Körperliches Training zur Frakturprophylaxe beim älteren Menschen

Zusammenfassung

Osteoporose-induzierte Frakturen sind ein zentrales Problem unserer alternden Gesellschaft. Große epidemiologische Untersuchungen zeigen, dass körperliche Aktivität mit einer deutlichen Reduktion (30–50 %) von Hüftfraktur und vertebralen Frakturen einhergehen kann. Aus methodischer Sicht weisen diese Studien aber Limitationen auf, die den klaren Nachweis eines kausalen Zusammenhangs zwischen Aktivität/Sport und Fraktur - reduktion verhindern. Kontrollierte Interventionsstudien mit dem Endpunkt Frakturhäufigkeit liegen aufgrund der nötigen hohen Stichprobenanzahl nur in beschränktem Maße vor. Fasst man die Ergebnisse dieser Untersuchungen zusammen, so zeigt die Mehrzahl der nach Literaturrecherche ausgewählten Studien positive Effekte auf die “overall”- und vertebrale Frakturhäufigkeit. Eine einfache Berechnung ohne Gewichtung zeigt eine signifikante Reduktion der Frakturhäufigkeit für “overall” (RR: 0,51; 95 %-KI: 0,41–0,63) und vertebrale (RR: 0,61; 95 %-KI: 0,44–0,84) Frakturen. Große Interventionsstudien mit klar definierten Trainingsprotokollen und Endpunkten sind dennoch nötig, den Effekt körperlichen Trainings auf das Frakturrisiko evidenzbasiert nachzuweisen.

Summary

Fragility fractures are a major health problem in our aging society. Observational studies showed that a physically active lifestyle is associated with a 30–50 % reduction of vertebral or hip fractures. However, due to high sample sizes only a paucity of controlled exercise studies determined fractures, as yet, causality between sedentary lifestyle and fractures may be potentially confounded by poor health status of the participants in observation studies. Summarizing the result of these rather heterogeneous exercise trials as identified by a systematic review of the literature, the majority of studies determined positive effects of exercise on “overall” or vertebral fractures. Roughly calculated, the corresponding relative risk (rate ratio) for overall fractures was reduced by ≈50 % concerning “overall”(RR: 0.51; 95 %-CI: 0.41–0.63) and ≈40 % for vertebral (RR: 0.61; 95 %-CI: 0.44–0.84) fractures. However, due to problems (i. e. publication bias, suboptimum exercise regimes etc.) that prevent a meaningful interpretation of these data, adequate randomized controlled exercise trails are required to clearly determine the effect of exercise on fracture incidence.

Schlüsselwörter

Körperliche Aktivität - Sport - Training - Fraktur

Keywords

Physical activity - exercise - fracture

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