Table 3

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

Authors, country, setting if statedStudy designPopulation characteristics; number of participants for outcomes of interestIntervention; healthcare professional if statedMain findingsLoE
i) Exercise
Diong et al hospital and community28MAPatients after HF surgery;
13 studies (n=1903)
Structured exercise, mean (SD) dose 37 (31) hOverall 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 PRE1
Lee et al hospital and community29MAPatients after HF surgery;
6 studies (n=420)
Progressive resistive exerciseSignificant 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, inpatients35RCTPatients after HF surgery
1.Group 1 (n=45); 2. Group 2 (n=45)
  1. PRE+routine physiotherapy

  2. Routine physiotherapy

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 102
Liu et al27MAPatients with OVF; three studies (n=128)Exercise programmesNo influence on TUG (SMD=−0.36, 95% CI −0.96 to 0.24; p=0.24)2
Mikó et al Hungary, community43RCTWomen with OP fracture
  1. Group 1 (n=49)

  2. Group 2 (n=48)

  1. Balance training

  2. Usual care

Significantly greater improvement in balance and fewer falls at 12 months in the balance training group2
ii) Nutrients including vitamin D plus calcium and oral nutritional supplements
Avenell et al community26MAPatients with a history of OP fracture;
4 studies (n=6134)
Vitamin D (800 IU) plus calcium (1000 mg) daily for a minimum of 12 monthsNo 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 inpatients44RCTPatients after HF surgery
1.Group 1 (n=106); 2. Group 2 (n=104)
  1. Single dose of 250 000 IU vitamin D3

  2. 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 inpatient45RCTPatients after HF surgery
1.Group 1 (n=58); 2. Group 2 (n=58)
  1. Daily oral nutritional supplement for 28 days

  2. Usual care

No significant between group difference in Elderly Mobility Scale 4 weeks postdischarge.2
iii) Orthoses
Newman et al inpatient, outpatient and community38SRPatients with OVF; 12 studies (n=626)Spinal orthoses2/12 studies showed improvements in balance with orthoses2
de Morais Barbosa et al Brazil, community37RCTWomen with OP ±fracture
1.Group 1 (n=44); 2. Group 2 (n=45)
  1. Custom foot orthoses

  2. No intervention

Significant between group difference in TUG (p<0.001) and BBS (p<0.001) favouring orthoses at 4 weeks2
iv) Falls prevention programmes
Visschedijk et al inpatient and community46SRPatients with HF; 4 studies (n=221)Home-based rehabilitation, community exercise programme, ambulatory training2/4 studies showed a statistically significant reduction in fear of falling2
van Ooijen et al The Netherlands, rehabilitation centre34RCTPatients with HF
1.Group 1 (n=14); 2. Group 2 (n=16); 3. Group 3 (n=16)
  1. Treadmill training with visual context

  2. Conventional treadmill training

  3. 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 community49RCTWomen with HF
  1. Group 1 (n=78)

  2. Group 2 (n=75)

  1. MDT programme +telephone call post d/c

  2. 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, community50Quasi-RCTWomen with HF
  1. Group 1 (n=45)

  2. Group 2 (n=50)

  1. MDT programme +home visit post d/c

  2. 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 outpatient51RCTPatients after HF surgery
  1. Group 1 (n=102)

  2. Group 2 (n=97)

  1. Geriatric rehabilitation +home visit

  2. 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 community52RCTPatients after HF surgery
  1. Group 1 (n=79)

  2. Group 2 (n=81)

  1. Orthogeriatrics, rehabilitation +d/c plan

  2. 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.