 nanocapsules promote early bone repair of osteoporotic fractures by stimulating the osteogenic differentiation of bone marrow mesenchymal stem cells

Objective

The healing of osteoporotic fractures in the elderly patients is a difficult clinical problem. Currently, based on the internal fixation of fractures, the available drug treatments mainly focus on either inhibiting osteoclast function, such as bisphosphonate, calcitonin, oestrogen or promoting osteogenesis, such as parathyroid hormones. However, the availability of current antiosteoporotic drugs in promoting osteoporotic fracture healing is limited. The objective of the present study was to investigate the ability of the MiR-21/nanocapsule to enhance the early bone repair of osteoporotic fractures.

Methods

Based on the presence of matrix metalloproteinases that are overexpressed at the fracture site, we designed the matrix metalloproteinase–sensitive nanocapsules which were formed by in situ free radical polymerisation on the surface of MiR-21 with 2-(methacryloyloxy) ethyl phosphorylcholine and the bisacryloylated VPLGVRTK peptide. The MiR-21/nanocapsule [n (miR-21)] and O-carboxymethyl chitosan (CMCS) were mixed until they formed a gel-like material [CMCS/n (miR-21)] with good fluidity and injectability. Thirty elderly Sprague Dawley (SD) rats (female, 14-month-old, 380 ± 10 g) were subjected to bilateral removal of the ovaries (ovariectomised). All rats were subjected to bilateral bone defects (2 mm diameter) of the proximal tibia and randomly divided into three groups (groups A, B, and C): separately injected with CMCS/n (miR-21), CMCS/n (NC-miR), and saline. Micro-computed tomography (CT) imaging was performed to evaluate newly formed bone volume and connectivity. Nondecalcified histology and toluidine blue staining were performed to measure the effects of CMCS/n (miR-21) on bone repair. In vitro, the effect of n (miR-21) on osteogenic differentiation to bone marrow mesenchymal stem cells (BMSCs) which derived from the ovariectomised rat model was observed.

Results

The morphology of n (miR-21) was a regular spherical nanocapsule with a uniform small size (25–35 nm). The results confirmed that n (miR-21) could be efficiently phagocytosed by BMSCs and released in the cytoplasm to promote osteogenesis. The expression level of alkaline phosphatase and Runt-related transcription factor 2 mRNA in the n (miR-21) group was higher than that in the n (NC-miR) group. Animal experiments proved that CMCS/n (miR-21) produced better bone repair compared with the CMCS/n (NC-miR) group in the early stages of fracture healing at 4 weeks. In the late stage of fracture healing (8 weeks), micro-CT quantitative analysis showed that the new bone trabeculae in the CMCS/n (miR-21) group has decreased compared with the CMCS/n (NC-miR) group. In the CMCS/n (miR-21) group, the new cancellous bone had been absorbed, and the process of bone healing was almost completed. In contrast, the new bone in the CMCS/n (NC-miR) and the control groups was still in the healing process.

Conclusion

The cytological tests confirmed that n (miR-21) can promote osteogenic differentiation of BMSCs derived from the osteoporosis rat model. Furthermore, the results of animal tests demonstrated that local injection of CMCS/n (miR-21) promoted the early healing of osteoporotic bone defects. Consequently CMCS/n (miR-21) promoted the bone repair process to enter the moulding phase earlier.

The translational potential of this article

CMCS/n (miR-21) can be widely applied to elderly patients with osteoporotic fractures. This method can help patients with osteoporotic fractures recover earlier and avoid serious complications. It provides a potential approach for the clinical treatment of osteoporotic fractures in the elderly.

Effects of hip replacement combined with alendronate sodium on postoperative healing of osteoporotic femoral neck fracture and levels of CTX-1 and BALP in patients

This study aimed to explore the improvement of hip replacement combined with alendronate sodium on the condition of patients with osteoporotic femoral neck fracture and factors affecting the efficacy of patients. In total, 140 patients with femoral neck fracture from July 2015 to October 2017 in the Affiliated Xuzhou Hospital of Jiangsu University were collected. Of these, 61 patients were treated with hip replacement as the control group and 79 patients were treated with alendronate sodium as the observation group on the basis of the control group. ELISA was used to detect levels of carboxy-terminal opeptide of type I collagen (CTX–I) and bone alkaline phosphatase (BALP) in serum of patients before and after treatment. Harris score was used to compare the clinical efficacy of patients after treatment. Changes in the expression of CTX–I and BALP before and after treatment were compared between the two groups, and the correlation between CTX–I and BALP levels and Harris score was analyzed. According to the clinical efficacy of patients, the two groups were divided into the significant effect group and poor effect group. Risk factors affecting the efficacy of patients were analyzed, and the ROC of subjects with risk factors was drawn. After treatment, the expression of BALP in serum increased significantly compared with that before treatment, and the expression of CTX–I decreased significantly. After treatment, the expression of BALP in serum in the observation group was significantly higher than that in the control group (P<0.05). Multivariate analysis revealed that age, time of operation, CTX–I after treatment and BALP after treatment were independent risk factors affecting the efficacy of patients. In conclusion, hip replacement combined with alendronate sodium can effectively improve the clinical efficacy of patients, and age, time of operation, CTX–I after treatment and BALP after treatment are found to be independent risk factors affecting the postoperative efficacy of patients.