65-year-old Ms. Zhang accidentally fell down while visiting the supermarket two months ago, resulting in her right wrist fracture, and was treated with internal fixation in orthopedics. Two months after the operation, her right wrist was still painful, her flexion and extension activities were impaired, and it was difficult to make a fist with her right hand. After consultation, it was learned that Ms. Zhang had a lumbar fracture and a right upper arm humeral fracture within two years. After bone mineral density and other related examinations, I found the cause of Ms. Zhang's multiple fractures: osteoporosis!
We know that osteoporosis mostly occurs in middle-aged and elderly people, which is characterized by decreased bone mass and degeneration of bone microstructure, leading to increased bone brittleness. Its clinical manifestations are mainly pain, shortened body length, hunchback and brittle fracture. The common fracture sites are spine, distal radius and femur.
According to the pathogenesis, osteoporosis can be divided into three categories:
One is primary osteoporosis, the most common is senile and postmenopausal osteoporosis;
The second type is secondary osteoporosis, which is often induced by diseases such as hyperparathyroidism syndrome, chronic kidney disease or taking glucocorticoid.
The third type is idiopathic osteoporosis, such as osteoporosis in pregnancy, which may be accompanied by a family genetic history.
Which department do high-risk groups or patients with osteoporosis need to go to?
At present, osteoporosis is a multidisciplinary disease, involving osteoporosis and osteopathy, endocrinology and metabolism, orthopedics, rehabilitation medicine, clinical nutrition, nephrology and other departments. Many osteoporosis patients don't understand why so many departments need to participate, especially rehabilitation medicine, which is often ignored. Because the treatment of osteoporosis includes drug therapy and non-drug therapy, and non-drug therapy involves education, nutrition, rehabilitation and so on.
What can rehabilitation medicine do for osteoporosis patients?
Effective rehabilitation treatment can improve bone strength, prevent falls and correct deformities caused by osteoporosis. After osteoporotic fracture, timely rehabilitation intervention can promote the improvement of function and improve the ability of living activities.
Exercise therapy is an important branch of rehabilitation medicine. Exercise can increase blood flow of bone tissue and promote osteoblast activity. By improving local circulation, the loss of calcium ions can be reduced. Exercise and load-bearing can also make calcium precipitate easily. In addition, exercise can regulate the secretion of sex hormones and improve bone metabolism. However, it is best for patients with osteoporosis to choose appropriate exercise according to their different situations under the guidance of rehabilitation doctors.
What are the exercise therapies suitable for patients with osteoporosis?
Research shows that strength training, aerobic training, stretching training, balance coordination and flexible exercise are all important components of rehabilitation exercise therapy.
Strength training: or resistance training, which increases the local stress of the bone by enhancing the contraction activity of the target muscle. In strength training, we should make clear the target muscle groups, design targeted training methods, follow the overload principle and gradually increase the training load. Training can be achieved by overcoming the resistance of sandbags and rubber bands or by using their own weight. Lumbar back, hip and wrist are the most common parts of osteoporotic fractures, so muscle strength training in these parts is often the goal.
Drafting training: refers to the passive elongation of soft tissue. Stress is exerted on local bone tissue through passive joint movement and soft tissue stretching. Before and after strength training, you can also carry out targeted drafting, such as the drafting of back muscles.
Aerobic exercise: it is an exercise with sufficient oxygen. Common aerobic training includes brisk walking, fitness running, cycling, aerobic exercise, dancing and so on. This kind of exercise can effectively exercise large muscle groups. Moderate and low intensity aerobic training lasting more than 20 minutes can also enhance cardiopulmonary function, regulate hormone secretion and effectively prevent osteoporosis.
Balance, coordination and flexible exercise: it is one of the important measures to prevent falls in the elderly, which can further reduce the risk of fractures caused by osteoporosis. The plan of balance coordination training includes balance instrument, balance board and some ball activities (beat, throw or bounce).
Medical gymnastics: strength training, aerobic training, drafting, balance training and other sports methods can be comprehensively used. Different training modes can be adopted, such as unarmed training or weapon training, individual training or group training, to enhance the interest of training.
Although the rehabilitation treatment of osteoporosis has many benefits, exercise therapy should also follow the principle of individualization. Effective exercise prescription requires proper exercise items and amount, as well as special precautions.
On the one hand, we need to design exercise according to the characteristics of the disease, on the other hand, we should pay attention to controlling the amount of exercise. There are many ways to control the amount of exercise, and the most common one is based on self-feeling. It is generally believed that it is best to achieve a certain degree of fatigue but improve after rest. In addition, it is necessary to adjust breathing during exercise to avoid pain, pay attention to sports protection and guard against sports injuries.