Table 3

Characteristics of intervention studies and their main findings: non-pharmacological treatments provided after osteoporotic fracture

Authors, country, setting if stated	Study design	Population characteristics; number of participants for outcomes of interest	Intervention; healthcare professional if stated	Main findings	LoE
i) Exercise
Diong et al hospital and community28	MA	Patients after HF surgery; 13 studies (n=1903)	Structured exercise, mean (SD) dose 37 (31) h	Overall mobility was significantly better in the IG versus CG at 12 (6) weeks (SMD=0.35; 95% CI 0.12 to 0.58). Larger effects with PRE	1
Lee et al hospital and community29	MA	Patients after HF surgery; 6 studies (n=420)	Progressive resistive exercise	Significant improvement in overall mobility in IG compared with CG (SMD=0.501; 95% CI 0.297 to 0.705; p<0.001)	1
Kronborg et al Denmark, inpatients35	RCT	Patients after HF surgery 1.Group 1 (n=45); 2. Group 2 (n=45)	PRE+routine physiotherapy Routine physiotherapy Physiotherapists	No significant between group difference in max. isometric knee-extension strength in the fractured limb in % of the non-fractured limb at d/c or postoperative day 10	2
Liu et al27	MA	Patients with OVF; three studies (n=128)	Exercise programmes	No influence on TUG (SMD=−0.36, 95% CI −0.96 to 0.24; p=0.24)	2
Mikó et al Hungary, community43	RCT	Women with OP fracture Group 1 (n=49) Group 2 (n=48)	Balance training Usual care Physiotherapists	Significantly greater improvement in balance and fewer falls at 12 months in the balance training group	2
ii) Nutrients including vitamin D plus calcium and oral nutritional supplements
Avenell et al community26	MA	Patients with a history of OP fracture; 4 studies (n=6134)	Vitamin D (800 IU) plus calcium (1000 mg) daily for a minimum of 12 months	No significant difference between IG and CG in incidence of HF (risk ratio=1.02, 95% CI 0.71 to 1.47) or any new fracture (risk ratio=0.93, 95% CI 0.79 to 1.10).	1
Mak et al Australia inpatients44	RCT	Patients after HF surgery 1.Group 1 (n=106); 2. Group 2 (n=104)	Single dose of 250 000 IU vitamin D3 Placebo	Statistically significant reduction in falls incidence in IG at 4 weeks. No significant difference in fractures between groups at 4 weeks.	2
Myint et al Hong Kong inpatient45	RCT	Patients after HF surgery 1.Group 1 (n=58); 2. Group 2 (n=58)	Daily oral nutritional supplement for 28 days Usual care	No significant between group difference in Elderly Mobility Scale 4 weeks postdischarge.	2
iii) Orthoses
Newman et al inpatient, outpatient and community38	SR	Patients with OVF; 12 studies (n=626)	Spinal orthoses	2/12 studies showed improvements in balance with orthoses	2
de Morais Barbosa et al Brazil, community37	RCT	Women with OP ±fracture 1.Group 1 (n=44); 2. Group 2 (n=45)	Custom foot orthoses No intervention	Significant between group difference in TUG (p<0.001) and BBS (p<0.001) favouring orthoses at 4 weeks	2
iv) Falls prevention programmes
Visschedijk et al inpatient and community46	SR	Patients with HF; 4 studies (n=221)	Home-based rehabilitation, community exercise programme, ambulatory training	2/4 studies showed a statistically significant reduction in fear of falling	2
van Ooijen et al The Netherlands, rehabilitation centre34	RCT	Patients with HF 1.Group 1 (n=14); 2. Group 2 (n=16); 3. Group 3 (n=16)	Treadmill training with visual context Conventional treadmill training Usual physical therapy Physical therapists	No significant difference in fall rate between groups at 12 months.	2
Di Monaco et al Italy, rehabilitation hospital and community49	RCT	Women with HF Group 1 (n=78) Group 2 (n=75)	MDT programme +telephone call post d/c MDT programme Occupational therapist	14.1% women in the IG and 13.3% in the CG sustained at least 1 fall during 6-month follow-up (relative risk 1.06, 95% CI 0.48 to 2.34).	2
Di Monaco et al Italy, community50	Quasi-RCT	Women with HF Group 1 (n=45) Group 2 (n=50)	MDT programme +home visit post d/c MDT programme Occupational therapist	Significantly lower proportion of fallers in IG at 6-month post d/c compared with CG (Adj OR 0.275; 95% CI 0.081 to 0.937; p=0.039)	2
Berggren et al Sweden inpatient and outpatient51	RCT	Patients after HF surgery Group 1 (n=102) Group 2 (n=97)	Geriatric rehabilitation +home visit Care on orthopaedic ward Physiotherapists, occupational therapists	At 12 months, crude fall-incidence rate was 4.16/1000 days in the IG and 6.43/1000 days in CG (IRR 0.64, 95% CI 0.40 to 1.02; p=0.063)	2
Shyu et al Taiwan, inpatient and community52	RCT	Patients after HF surgery Group 1 (n=79) Group 2 (n=81)	Orthogeriatrics, rehabilitation +d/c plan Usual care Nurse, Physician, Physical Therapist	29.6% of IG and 34.2% of CG had cognitive impairment. Only participants without cognitive impairment showed reduced fall occurrence (OR=0.47; 95% CI 0.25 to 0.86) at 2 years.	2

Adj, Adjusted; BBS, Berg Balance Scale; CG, control group; d/c, discharge; HF, hip fracture; IG, intervention group; IRR, incidence rate ratio; LoE, level of evidence; MA, meta-analysis; MDT, multidisciplinary team; OP, osteoporosis; OR, Odds ratio; OVF, osteoporotic vertebral fracture; PRE, progressive resistive exercise; RCT, randomised controlled trial; RR, risk ratio; RR, Relative Risk; SMD, standardised mean difference; SR, systematic review; TUG, Timed Up and Go.