View Full Version : Re: Exercising for Osteoporosis discussion

Bryan Kirking
07-06-1998, 01:10 AM
>From Dr. Beck's Posting:

I would respectfully disagree with these statements. In the first
instance, what is normal bone? Osteoporosis, by definition, is merely a
condition of substantially reduced bone mass with the presence of
osteopenia-related fracture. The tissue is essentially the same. There is
just less of it. Granted, it is normally a condition of the elderly and
the ability of bone to respond to adaptive stimuli may be somewhat reduced
as we age. But both animal and human exercise intervention trials have
concluded that even the very old can derive skeletal benefit from increased
levels of physical activity. For this reason I think you could be held
liable if you DON'T recommend physical activity in therapy. Particularly
in mildy osteoporotic individuals, it is not a dangerous approach, given
appropriate screening for other medical conditions, careful exercise design
and execution technique (such as excluding seated rows and other exercises
which may increase the risk of crush fracture in comprimised skeletal
components) and adequate supervision.

"Respectfully disagree"{ing} is what makes the discussions here interesting.

You have a point, osteoporosis is not abnormal in that it is a common condition in the elderly. I was unsuccessfully attempting to point out that our bone adaptation models may not be applicable to osteoporotic bone as they may be based on "normal" i.e. healthy young bone, but I am not that familiar with this research.

I agree with you that physical activity and exercise is good for people. Prescribing an exercise program for people with osteoporosis is most likely a good thing. However, consider this: if nothing is done and the patients get worse is there sufficient scientific evidence as well as clinical history to have a solid negligence case? Compare this to prescribing a treatment of exercise and someone gets hurt. Is there sufficient scientific evidence as well as clinical history to justify the treatment? Ultimately I think it would come down to being able to convince a jury of one's peers - and to me, that's a really scary thought.

This seems to be a relatively straight forward clinical research study (but don't they all), and may have been addressed already. With such support, then an exercise program design could be a winner for all. Without such support, while I would expect a positive outcome, there are substantial legal and medical risks.

Of course, I am not a lawyer, have never studied law, and don't even watch those lawyer TV shows :-)

Bryan Kirking
Research Engineer
Department of Orthopedic Surgery
Baylor College of Medicine
Houston, Texas

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