Issue 2-21, 2022
Review article
Modern Approaches to Rehabilitation of Patients with Osteoporotic Hip Fracture: the Role of Pathogenetic Therapy with Zoledronic Acid
1 National Medical Research Center of Rehabilitation and Balneology, Moscow, Russian Federation
ABSTRACT
The article gives literature data systematic analysis (20 Russian and 47 foreign literature sources) on the issue of rehabilitation ofpatients with hip fracture (HF) against the background of osteoporosis (OP) and the role of pathogenetic therapy with zoledronic acidin the complex rehabilitation of such patients. Literature data testify to the high prevalence and medical and social significance ofosteoporotic HF in Russia and abroad. The need to develop effective methods for the rehabilitation of patients with OP is due to thedemand for patient’s life quality recovery in short terms, treatment cost reduction and death risk reduction, the highest during the firstyear after a pathological HF. The main objective of rehabilitation measures after osteoporotic HF is to reduce the likelihood of disabilityand death of the patient that is extremely high in the first months after the fracture – about 10% of elderly patients die in the first 3months after HF. The effectiveness of medical rehabilitation of patients with HF depends on the surgical treatment and mobilizationtime frames. Exercises are recommended to strengthen the muscles – knee extensors in the first 2–5 days after surgical treatment ofosteoporotic HF. After 3 weeks, progressive strength training should be included in rehabilitation programs to improve the functionalcapabilities of patients.Conclusion. Given the high risk of recurrent fractures in patients with osteoporosis undergoing rehabilitation after HF, the appointmentof pharmacological therapy for OP, primarily zoledronic acid at a dose of 5 mg once a year, should be a mandatory addition to physicaltherapy procedures.
KEYWORDS: osteoporosis, hip fracture, medical rehabilitation, quality of life, physical functioning, zoledronic acid
FOR CITATION:
Marchenkova L.A. Modern Approaches to Rehabilitation of Patients with Osteoporotic Hip Fracture:
the Role of Pathogenetic Therapy with Zoledronic Acid. Bulletin of Rehabilitation Medicine. 2022; 21(2): 139-149. https://doi.org/10.38025/2078-1962-2022-21-2-139-149
For correspondence: Larisa A. Marchenkova, e-mail: MarchenkovaLA@nmicrk.ru
References:
- Belaya Z.E., Rozhinskaya L.Ya., Grebennikova T.A. Kratkoe izlozhenie proekta federal’nyh klinicheskih rekomendacij po osteoporozu [Summary of the Draft Federal Clinical Guidelines for Osteoporosis]. Osteoporosis and Bone Diseases. 2020; 23(2): 4–21 (In Russ.).
- Kanis J.A., Cooper C., Rizzoli R. et al. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporosis International. 2019; (30): 3–44. https://doi.org/10.1007/s00198-018-4704-5
- Lesnyak O.M. Audit sostoyaniya problemy osteoporoza v stranakh Vostochnoy Yevropy i Tsentral’noy Azii 2011 [Audit of the state of the problem of osteoporosis in Eastern Europe and Central Asia 2011]. Osteoporosis and Bone Diseases. 2011; (2): 3–6 (In Russ.).
- Lesnyak O.M. Sotsial’no-ekonomicheskoye bremya osteoporoza dlya Rossiyskoy Federatsii [Socio-economic burden of osteoporosis for the Russian Federation]. Osteoporosis and Bone Diseases. 2010; (1): 27 p. (In Russ.).
- Lesnyak O.M., Baranova I.A., Belova K.Yu., Gladkova E.N., Evstigneeva L.P., Ershova O.B., Karonova T.L., Kochish A.Yu., Nikitinskaya O.A., Skripnikova I.A., Toroptsova N.V., Aramisova R.M. [Osteoporosis in Russian Federation: Epidemiology, Socio-Medical and Economical Aspects (Review)]. Traumatology and Orthopedics of Russia. 2018; 24(1): 155–168. https://doi.org/10.21823/2311-2905-2018-24-1-155-168 (In Russ.).
- Yershova O.B., Belova K.Yu., Belov M.V. Epidemiologiya perelomov proksimal’nogo otdela bedrennoy kosti u gorodskogo naseleniya Rossiyskoy Federatsii: rezul’taty mnogotsentrovogo issledovaniya [Epidemiology of fractures of the proximal femur in the urban population of the Russian Federation: results of a multicenter study]. Abstract-book of the scientific-practical conference «Osteoporosis is the most important multidisciplinary problem of the XXI century.» St. Petersburg, September 23–25. 2012: 23–27 (In Russ.).
- Lesnyak O., Ershova O., Belova K. et al. Epidemiology of fracture in the Russian Federation and the development of a FRAX model. Archives of Osteoporosis. 2012; (7): 67–73. https://doi.org/10.1007/s11657-012-0082-3
- Komissarov A.N., Pal’shin G.A., Rodionova S.S. Chastota perelomov proksimal’nogo otdela bedrennoy kosti sredi zhiteley goroda Yakutska [The frequency of fractures of the proximal femur among residents of the city of Yakutsk]. Osteoporosis and Bone Diseases. 2004; (1): 2–3 (In Russ.).
- Seryapina Yu.V., Fedyaev D.V., Musina N.Z. Zabolevaemost’ perelomami proksimal’nogo otdela bedrennoj kosti pacientov v vozraste 60 let i starshe v Rossijskoj Federacii [Incidence of proximal femur fractures in patients aged 60 years and older in the Russian Federation. Medical Technologies. Assessment and Choice. 2020; 40(2): 59–66. https://doi.org/10.17116/medtech20204002159 (In Russ.).
- Belova K.Yu., Lesnyak O.M., Yershova O.B., Belov M.V., Gladkova Ye.N. Zabolevayemost’ perelomami proksimal’nogo otdela bedrennoy kosti patsiyentov v vozraste 60 let i starshe v Rossiyskoy Federatsii [Commentary on the article by Yu.V. Seryapina et al. The incidence of fractures of the proximal femur in patients aged 60 years and older in the Russian Federation]. Medical Technologies. Assessment and Choice. 2021; (1): 73–76 (In Russ.).
- Bessette L., Jean S., Lapointe-Garant M.P. et al. Direct medical costs attributable to peripheral fractures in Canadian post-menopausal women. Osteoporosis International. 2012; 23(6): 1757–1768. https://doi.org/10.1007/s00198-011-1785-9
- Aziziyeh R., Amin M., Habib M. et al. A scorecard for osteoporosis in four Latin American countries: Brazil, Mexico, Colombia, and Argentina. Archives of Osteoporosis. 2019; 14(1): 69 p. https://doi.org/10.1007/s11657-019-0622-1
- Williamson S., Landeiro F., McConnell T. et al. Costs of fragility hip fractures globally: a systematic review and meta-regression analysis. Osteoporosis International. 2017; 28(10): 2791–2800. https://doi.org/10.1007/s00198-017-4153-6
- Ilieva E. What are the effects of exercise for improving outcomes after osteoporotic vertebral fracture? - A Cochrane Review summary with commentary. Journal of Musculoskeletal and Neuronal Interactions. 2020; 20(2): 165–167.
- LeBlanc E.S., Hillier T.A., Pedula K.L. et al. Hip fracture and increased short-term but not long-term mortality in healthy older women. Archives of Internal Medicine. 2011; 171(20): 1831–1837. https://doi.org/10.1001/archinternmed.2011.447
- Cooper C. The crippling consequences of fractures and their impact on quality of life. The American Journal of Medicine. 1997; 103(S.2A): 12–19.
- Cooper C., Cole Z.A., Holroyd C.R. et al. Secular trends in the incidence of hip and other osteoporotic fractures. Osteoporosis International. 2011; 22(5): 1277–1288. https://doi.org/10.1007/s00198-011-1601-6
- Nikitovic M., Wodchis W.P., Krahn M.D., Cadarette S.M. Direct health-care costs attributed to hip fractures among seniors: a matched cohort study. Osteoporosis International. 2013; 24(2): 659–669. https://doi.org/10.1007/s00198-012-2034-6
- De Rui M., Veronese N., Manzato E., Sergi G. Role of comprehensive geriatric assessment in the management of osteoporotic hip fracture in the elderly: an overview. Disability and Rehabilitation. 2013; 35(9): 758–765. https://doi.org/10.3109/09638288.2012.707747
- Dyer S.M., Crotty M., Fairhall N. et al. Fragility Fracture Network (FFN) Rehabilitation Research Special Interest Group. A critical review of the longterm disability outcomes following hip fracture. BMC Geriatrics. 2016; 16(1): 158 p. https://doi.org/10.1186/s12877-016-0332-0
- Menshikova L.V., Khramtsova N.A. Retrospektivnoye izucheniye chastoty perelomov proksimal’nogo otdela bedra i distal’nogo otdela predplech’ya sredi zhiteley Irkutskoy oblasti [A retrospective study of the incidence of fractures of the proximal femur and distal forearm among residents of the Irkutsk region]. Osteoporosis and Bone Diseases. 2000; (4): 5–8 (In Russ.).
- Markova T.N., Markov D.S., Markelova T.N. Rasprostranennost’ defitsita vitamina D i faktorov riska osteoporoza u lits molodogo vozrasta [Prevalence of vitamin D deficiency and risk factors for osteoporosis in young adults]. Bulletin of the Chuvash University. 2012; (3): 441–445 (In Russ.).
- Gladkova E.N., Khodyrev V.N., Lesnyak O.M. Analiz dvigatel’noy aktivnosti posle pereloma proksimal’nogo otdela bedra v populyatsii gorodskikh zhiteley Sverdlovskoy oblasti [Analysis of motor activity after a fracture of the proximal femur in the population of urban residents of the Sverdlovsk region]. Proceedings of the scientific-practical conference «Osteoporosis is the most important multidisciplinary problem of the XXI century.» St. Petersburg, September 23–25. 2012: 15–19 (In Russ.).
- Bower E.S., Wetherell J.L., Petkus A.J., Rawson K.S., Lenze E.J. Fear of falling after hip fracture: prevalence, course, and relationship with one-year functional recovery. The American Journal of Geriatric Psychiatry. 2016; 24(12): 1228–1236. https://doi.org/10.1016/j.jagp.2016.08.006
- Moraes S.A., Furlanett E.C., Ricci N.A., Perracini M.R. Sedentary beh * avior: barriers and facilitators among older adults after hip fracture surgery. A qualitative study. Brazilian Journal of Physical Therapy. 2020; 24(5): 407–414. https://doi.org/10.1016/j.bjpt.2019.07.001
- Bischoff-Ferrari H.A., Dawson-Hughes B., Platz A. et al. Effect of high-dosage cholecalciferol and extended physiotherapy on complications after hip fracture: a randomized controlled trial. Archives of Internal Medicine. 2010; 170(9): 813–820. https://doi.org/10.1001/archinternmed.2010.67
- Cristancho P., Lenze E.J., Avidan M.S., Rawson K.S. Trajectories of depressive symptoms after hip fracture. Psychological Medicine. 2016; 46(7): 1413–1425. https://doi.org/10.1017/S0033291715002974
- Falaschi P., Marsh D. The Management of Older Patients with Fragility Fractures. Second Edition. Practical Issues in Geriatrics (eBook). Springer. 2021: 357 p. https://doi.org/10.1007/978-3-030-48126-1
- Abrahamsen B., van Staa T., Ariely R., Ariely R., Olson M., Cooper C. Excess mortality following hip fracture: a systematic epidemiological review. Osteoporosis International. 2009; 20(10): 1633–1650. https://doi.org/10.1007/s00198-009-0920-3
- Gronskag А.B., Romundstad P., Forsmo S., Langhammer A., Schei B. Excess mortality after hip fracture among elderly women in Norway. Osteoporosis International. 2012; 23(6): 1807–1811. https://doi.org/10.1007/s00198-011-1811-y
- Koh G.C.-H., Tai B.C., Ang L.-W., Heng D., Yuan J.M., Koh W.P. All-cause and cause-specific mortality after hip fracture among Chinese women and men. Osteoporosis International. 2013; 24(7): 1981–1989. https://doi.org/10.1007/s00198-012-2183-7
- Belova K.Yu., Ershova O.B., Ganert O.A. Analiz letal’nosti posle perelomov proksimal’nogo otdela bedra sredi zhiteley goroda Yaroslavlya v vozraste 50 let i starshe. [Analysis of mortality after fractures of the proximal femur among residents of the city of Yaroslavl aged 50 years and older]. Proceedings of the scientific-practical conference “Osteoporosis is the most important multidisciplinary problem of the XXI century.” St. Petersburg, September 23–25. 2012: 11–15 (In Russ.).
- Mikhaylov E.E., Benevolenskaya L.I., Barkova T.V. Epidemiologicheskaya kharakteristika perelomov konechnostey v populyatsionnoy vyborke lits 50 let i starshe [Epidemiological characteristics of limb fractures in a population sample of people aged 50 years and older]. Osteoporosis and Bone Diseases. 1998; (2): 2–6 (In Russ.).
- Mikhaylov Ye.Ye., Benevolenskaya L.I., Mylov N.M. Rasprostranennost’ perelomov pozvonochnika v populyatsionnoy vyborke lits 50 let i starshe [The prevalence of vertebral fractures in a population sample of people aged 50 years and older]. N.N. Priorov Journal of Traumatology and Orthopedics. 1999; (3): 20–27 (In Russ.).
- Warhurst S., Labbe-Hubbard S., Yi M. et al. Patient haracteristics, treatment outcomes and rehabilitation practices for patients admitted with hip fractures using multiple data set analysis. New Zealand Medical Journal. 2020; 133(1526): 31–44.
- Leslie W.D., Brennan S.L., Prior H.J., Lix L.M., Metge C., Elias B. The contributions of First Nations ethnicity, income, and delays in surgery on mortality post-fracture: a population-based analysis. Osteoporosis International. 2013; 24(4): 1247–1256. https://doi.org/10.1007/s00198-012-2099-2
- Vidal E.I.O., Moreira-Filho D.C., Pinheiro R.S. et al. Delay from fracture to hospital admission: a new risk factor for hip fracture mortality? Osteoporosis International. 2012; 23(12): 2847–2853. https://doi.org/10.1007/s00198-012-1917-x
- Carlin L., Sibley K., Jenkinson R. et al. Exploring Canadian surgeons’ decisions about postoperative weight bearing for their hip fracture patients. Journal of Evaluation in Clinical Practice. 2018; 24(1): 42–47. https://doi.org/10.1111/jep.12645
- Kerschan-Schindl K. Prevention and rehabilitation of osteoporosis. Wiener Medizinische Wochenschrift. 2016; 166(1-2): 22–27. https://doi.org/10.1007/s10354-015-0417-y
- Kammerlander С., Pfeufer D., Lisitano L.A., Mehaffey S., Böcker W., Neuerburg C. Inability of older adult patients with hip fracture to maintain postoperative weight-bearing restrictions. The Journal of Bone and Joint Surgery. 2018; 100(11): 936–941. https://doi.org/10.2106/JBJS.17.01222
- Siu A.L., Penrod J.D., Boockvar K.S. et al. Early ambulation after hip fracture: Effects on function and mortality. Archives of Internal Medicine. 2006; 166(7): 766–771. https://doi.org/10.1001/archinte.166.7.766
- Kochish A.Yu., Lesnyak O.M., Belenkiy I.G. Kommentarii k rekomendatsiyam EULAR/EFORT po lecheniyu patsiyentov starshe 50 let s nizkoenergeticheskimi perelomami i profilaktike u nikh povtornykh perelomov. [Comments to EULAR/EFORT recommendations for management of patients older than 50 years with a fragility fracture and prevention of subsequent fractures]. Genij Ortopedii. 2019; 25(1): 6–14. https://doi.org/10.18019/1028-4427-2019-25-1-6-14 (In Russ.).
- Kronborg L., Bandholm T., Palm H., Kehlet H., Kristensen M.T. Feasibility of progressive strength training implemented in the acute ward after hip fracture surgery. PLoS One. 2014; 9(4): e93332 p. https://doi.org/10.1371/journal.pone.0093332
- Mitchell S.L., Stott D.J., Martin B.J., Grant S.J. Randomized controlled trial of quadriceps training after proximal femoral fracture. Clinical Rehabilitation. 2001; 15(3): 282–290. https://doi.org/10.1191/026921501676849095
- Overgaard J., Kristen M.T. Feasibility of progressive strength training shortly after hip fracture surgery. World Journal of Orthopedics. 2013; 4(4): 248–258. https://doi.org/10.5312/wjo.v4.i4.248
- Monticone M., Ambrosini E., Brunati R. et al. How balance task-specific training contributes to improving physical function in older subjects undergoing rehabilitation following hip fracture: a randomized controlled trial. Clinical Rehabilitation. 2018; 32(3): 340–351. https://doi.org/10.1177/0269215517724851
- Gillespie L.D., Robertson M.C., Gillespie W.J. et al. Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews. 2012; (12): CD007146 p. https://doi.org/10.1002/14651858.CD007146.pub3
- El-Khoury F., Cassou B., Charles M.A., Dargent-Molina P. The effect of fall prevention exercise programmes on fall induced injuries in community dwelling older adults: systematic review and meta-analysis of randomised controlled trials. The BMJ. 2013; (347): f6234 p.
- Cameron I.D., Gillespie L.D., Robertson M.C. et al. Interventions in preventing falls in older people in care facilities and hospitals. Cochrane Database of Systematic Reviews. 2012; (12): CD005465 p. https://doi.org/10.1002/14651858.CD005465.pub3
- Héquette-Ruz R., Beuscart J.-B., Ficheur G. et al. Hip fractures and characteristics of living area: a fine-scale spatial analysis in France. Osteoporosis International. 2020; 31(7): 1353–1360. https://doi.org/10.1007/s00198-020-05363-7
- George A.A., Way M., Varughese I. The effect of pre-operative medical co-morbidities on rehabilitation outcomes following surgery for hip fracture management in geriatric populations. Geriatric Orthopaedic Surgery & Rehabilitation. 2020; (11): 1–4. https://doi.org/10.1177/2151459320964030
- Borinsky S.Yu., Shavieva I.A. Kompleksnaya reabilitatsiya patsiyentov s osteoporozom posle endoprotezirovaniya tazobedrennogo sustava v starshikh vozrastnykh gruppakh [Comprehensive rehabilitation of patients with osteoporosis after hip arthroplasty in older age groups]. II International Congress of the Association of Rheumo-orthopedists. Abstracts of the congress reports. Association of rheumatic orthopedists. 2018: 22–24 (In Russ.).
- Mazurov V.I., Lesnyak O.M., Belova K.Yu. Algoritmy vybora terapii osteoporoza pri okazanii pervichnoy mediko-sanitarnoy pomoshchi i organizatsii l’gotnogo lekarstvennogo obespecheniya otdel’nykh kategoriy grazhdan, imeyushchikh pravo na polucheniye gosudarstvennoy sotsial’noy pomoshchi. Sistemnyy obzor i rezolyutsiya Ekspertnogo soveta Rossiyskoy assotsiatsii po osteoporozu [Algorithm for selection of drug for osteoporosis treatment in primary care and in organization of provision with medicinal products of citizens eligible for state social assistance. Review of the literature and position of Russian association on osteoporosis expert council]. Profilakticheskaya Meditsina. 2019; 22(1); 57–65 https://doi.org/10.17116/profmed20192201157 (In Russ.).
- Conley R.B., Adib G., Adler R.A. et al. Secondary fracture prevention: consensus clinical recommendations from a multistakeholder coalition. The Journal of Bone and Mineral Research. 2020; 35(1): 36–52. https://doi.org/10.1002/jbmr.3877
- Shibasaki K., Asahi T., Kuribayashi M. et al. Potential prescribing omissions of anti-osteoporosis drugs is associated with rehabilitation outcomes after fragility fracture: Retrospective cohort study. Geriatrics & Gerontology International. 2021; 21(5): 386–391. https://doi.org/10.1111/ggi.14145
- Black D.M., Delmas P.D., Eastell R. et al. Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis. The New England Journal of Medicine. 2007; 356(18): 1809–1822. https://doi.org/10.1056/NEJMoa067312
- Lyles K.W., Colon-Emeric C.S., Magaziner J.S. et al. Zoledronic acid and clinical fractures and mortality after hip fracture. The New England Journal of Medicine. 2007; 357(18): 1799–1809. https://doi.org/10.1056/NEJMoa074941
- Marchenkova L.A., Dreval A.V., Bakharev I.V. Effektivnost’ i perenosimost’ rezoklastina FC (5 mg) pri lechenii osteoporoza: retrospektivnyĭ analiz klinicheskogo opyta primeneniya preparata v Rossii [Efficacy and tolerability of resoclastin FS (5 mg) in the treatment of osteoporosis: a retrospective analysis of the clinical experience of using the drug in Russia]. Osteoporosis and Bone Diseases. 2014; (3): 22–26 (In Russ.).
- Hadji P., Ziller V., Gamerdinger D., Spieler W., Articus K., Baier M., Moericke R., Kann P.H. Quality of life and health status with zoledronic acid and generic alendronate – a secondary analysis of the Rapid Onset and Sustained Efficacy (ROSE) study in postmenopausal women with low bone mass. Osteoporosis International. 2012; 23(7): 2043–2051. https://doi.org/10.1007/s00198-011-1834-4
- Hamdy RC. Zoledronic acid: clinical utility and patient considerations in osteoporosis and low bone mass. Drug Design, Development and Therapy. 2010; (4): 321–335. https://doi.org/10.2147/DDDT.S6287
- Grey A., Bolland M.J. The effect of treatments for osteoporosis on mortality. Osteoporosis International. 2013; (24): 1–6. https://doi.org/10.1007/s00198-012-2176-6
- Huang S., Lin H., Zhu X., Chen X., Fan L., Liu C. Zoledronic acid increases bone mineral density and improves health-related quality of life over two years of treatment in Chinese women with postmenopausal osteoporosis. Endokrynologia Polska. 2014; 65(2): 96–104. https://doi.org/10.5603/EP.2014.0014
- Black D.M., Reid I.R., Boonen S. et al. The effect of 3 versus 6 years of zoledronic acid treatment of osteoporosis: a randomized extension to the HORIZON-Pivotal fracture trial (PFT). The Journal of Bone and Mineral Research. 2012; (2): 243–254. https://doi.org/10.1002/jbmr.1494
- Golounina O.O., Belaya Zh.Ye. Bisfosfonaty: 50 let v meditsinskoy praktike [Bisphosphonates: 50 years in medical practice]. Consilium Medicum. 2020; 22(4): 66–73 (In Russ.).
- Marchenkova L.A., Makarova Ye.V., Gerasimenko M.Yu., Yevstigneyeva I.S. Otsenka riska osteoporoticheskikh perelomov i rasprostranennosti osteoporoza u patsiyentov v vozraste 50 let i starshe, prokhodyashchikh meditsinskuyu reabilitatsiyu [Assessing the risk of osteoporotic fractures and the prevalence of osteoporosis in patients aged 50 years and older undergoing medical rehabilitation]. Physiotherapy, Balneology and Rehabilitation. 2020; 19(1): 13–19 (In Russ.).
- Kristensen P. K., Ehrenstein V., Shetty N., Pedersen A.B. Use of anti-osteoporosis medication dispensing by patients with hip fracture: could we do better? Osteoporosis International. 2019; 30(9): 1817–1825. https://doi.org/10.1007/s00198-019-05066-8
- Bernatz J.T., Brooks A.E., Squire M.W., Illgen R.I. 2nd, Binkley N.C., Anderson P.A. Osteoporosis is common and undertreated prior to total joint arthroplasty. The Journal of Arthroplasty. 2019; 34(7): 1347–1353. https://doi.org/10.1016/j.arth.2019.03.044

The content is available under the Creative Commons Attribution 4.0 License.
©
This is an open article under the CC BY 4.0 license. Published by the National Medical Research Center for Rehabilitation and Balneology.