Nefarmakološko liječenje osteoporoze: mit ili stvarnost?

Tonko Vlak, Jure Aljinović

Non-pharmacological treatment of osteoporosis is a mandatory part of all algorithms and recommendations for dealing with this disease. However, the belief that pharmacological therapy is much more superior to treating osteoporosis than non-pharmacological treatment is still common in the medical community. Th e probable reason is that pharmacological treatment can be measured and statistically analyzed, and that’s why the abundance
of data from controlled randomized trials, meta-analyses and systematic reviews are available. Non-pharmacological treatment of osteoporosis is not so much represented in evidence based medicine (EBM) because there are a lot of different exercise protocols, different machines with different setups for applying the same models of physical therapy. So the main problem are inclusion criteria in meta-analyses or systematic reviews of patients whose
data is collected using different protocols. Non-pharmacological treatment of osteoporosis: myth or reality? Maybe we did not answer this question in fullness, but by analyzing data from the scientifically relevant data bases we can conclude that non-pharmacological treatment is an important factor in prevention of osteoporosis and part of all treatment protocols available today – almost as equally significant as pharmacological treatment. Cochrane library database and PEDro database provide EBM information that can help to identify the best types of exercises and physical procedures for bone mineral density and prevention of falls. The best result in non-pharmacological treatment of osteoporosis showed a combination of exercise programs that include muscle strengthening exercises, aerobic exercises, exercises with progressive resistance increase, and high-impact exercises. As for individual exercises, a non-weight-bearing high force exercise showed small but statistically significant increase in bone mineral density in femoral neck, in some scientific papers. Exercises for balance and coordination resulted in fewer falls, and therefore fewer fractures caused by osteoporosis
in postmenopausal women.

Nefarmakološko liječenje (NFL) osteoporoze (OP) sastavni je dio svih algoritama i preporuka liječenja OP-a, kao neizbježna sastavnica u terapijskom pristupu liječenju OP-a. Ipak, uvijek ostaje dojam da je farmakoterapija OP-a znatno superiornija u postizanju zadanih ciljeva liječenja ove metaboličke bolesti kostiju. Najčešće je tako zbog znatno većeg broja podataka dobivenih visokovrijednim kliničkim studijama, preglednim radovima, meta-analizama i sistematskim pregledima literature poštujući sva načela uvažavanja dokaza i izvođenja zaključaka na osnovi medicine utemeljene ne dokazima (EBM) koji su pristupačniji i brojniji kod procjene učinka farmakoterapije, nego u slučaju NFL. Nefarmakološko liječenje osteoporoze: mit ili stvarnost? Možda nismo do kraja dali odgovor na to pitanje ili on nije bio dovoljno uvjerljiv i argumentiran, ali mislimo da nećemo pogriješiti kada kažemo da je NFL bitan čimbenik u prevenciji, planiranju terapijskih postupaka i kompleksnom liječenju OP-a, čemu pridonose i najnovija istraživanja. dostupnih baza podataka, koje nudi Cochrane knjiž- nica ili PEDro baza podataka dajući najveću važnost različitim modelima vježbanja, nudeći uvjerljive podatke o njihovom učinku na (re)modeliranje osteoporotične kosti i prevenciji novih prijeloma. Najbolji učinak kod postmenopazalnih žena pokazale su kombinacije vježbi, koje su uključivale vježbe snaženja muskulature, aerobik, vježbe s utezima i vježbe visokog intenziteta. Od tih vježbi, statističko znatno povećanje mineralne gustoće kostiju pokazale su samo vježbe protiv otpora, na spravama u teretani, i to samo za gustoću kosti vrata bedrene kosti, dok su vježbe koordinacije i ravnoteže smanjile broj padova i posljedično broj osteoporotičnih fraktura.