Effects of a Home-Based Physical Rehabilitation Program on Tibial Bone Structure, Density, and Strength After Hip Fracture: A Secondary Analysis of a Randomized Controlled Trial

Tuuli H Suominen; Johanna Edgren; Anu Salpakoski; Marja Arkela; Mauri Kallinen; Tomas Cervinka; Timo Rantalainen; Timo Törmäkangas; Ari Heinonen; Sarianna Sipilä

doi:10.1002/jbm4.10175

Effects of a Home-Based Physical Rehabilitation Program on Tibial Bone Structure, Density, and Strength After Hip Fracture: A Secondary Analysis of a Randomized Controlled Trial

JBMR Plus. 2019 Mar 6;3(6):e10175. doi: 10.1002/jbm4.10175. eCollection 2019 Jun.

Authors

Affiliations

¹ Gerontology Research Center Faculty of Sport and Health Sciences University of Jyväskylä Jyväskylä Finland.
² Rehabilitation Center Peurunka Laukaa Finland.
³ Department of Physical and Rehabilitation Medicine Central Finland Central Hospital Jyväskylä Finland.
⁴ Department of Medical Rehabilitation Oulu University Hospital and Center for Life Course Health Research University of Oulu Oulu Finland.
⁵ Satakunta University of Applied Sciences Pori Finland.
⁶ Faculty of Sport and Health Sciences University of Jyväskylä Jyväskylä Finland.

Abstract

Weight-bearing physical activity may decrease or prevent bone deterioration after hip fracture. This study investigated the effects of a home-based physical rehabilitation program on tibial bone traits in older hip fracture patients. A population-based clinical sample of men and women operated for hip fracture (mean age 80 years, 78% women) was randomly assigned into an intervention (n = 40) and a standard care control group (n = 41) on average 10 weeks postfracture. The intervention group participated in a 12-month home-based rehabilitation intervention, including evaluation and modification of environmental hazards, guidance for safe walking, nonpharmacological pain management, motivational physical activity counseling, and a progressive, weight-bearing home exercise program comprising strengthening exercises for the lower legs, balance training, functional exercises, and stretching. All participants received standard care. Distal tibia (5% proximal to the distal end plate) compressive bone strength index (BSI; g²/cm⁴), total volumetric BMD (vBMD_TOT; mg/cm³), and total area (CSA_TOT; mm²), as well as midtibia (55%) strength-strain index (SSI; mm³), cortical vBMD (vBMD_CO; mg/cm³), and ratio of cortical to total area (CSA_CO/CSA_TOT) were assessed in both legs by pQCT at baseline and at 3, 6, and 12 months. The intervention had no effect (group × time) on either the distal or midtibial bone traits. At the distal site, BSI of both legs, vBMD_TOT of the fractured side, and CSA_TOT of the nonfractured side decreased significantly over time in both groups 0.7% to 3.1% (12 months, p < 0.05). At the midshaft site, CSA_CO/CSA_TOT and SSI of both legs, and vBMD_CO of the fractured leg, decreased significantly over time in both groups 1.1% to 1.9% (12 months, p < 0.05). Trabecular and cortical bone traits of the tibia on the fractured and the nonfractured side deteriorated throughout follow-up. The home-based physical rehabilitation intervention aimed at promoting mobility recovery was unable to prevent bone deterioration in older people after hip fracture. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.

Keywords: AGING; BONE QCT/μCT; CLINICAL TRIALS; EXERCISE; INJURY/FRACTURE HEALING.