Abstract
Purpose
To conduct a review of the current state of the evidence for rehabilitation strategies post-fragility fracture.
Methods
Narrative review conducted by the Rehabilitation Working Group of the International Osteoporosis Foundation Committee of Scientific Advisors characterizing the range of rehabilitation modalities instrumental for the management of fragility fractures.
Results
Multi-modal exercise post-fragility fracture to the spine and hip is strongly recommended to reduce pain, improve physical function, and improve quality of life. Outpatient physiotherapy post-hip fracture has a stronger evidence base than outpatient physiotherapy post-vertebral fracture. Appropriate nutritional care after fragility fracture provides a large range of improvement in morbidity and mortality. Education increases understanding of osteoporosis which in turn increases utilization of other rehabilitation services. Education may improve other health outcomes such as pain and increase a patient’s ability for self-advocacy.
Conclusion
Rehabilitation interventions are inter-reliant, and research investigating the interaction of exercise, nutrition, and other multi-modal therapies may increase the relevance of rehabilitation research to clinical care.
Similar content being viewed by others
References
Black DM, Rosen CJ (2016) Postmenopausal osteoporosis. N Engl J Med 374(21):2096–2097
Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17(12):1726–1733
Kanis JA, Cooper C, Rizzoli R, Reginster JY, (IOF) SABotESfCaEAoOEatCoSAaNSotIOF (2019) European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int. 30(1):3–44
Curtis EM, van der Velde R, Moon RJ, van den Bergh JP, Geusens P, de Vries F et al (2016) Epidemiology of fractures in the United Kingdom 1988–2012: variation with age, sex, geography, ethnicity and socioeconomic status. Bone 87:19–26
Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A (2007) Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res 22(3):465–475
Svedbom A, Hernlund E, Ivergard M, Compston J, Cooper C, Stenmark J et al (2013) Osteoporosis in the European Union: a compendium of country-specific reports. Arch Osteoporos 8(1–2). https://doi.org/10.1007/s11657-013-0137-0
Magaziner J, Simonsick EM, Kashner TM, Hebel JR, Kenzora JE (1990) Predictors of functional recovery one year following hospital discharge for hip fracture: a prospective study. J Gerontol 45(3):M101–M107
Cooper C, Atkinson EJ, Jacobsen SJ, O’Fallon WM, Melton LJ 3rd (1993) Population-based study of survival after osteoporotic fractures. Am J Epidemiol 137(9):1001–1005
Ioannidis G, Papaioannou A, Hopman WM, Akhtar-Danesh N, Anastassiades T, Pickard L et al (2009) Relation between fractures and mortality: results from the Canadian Multicentre Osteoporosis Study. Can Med Assoc J 181(5):265–271
van der Velde RY, Wyers CE, Geusens PPMM, van den Bergh JPW, de Vries F, Cooper C et al (2018) Incidence of subsequent fractures in the UK between 1990 and 2012 among individuals 50years or older. Osteoporosis Int 29(11):2469–2475
Blain H, Masud T, Dargent-Molina P, Martin FC, Rosendahl E, van der Velde N et al (2016) A comprehensive fracture prevention strategy in older adults: the European Union Geriatric Medicine Society (EUGMS) statement. Aging Clin Exp Res 28(4):797–803
Baethge C, Goldbeck-Wood S, Mertens S (2019) SANRA-a scale for the quality assessment of narrative review articles. Res Integr Peer Rev 4:5
Phelan EA, Mahoney JE, Voit JC, Stevens JA (2015) Assessment and management of fall risk in primary care settings. Med Clin North Am 99(2):281–293
Sheehan KJ, Smith TO, Martin FC, Johansen A, Drummond A, Beaupre L et al (2019) Conceptual framework for an episode of rehabilitative care after surgical repair of hip fracture. Phys Ther 99(3):276–285
Beaupre, L. (2011). Functional Recovery (Rehabilitation). In J. Waddell (Ed.), National Hip Fracture Toolkit. Bone and Joint Canada. http://boneandjointcanada.com/wp-content/uploads/2014/05/National-hip-fracture-toolkit-June-2011.pdf
Sabharwal S, Wilson H (2015) Orthogeriatrics in the management of frail older patients with a fragility fracture. Osteoporos Int 26(10):2387–2399
FrenkelRutenberg T, Vitenberg M, Haviv B, Velkes S (2018) Timing of physiotherapy following fragility hip fracture: delays cost lives. Arch Orthop Trauma Surg 138(11):1519–1524
Akesson K, Marsh D, Mitchell PJ, McLellan AR, Stenmark J, Pierroz DD et al (2013) Capture the Fracture: a Best Practice Framework and global campaign to break the fragility fracture cycle. Osteoporos Int 24(8):2135–2152
Javaid MK, Kyer C, Mitchell PJ, Chana J, Moss C, Edwards MH et al (2015) Effective secondary fracture prevention: implementation of a global benchmarking of clinical quality using the IOF Capture the Fracture(R) Best Practice Framework tool. Osteoporos Int 26(11):2573–2578
MacIntyre, D. (2017). Falls and fracture consensus statement: Supporting commissioning for prevention. Retrieved 3 March 2020, from https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/586382/falls_and_fractures_consensus_statement.pdf
Drinkwater BL (1994) C. H. McCloy Research Lecture: does physical activity play a role in preventing osteoporosis? Res Q Exerc Sport 65(3):197–206
Daly RM, Dalla Via J, Duckham RL, Fraser SF, Helge EW (2019) Exercise for the prevention of osteoporosis in postmenopausal women: an evidence-based guide to the optimal prescription. Braz J Phys Ther 23(2):170–180
Singh NA, Quine S, Clemson LM, Williams EJ, Williamson DA, Stavrinos TM et al (2012) Effects of high-intensity progressive resistance training and targeted multidisciplinary treatment of frailty on mortality and nursing home admissions after hip fracture: a randomized controlled trial. J Am Med Dir Assoc 13(1):24–30
Beck BR, Daly RM, Singh MA, Taaffe DR (2017) Exercise and sports science Australia (ESSA) position statement on exercise prescription for the prevention and management of osteoporosis. J Sci Med Sport 20(5):438–445
Pegrum J, Crisp T, Padhiar N, Flynn J (2012) The pathophysiology, diagnosis, and management of stress fractures in postmenopausal women. Phys Sportsmed 40(3):32–42
Giangregorio LM, Macintyre NJ, Thabane L, Skidmore CJ, Papaioannou A (2013) Exercise for improving outcomes after osteoporotic vertebral fracture. Cochrane Database Syst Rev 1:CD008618
Stanghelle B, Bentzen H, Giangregorio L, Pripp AH, Skelton DA, Bergland A (2020) Effects of a resistance and balance exercise programme on physical fitness, health-related quality of life and fear of falling in older women with osteoporosis and vertebral fracture: a randomized controlled trial. Osteoporos Int 31(6):1069–1078
Stanghelle B, Bentzen H, Giangregorio L, Pripp AH, Skelton DA, Bergland A (2020) Physical fitness in older women with osteoporosis and vertebral fracture after a resistance and balance exercise programme: 3-month post-intervention follow-up of a randomised controlled trial. BMC Musculoskelet Disord 21(1):471
Cergel Y, Topuz O, Alkan H, Sarsan A, Sabir AN (2019) The effects of short-term back extensor strength training in postmenopausal osteoporotic women with vertebral fractures: comparison of supervised and home exercise program. Arch Osteoporos 14(1):82
Giangregorio LM, Gibbs JC, Templeton JA, Adachi JD, Ashe MC, Bleakney RR et al (2018) Build better bones with exercise (B3E pilot trial): results of a feasibility study of a multicenter randomized controlled trial of 12 months of home exercise in older women with vertebral fracture. Osteoporos Int 29(11):2545–2556
Gibbs JC, MacIntyre NJ, Ponzano M, Templeton JA, Thabane L, Papaioannou A et al (2019) Exercise for improving outcomes after osteoporotic vertebral fracture. Cochrane Database Syst Rev 7:CD008618
Shumway-Cook A, Ciol MA, Gruber W, Robinson C (2005) Incidence of and risk factors for falls following hip fracture in community-dwelling older adults. Phys Ther 85(7):648–655
Lee SY, Yoon BH, Beom J, Ha YC, Lim JY (2017) Effect of lower-limb progressive resistance exercise after hip fracture surgery: a systematic review and meta-analysis of randomized controlled studies. J Am Med Dir Assoc 18(12):1096.e19-.e26
Chen X, Yang W, Wang X (2020) Balance training can enhance hip fracture patients’ independence in activities of daily living: a meta-analysis of randomized controlled trials. Medicine (Baltimore). 99(16):e19641
Wu JQ, Mao LB, Wu J (2019) Efficacy of balance training for hip fracture patients: a meta-analysis of randomized controlled trials. J Orthop Surg Res 14(1):83
Lee SY, Jung SH, Lee SU, Ha YC, Lim JY (2019) Effect of balance training after hip fracture surgery: a systematic review and meta-analysis of randomized controlled studies. J Gerontol A Biol Sci Med Sci 74(10):1679–1685
Diong J, Allen N, Sherrington C (2016) Structured exercise improves mobility after hip fracture: a meta-analysis with meta-regression. Br J Sports Med 50(6):346–355
Watson SL, Weeks BK, Weis LJ, Harding AT, Horan SA, Beck BR (2018) High-Intensity resistance and impact training improves bone mineral density and physical function in postmenopausal women with osteopenia and osteoporosis: the LIFTMOR randomized controlled trial. J Bone Miner Res 33(2):211–220
Auais MA, Eilayyan O, Mayo NE (2012) Extended exercise rehabilitation after hip fracture improves patients’ physical function: a systematic review and meta-analysis. Phys Ther 92(11):1437–1451
Wu D, Zhu X, Zhang S (2018) Effect of home-based rehabilitation for hip fracture: a meta-analysis of randomized controlled trials. J Rehabil Med 50(6):481–486
Chen B, Hu N, Tan JH (2020) Efficacy of home-based exercise programme on physical function after hip fracture: a systematic review and meta-analysis of randomised controlled trials. Int Wound J 17(1):45–54
Latham NK, Harris BA, Bean JF, Heeren T, Goodyear C, Zawacki S et al (2014) Effect of a home-based exercise program on functional recovery following rehabilitation after hip fracture: a randomized clinical trial. JAMA 311(7):700–708
Thomas S, Mackintosh S, Halbert J (2011) Determining current physical therapist management of hip fracture in an acute care hospital and physical therapists’ rationale for this management. Phys Ther 91(10):1490–1502
Mangione KK, Lopopolo RB, Neff NP, Craik RL, Palombaro KM (2008) Interventions used by physical therapists in home care for people after hip fracture. Phys Ther 88(2):199–210
Kimmel LA, Liew SM, Sayer JM, Holland AE (2016) HIP4Hips (high intensity physiotherapy for hip fractures in the acute hospital setting): a randomised controlled trial. Med J Aust 205(2):73–78
Moseley AM, Sherrington C, Lord SR, Barraclough E, St George RJ, Cameron ID (2009) Mobility training after hip fracture: a randomised controlled trial. Age Ageing 38(1):74–80
Mehta SP, Roy JS (2011) Systematic review of home physiotherapy after hip fracture surgery. J Rehabil Med 43(6):477–480
Handoll HH, Elliott J (2015) Rehabilitation for distal radial fractures in adults. Cochrane Database Syst Rev. 9:CD003324
Edgren J, Salpakoski A, Sihvonen SE, Portegijs E, Kallinen M, Arkela M et al (2015) Effects of a home-based physical rehabilitation program on physical disability after hip fracture: a randomized controlled trial. J Am Med Dir Assoc. 16(4):350 e1–7
Williams NH, Roberts JL, Din NU, Totton N, Charles JM, Hawkes CA et al (2016) Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR): a phase II randomised feasibility study of a multidisciplinary rehabilitation package following hip fracture. BMJ Open. 6(10):e012422
Asplin G, Carlsson G, Ziden L, Kjellby-Wendt G (2017) Early coordinated rehabilitation in acute phase after hip fracture - a model for increased patient participation. BMC Geriatr 17(1):240
O’Halloran PD, Shields N, Blackstock F, Wintle E, Taylor NF (2016) Motivational interviewing increases physical activity and self-efficacy in people living in the community after hip fracture: a randomized controlled trial. Clin Rehabil 30(11):1108–1119
Scheffers-Barnhoorn MN, van Eijk M, van Haastregt JCM, Schols J, van Balen R, van Geloven N et al (2019) Effects of the FIT-HIP intervention for fear of falling after hip fracture: a cluster-randomized controlled trial in geriatric rehabilitation. J Am Med Dir Assoc. 20(7):857–65 e2
Turunen K, Salpakoski A, Edgren J, Tormakangas T, Arkela M, Kallinen M et al (2017) Physical activity after a hip fracture: effect of a multicomponent home-based rehabilitation program-a secondary analysis of a randomized controlled trial. Arch Phys Med Rehabil 98(5):981–988
Salpakoski A, Tormakangas T, Edgren J, Kallinen M, Sihvonen SE, Pesola M et al (2014) Effects of a multicomponent home-based physical rehabilitation program on mobility recovery after hip fracture: a randomized controlled trial. J Am Med Dir Assoc 15(5):361–368
Bennell KL, Matthews B, Greig A, Briggs A, Kelly A, Sherburn M et al (2010) Effects of an exercise and manual therapy program on physical impairments, function and quality-of-life in people with osteoporotic vertebral fracture: a randomised, single-blind controlled pilot trial. BMC Musculoskelet Disord 11:36
Barker KL, Newman M, Stallard N, Leal J, Lowe CM, Javaid MK et al (2020) Physiotherapy rehabilitation for osteoporotic vertebral fracture-a randomised controlled trial and economic evaluation (PROVE trial). Osteoporos Int 31(2):277–289
Bradley SM, Hernandez CR (2011) Geriatric assistive devices. Am Fam Physician 84(4):405–411
Hofler RC, Jones GA (2020) Bracing for acute and subacute osteoporotic compression fractures: a systematic review of the literature. World Neurosurg 141:e453–e460
Kato T, Inose H, Ichimura S, Tokuhashi Y, Nakamura H, Hoshino M et al (2019) Comparison of Rigid and soft-brace treatments for acute osteoporotic vertebral compression fracture: a prospective, randomized, multicenter study. J Clin Med 8(2):198
Palmer S, Barnett S, Cramp M, Berry A, Thomas A, Clark EM (2018) Effects of postural taping on pain, function and quality of life following osteoporotic vertebral fractures-A feasibility trial. Musculoskeletal Care 16(3):345–352
Sherrington C, Fairhall NJ, Wallbank GK, Tiedemann A, Michaleff ZA, Howard K et al (2019) Exercise for preventing falls in older people living in the community. Cochrane Database Syst Rev 1:CD012424
Li F, Eckstrom E, Harmer P, Fitzgerald K, Voit J, Cameron KA (2016) Exercise and fall prevention: narrowing the research-to-practice gap and enhancing integration of clinical and community practice. J Am Geriatr Soc 64(2):425–431
Wolf SL, Coogler C, Xu T (1997) Exploring the basis for Tai Chi Chuan as a therapeutic exercise approach. Arch Phys Med Rehabil 78(8):886–892
Sun Z, Chen H, Berger MR, Zhang L, Guo H, Huang Y (2016) Effects of tai chi exercise on bone health in perimenopausal and postmenopausal women: a systematic review and meta-analysis. Osteoporos Int 27(10):2901–2911
Rizzoli R (2014) Nutritional aspects of bone health. Best Pract Res Clin Endocrinol Metab 28(6):795–808
Miu MKYD, Lam PS (2017) Effects of nutritional status on 6-month outcome of hip fractures in elderly patients. Ann Rehab Med 41(6):1005–12
Koren-Hakim T, Weiss A, Hershkovitz A, Otzrateni I, Anbar R, Gross Nevo RF et al (2016) Comparing the adequacy of the MNA-SF, NRS-2002 and MUST nutritional tools in assessing malnutrition in hip fracture operated elderly patients. Clin Nutr 35(5):1053–1058
Malafarina V, Reginster JY, Cabrerizo S, Bruyere O, Kanis JA, Martinez JA et al (2018) Nutritional status and nutritional treatment are related to outcomes and mortality in older adults with hip fracture. Nutrients. 10(5):555
Bell BJJ, Pulle RC, Crouch AM, Kuys SS, Ferrier RL, Whitehouse SL (2016) Impact of malnutrition on 12-month mortality following acute hip fracture. ANZ J Surg 86(3):157–61
Ihle C, Freude T, Bahrs C, Zehendner E, Braunsberger J, Biesalski HK et al (2017) Malnutrition - An underestimated factor in the inpatient treatment of traumatology and orthopedic patients: A prospective evaluation of 1055 patients. Injury 48(3):628–636
Milne MAC, Avenell A, Potter J (2006) Meta-analysis: protein and energy supplementation in older people. Ann Intern Med 144(1):37–48
Li HJ, Cheng HS, Liang J, Wu CC, Shyu YI (2013) Functional recovery of older people with hip fracture: does malnutrition make a difference? J Adv Nurs 69(8):1691–1703
Sullivan DH, Nelson CL, Klimberg VS, Bopp MM (2004) Nightly enteral nutrition support of elderly hip fracture patients: a pilot study. J Am Coll Nutr 23(6):683–691
Hommel A, Bjorkelund KB, Thorngren KG, Ulander K (2007) Nutritional status among patients with hip fracture in relation to pressure ulcers. Clin Nutr 26(5):589–596
Gunnarsson GAK, Lonn K, Gunningberg L (2009) Does nutritional intervention for patients with hip fractures reduce postoperative complications and improve rehabilitation? J Clin Nurs 18(9):1325–33
Delmi M, Rapin CH, Bengoa JM, Delmas PD, Vasey H, Bonjour JP (1990) Dietary supplementation in elderly patients with fractured neck of the femur. Lancet 335(8696):1013–1016
Tkatch TL, Rapin CH, Rizzoli R, Slosman D, Nydegger V, Vasey H et al (1992) Benefits of oral protein supplementation in elderly patients with fracture of the proximal femur. J Am Coll Nutr 11(5):519–25
Schurch SMA, Rizzoli R, Slosman D, Vadas L, Vergnaud P, Bonjour JP (1998) Protein supplements increase serum insulin-like growth factor-I levels and attenuate proximal femur bone loss in patients with recent hip fracture. A randomized, double-blind, placebo-controlled trial. Ann Intern Med. 128(10):801–9
Espaulella J, Guyer H, Diaz-Escriu F, Mellado-Navas JA, Castells M, Pladevall M (2000) Nutritional supplementation of elderly hip fracture patients. A randomized, double-blind, placebo-controlled trial. Age Ageing 29(5):425–31
Houwing RH, Rozendaal M, Wouters-Wesseling W, Beulens JW, Buskens E, Haalboom JR (2003) A randomised, double-blind assessment of the effect of nutritional supplementation on the prevention of pressure ulcers in hip-fracture patients. Clin Nutr 22(4):401–405
Tidermark J, Ponzer S, Carlsson P, Soderqvist A, Brismar K, Tengstrand B et al (2004) Effects of protein-rich supplementation and nandrolone in lean elderly women with femoral neck fractures. Clin Nutr 23(4):587–596
Tengstrand B, Cederholm T, Soderqvist A, Tidermark J (2007) Effects of protein-rich supplementation and nandrolone on bone tissue after a hip fracture. Clin Nutr 26(4):460–465
Botella-Carretero JI, Iglesias B, Balsa JA, Arrieta F, Zamarron I, Vazquez C (2010) Perioperative oral nutritional supplements in normally or mildly undernourished geriatric patients submitted to surgery for hip fracture: a randomized clinical trial. Clin Nutr 29(5):574–579
Myint MW, Wu J, Wong E, Chan SP, To TS, Chau MW et al (2013) Clinical benefits of oral nutritional supplementation for elderly hip fracture patients: a single blind randomised controlled trial. Age Ageing 42(1):39–45
Flodin L, Cederholm T, Saaf M, Samnegard E, Ekstrom W, Al-Ani AN et al (2015) Effects of protein-rich nutritional supplementation and bisphosphonates on body composition, handgrip strength and health-related quality of life after hip fracture: a 12-month randomized controlled study. BMC Geriatr 15:149
Wyers WCE, Reijven PLM, Breedveld-Peters JJL, Denissen KFM, Schotanus MGM, van Dongen M et al (2018) Efficacy of nutritional intervention in elderly after hip fracture: a multicenter randomized controlled trial. J Gerontol A Biol Sci Med Sci. 73(10):1429–37
Niitsu NM, Ichinose D, Hirooka T, Mitsutomi K, Morimoto Y, Sarukawa J et al (2016) Effects of combination of whey protein intake and rehabilitation on muscle strength and daily movements in patients with hip fracture in the early postoperative period. Clin Nutr 35(4):943–9
Ekinci EO, Yanik S, TerziogluBebitoglu B, YilmazAkyuz E, Dokuyucu A, Erdem S (2016) Effect of calcium beta-hydroxy-beta-methylbutyrate (CaHMB), vitamin d, and protein supplementation on postoperative immobilization in malnourished older adult patients with hip fracture: a randomized controlled study. Nutr Clin Pract 31(6):829–35
Malafarina MV, Uriz-Otano F, Malafarina C, Martinez JA, Zulet MA (2017) Effectiveness of nutritional supplementation on sarcopenia and recovery in hip fracture patients. A multi-centre randomized trial. Maturitas 101:42–50
Invernizzi M, de Sire A, D’Andrea F, Carrera D, Reno F, Migliaccio S et al (2018) Effects of essential amino acid supplementation and rehabilitation on functioning in hip fracture patients: a pilot randomized controlled trial. Aging Clin Exp Res. 31(10):1517–1524
Bauer J, Biolo G, Cederholm T, Cesari M, Cruz-Jentoft AJ, Morley JE et al (2013) Evidence-based recommendations for optimal dietary protein intake in older people: a position paper from the PROT-AGE Study Group. J Am Med Dir Assoc 14(8):542–559
Chevalley CT, Hoffmeyer P, Bonjour JP, Rizzoli R (2010) Early serum IGF-I response to oral protein supplements in elderly women with a recent hip fracture. Clinical nutrition. 29(1):78–83
Liu LM, Yang J, Yu X, Huang X, Vaidya S, Huang F et al (2015) The role of perioperative oral nutritional supplementation in elderly patients after hip surgery. Clin Interv Aging. 10:849–58
Avenell A, Smith TO, Curtain JP, Mak JC, Myint PK (2016) Nutritional supplementation for hip fracture aftercare in older people. Cochrane Database Syst Rev. 11:CD001880
Rizzoli R, Stevenson JC, Bauer JM, van Loon LJ, Walrand S, Kanis JA et al (2014) The role of dietary protein and vitamin D in maintaining musculoskeletal health in postmenopausal women: a consensus statement from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). Maturitas 79(1):122–132
Jensen AL, Lomborg K, Wind G, Langdahl BL (2014) Effectiveness and characteristics of multifaceted osteoporosis group education–a systematic review. Osteoporos Int 25(4):1209–1224
Morfeld JC, Vennedey V, Muller D, Pieper D, Stock S (2017) Patient education in osteoporosis prevention: a systematic review focusing on methodological quality of randomised controlled trials. Osteoporos Int 28(6):1779–1803
Raybould G, Babatunde O, Evans AL, Jordan JL, Paskins Z (2018) Expressed information needs of patients with osteoporosis and/or fragility fractures: a systematic review. Arch Osteoporos 13(1):55
Merle B, Chapurlat R, Vignot E, Thomas T, Haesebaert J, Schott AM (2017) Post-fracture care: do we need to educate patients rather than doctors? The PREVOST randomized controlled trial. Osteoporos Int 28(5):1549–1558
Acknowledgements
This work was supported by the International Osteoporosis Foundation (IOF) and undertaken through the Rehabilitation Working Group of the IOF Committee of Scientific Advisers.
Rehabilitation Working Group of IOF members:
Chairs:
O Bruyère
D Pinto
Members:
R Blank
B Buehring
R Chapurlat
T Chevalley
C Cooper
E Dennison
S Ferrari
JA Kanis
JF Kaux
NE Lane
OD Messina
J Morales Torres
BM Camargos
J Paccou
A Papaioannou
JY Reginster
R Rizzoli
S Silverman
Ş Tüzün
Funding
This work was supported by the International Osteoporosis Foundation (IOF) and undertaken through the Rehabilitation Working Group of the IOF Committee of Scientific Advisors.
Author information
Authors and Affiliations
Consortia
Corresponding author
Ethics declarations
Conflict of interest
The authors declare no competing interests.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Pinto, D., Alshahrani, M., Chapurlat, R. et al. The global approach to rehabilitation following an osteoporotic fragility fracture: A review of the rehabilitation working group of the International Osteoporosis Foundation (IOF) committee of scientific advisors. Osteoporos Int 33, 527–540 (2022). https://doi.org/10.1007/s00198-021-06240-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00198-021-06240-7