Patient discussions
All patients should receive verbal and written information about osteoporosis and vertebral fracture to enhance their understanding of the condition and how medication, nutrition, fall prevention, and exercise are important in its management.[57]
Patients should be advised:
To avoid bending forward, especially in combination with twisting movements.
To avoid long-term immobilization. Bed rest should be used only when required and for as short a duration as possible. Patients should try to alternate bed rest with periods of sitting and ambulating. Ongoing physical activity that supports healing and maintenance of bone mass is a key part of rehabilitation following fracture. For patients with fractures or at high risk for fractures instruction in safe body mechanics can reduce disability, improve physical function and quality of life, and lower risk for injurious falls.[11]
To use regular and preemptive pain relief (physical, pharmacologic, and behavioral) as prescribed to allow mobilization.[57] Pharmacologic pain relief should not be used to the point that it increases the risk of falls by causing disorientation or sedation.[11]
Against cigarette smoking and excessive alcohol consumption.[11]
To adopt a daily exercise regimen for improving balance and strengthening the trunk and lower limbs. The Royal Orthopaedic Society in the UK recommends consideration of an individualized exercise program 4-12 weeks after vertebral fracture, as tolerated, or when acute fracture-related pain has diminished, or after 12 weeks (when most fractures will have healed), based on patient preference and clinician judgement. The exercise program should focus on goals such as improving back extensor endurance, balance and physical functioning.[57] Patients should avoid heavy lifting. They should consider the use of walking poles, or all-terrain rollators with seating built in, when walking out.
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