Leitlinie Physiotherapie und Bewegungstherapie bei Osteoporose

R. Dietzel; B. Begerow; G. Bollert; B. Kladny; H. Kleinöder; A. Kwiet; L. Pientka; E. Preisinger; M. Runge; J. Swanenburg; E. Wieland; D. Felsenberg

doi:10.1055/s-0028-1109425

physioscience 2009; 5(2): 65-75
DOI: 10.1055/s-0028-1109425

Originalarbeit

Leitlinie Physiotherapie und Bewegungstherapie bei Osteoporose

Guideline Physiotherapy and Exercise Therapy in OsteoporosisR. Dietzel¹ , B. Begerow² , G. Bollert³ , B. Kladny⁴ , H. Kleinöder⁵ , A. Kwiet⁶ , L. Pientka⁷ , E. Preisinger⁸ , M. Runge⁹ , J. Swanenburg¹⁰ , E. Wieland¹¹ , D. Felsenberg¹¹

¹Zentrum für Muskel- und Knochenforschung, Charité Berlin
²Institut für Qualitätssicherung in Prävention und Rehabilitation, Sporthochschule Köln
³Fachhochschule Kiel
⁴Fachklinik Herzogenaurach
⁵Sporthochschule Köln
⁶Klinik für Manuelle Medizin, Sana Kliniken Sommerfeld
⁷Klinik für Altersmedizin und Frührehabilitation, Ruhr-Universität Bochum
⁸Institut für Physikalische Medizin und Rehabilitation Krankenhaus Hietzing, Wien
⁹Aerpah-Klinik, Esslingen
¹⁰Rheumaklinik und Institut für Physikalische Medizin, Universitäts-Spital Zürich
¹¹Praxis für Allgemeinmedizin, Berlin

Abstract

Zusammenfassung

Hintergrund: Die Potenziale der Prävention von durch Osteoporose bedingten Frakturen durch gezielte neuromuskuläre Diagnostik und daraus abgeleitete Bewegungsprogramme zum Erhalt von Knochenmasse sowie zur Verringerung von Sturzinzidenz und Sturzangst bleiben bisher weitgehend ungenutzt.

Ziel: Die Leitlinie soll eine evidenzbasierte Informationsquelle bereitstellen, um die Qualität bewegungstherapeutischer Präventionsangebote der osteoporotischen Fraktur in primärer, sekundärer und tertiärer Prävention zu verbessern.

Methode: In einer systematischen Literaturrecherche wurden die Datenbanken Medline, Cinahl und Embase mithilfe festgelegter Ein- und Ausschlusskriterien nach randomisierten, kontrollierten Studien durchsucht. Die Synthetisierung der Evidenz in Handlungsempfehlungen erfolgte anhand einer Qualitätsbewertung mit der PEDro-Skala, der Beurteilung der klinischen Relevanz der Studien sowie über Konsens durch das Leitlinienteam.

Ergebnisse: Zum Thema Frakturreduktion durch Bewegungsprogramme gibt es bisher unzureichende Evidenz. Mit einem mittleren bis hohen Evidenzgrad ist die Wirksamkeit gezielter Bewegungstherapie zum Erhalt der Knochenmasse, zur Verringerung der Sturzinzidenz und zur Verminderung der Sturzangst nachgewiesen.

Schlussfolgerungen: Die Wirksamkeit gezielter Bewegungstherapie auf entscheidende Risikofaktoren der durch Osteoporose bedingten Fraktur ist belegt. Die Prinzipien sollten flächendeckend in spezielle Präventionsprogramme umgesetzt werden.

Abstract

Background: The potential of preventing osteoporotic fractures by tailored exercise regimes to preserve bone mass, reduce incidence of falls and decrease fear of falling is not widely used.

Objective: This guideline aims to provide evidence-based recommendations on exercise regimes in primary, secondary and tertiary prevention of osteoporotic fractures.

Method: A systematic literature search for randomised controlled trials was conducted using the databases Medline, Cinahl und Embase. On the basis of quality assessment with the PEDro scale, clinical relevance evaluation and expert panel judgement evidence-based recommendations were posed.

Results: Evidence for the efficacy of exercises programmes for the prevention of osteoporotic fractures is insufficient. There is medium to high evidence that physical exercise regimes are effective in preventing loss of bone mass, reducing incidence of falling and minimizing fear of falling.

Conclusion: The efficacy of exercise regime on major risk factors for osteoporotic fractures is proven. Following these principles, community-based exercise programmes should be implemented.

Schlüsselwörter

Leitlinie - Physiotherapie - Bewegungstherapie - Osteoporose - Frakturprävention

Key words

guideline - physiotherapy - exercise therapy - osteoporosis - bone fractures prevention

Full Text

References

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Roswitha Dietzel, PT, M.Pthy

Zentrum für Muskel- und Knochenforschung, Charité – Campus Benjamin Franklin

Hindenburgdamm 30

12200 Berlin

Email: roswitha.dietzel@charite.de