Leitlinie Bewegungstherapie und Physiotherapie bei Osteoporose – Methoden und Ergebnisdarstellung

Hintergrund: Die Ausschöpfung präventiver Potenziale zur Reduzierung und Verhinderung osteoporosebedingter Beschwerden und Funktionsstörungen erfordert die Inte­gration von Bewegungstherapien und unterstreicht demzufolge den Bedarf an zuverlässigen bewegungs- und physiotherapeutischen Behandlungsempfehlungen. Ziel: Die Leitlinie Bewegungs- und Physiotherapie soll eine evidenzbasierte Informationsquelle darstellen und das präventive Versorgungsangebot der pharmazeutischen Leitlinie ­ergänzen und ihnen vorangestellt werden. Methode: In einer systematischen Literaturrecherche wurden die Datenbanken Medline, Cinahl, Embase nach randomisierten, kontrollierten Studien entsprechend festgelegter Selektionskriterien in Bezug auf die gewählten Endpunkte durchsucht. Die Synthetisierung der Evidenz in Handlungsempfehlungen erfolgte anhand der Qualitätsbewertung mit der PEDro-Skala sowie der ­Beurteilung der klinischen Relevanz der Studien. Ergebnisse: Zum Endpunkt „Fraktur­reduktion“ ist die Evidenz aus der Studienlage bislang nicht ausreichend, um daraus Empfehlungen für Bewegungsprogramme abzuleiten. Dennoch wurden Ergebnisse aus den Studien dargestellt, um Informationen und Handlungsgrundlagen anzubieten. Für die Endpunkte „Knochenmasse“ sowie „Sturzinzidenz“ und „Sturzangst“ konnten ­Wirksamkeitsnachweise mittlerer bis hoher Evidenz erbracht werden, die als Basis zur Formulierung von Handlungsempfehlungen dienten. Schlussfolgerung: Bewegungsprogramme können einen signifikanten und relevanten Einfluss auf Risikofaktoren osteoporosebedingter Frakturen nehmen. Daher sollte Bewegung zukünftig in allen Phasen der Prävention integriert werden.

Abstract

Background: To achieve the best possible effect in preventing osteoporosis associated impairments and fractures, specially tailored exercise regimes need to be integrated. Evident programmes with the potential to preserve bone mass, reduce incidence of falls, and decrease fear of falling are therefore important. 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. Evidence-based recommendations were made in accordance with the PEDro scale quality assessment, clinical relevance evaluation and expert panel judgement. Results: Evidence for the efficacy of exercise 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.

Stichworte:

Leitlinie - Bewegungstherapie - Physiotherapie - Frakturprävention - Sturz­prävention - Osteoporose

Key words:

Guidelines - exercise therapy - physiotherapy - fracture prevention - fall prevention - osteoporosis

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