Effect of precise health management combined with physical rehabilitation on bone biomarkers in senile osteoporosis patients

Participants
This study started in January 2021 and ended in December 2022. A total of 240 patients diagnosed with senile osteoporosis were enrolled from both outpatient and inpatient departments of our hospital between January 2021 and December 2021. The cohort comprised 128 males and 112 females, with an average age of (66.82 ± 5.42) years. Inclusion criteria: (1) Clinical diagnosis meeting the relevant diagnostic criteria outlined in the 2016 Guidelines for the Diagnosis and Treatment of Senile Osteoporosis by the American Medical Association. (2) Age between 60 and 75 years. (3) Sufficient cognitive ability to complete the scale content and cooperate with intervention and regular reviews. (4) Normal cognitive function screening results, ensuring cooperation with intervention and regular assessments. (5) Voluntary participation in the study. (6) All study participants and their families provided signed informed consent forms. Exclusion Criteria: (1) Allergy to any drugs used in this study. (2) Presence of significant organ damage, such as heart, liver, or kidney complications. (3) Secondary osteoporosis due to factors such as medication use or disuse. (4) Receipt of regular anti-osteoporosis treatment within the past 3 months. (5) Occurrence of other diseases during the intervention period that could potentially impact the intervention.
The research team randomly selected 240 patients and divided them into two groups: the observation group (receiving precise health management, n = 120) and the control group (receiving routine health management, n = 120). Both groups had health management files established using health management software and were prescribed oral anti-osteoporosis drugs, specifically calcitriol and vitamin D calcium chewable tablets. This study was approved by the Ethics Committee of The First Hospital of Hebei Medical University (No.20200606).
Routine health management
Routine health management included standard disease education and management practices. This encompassed educating patients about osteoporosis causes, precautions for fracture prevention, dietary and exercise guidelines, as well as information on medications affecting osteoporosis.
Accurate health management combined with physical rehabilitation
Accurate health management
Patients underwent accurate management for a duration of 2 years, with intervention measures tailored to their individual risk factors. Specific interventions included strengthening patients’ awareness of osteoporosis management through various channels such as the WeChat platform, regular lectures, home education sessions, and remote real-time monitoring. This monitoring involved tracking patients’ diet, exercise, physiological indicators, and medication adherence through health management software and continuously updated wearable devices. Guidance and adjustments were made according to individual patient conditions to improve lifestyle factors and provide psychological support7. (1) Build a digital platform: the platform includes patient case data, fracture risk assessment system, osteoporosis knowledge, quality of life and other scale assessment systems. (2) Sustainable osteoporosis health management based on the digital platform: (1) Continuous systematic health education: the combination of regular on-site education guidance and information push means is adopted to provide targeted long-term and continuous comprehensive guidance on osteoporosis health knowledge, diet guidance, exercise guidance, medication guidance and psychological guidance; Especially for patients with a higher risk of fracture, special emphasis is put on fall prevention programs: such as room layout, balance training, scientific support and so on. ② Develop a standardized treatment plan: According to the results of the stratified assessment of fracture risk and the results of laboratory examination, develop a scientific anti-osteoporosis treatment plan, and constantly adjust and optimize the treatment plan according to the follow-up data in the database. (3) Continuous information follow-up and guidance supervision: establish a follow-up mechanism based on the digital platform, push medication reminders and follow-up reminders on time, and regularly push diet, exercise list, etc.
Specific physical rehabilitation program
Patients were provided with the option to choose from aerobic exercises such as walking and Taijiquan based on personal preferences. Each exercise session lasted approximately 15 min, with patients maintaining a heart rate close to the appropriate target rate (calculated as 170 minus age) during exercise. Exercise intensity was controlled to induce mild fatigue, gradually increasing as the session progresses. After a 5-minute rest period, strength training commenced. Exercises including leg elevation, half squats, plank holds, and seated rows were selected based on individual capabilities. Each exercise comprised 8 repetitions per set, with a total of 3 sets and a 1-minute rest between each set. Balance training followed after a 10-minute rest period. This included one-legged balance exercises, with patients maintaining balance for over 1 min per leg. Additionally, ankle joint exercises involved rotating each foot clockwise and counterclockwise 5 times, repeated for a total of 5 sets. Foot exercises were performed using a toe towel for 1 min. Finally, patients engaged in another 10 min of walking. Family members accompanied patients throughout the exercise session, with training duration, intensity, and frequency adjusted accordingly based on the partner’s endurance level.
Observation indicators
Pain levels
The Visual Analog Scale (VAS) was utilized to evaluate pain levels in both groups before treatment and at 6, 12, 18, and 24 months post-treatment. Scores ranged from 0 to 10, with 0 indicating no pain. A score below 3 signified effective pain relief, while scores between 4 and 6 indicated manageable pain. Scores of 7 to 10 indicated inadequate pain relief, with increasing intensity impacting appetite and sleep8.
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(1)
Nutritional balance is the key to maintaining bone health9. Patients should consume foods high in calcium, low in salt, and moderate in protein, while ensuring adequate intake of vitamin D, avoiding caffeine and alcohol interference with calcium absorption, and ensuring comprehensive nutritional support for the bones. Osteoporosis patients should eat more calcium rich foods, such as milk, yogurt, cheese and other dairy products, and bean products such as tofu, soybean milk. In addition, deep-sea fish, leafy vegetables, and nuts are also good sources of calcium. A balanced diet ensures diverse calcium intake. Vitamin D is crucial for bone health as it promotes the absorption of calcium and phosphorus, maintains bone strength, and reduces the risk of fractures. Daily intake can be achieved through sun exposure and consumption of foods rich in vitamin D, such as seafood and egg yolks. If necessary, consider supplementing with vitamin D supplements in moderation. High salt, high sugar, high-fat, and excessive caffeine intake should be avoided in diet, as these unhealthy habits can lead to calcium loss and affect bone health. At the same time, quit smoking and limit alcohol consumption, avoid overeating and excessive consumption of raw, cold, and stimulating foods to protect bone health.
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(2)
Suitable exercise types for osteoporosis patients: The appropriate exercise types for osteoporosis patients mainly include weight bearing aerobic exercise (such as walking, dancing), flexibility training (such as stretching), and strength training (such as lifting dumbbells). These exercises can reduce bone mineral loss, enhance bone strength, and improve body balance. In sports and rehabilitation exercises, it is necessary to control the intensity of exercise reasonably according to individual physical fitness and condition. In the initial stage, mild exercise is mainly used, and gradually the intensity can be increased appropriately after adaptation. If you feel uncomfortable, you should immediately adjust or stop exercising to ensure safety and effectiveness. Rehabilitation exercises include stepping, tiptoeing, hip abduction, knee extension, shoulder rotation, etc., which can be combined with dumbbells, elastic bands, etc. for strength training. Pay attention to gradual progress and avoid high-intensity, high impact sports such as jumping. Exercise for 30–60 min each time, 3–5 times a week. During exercise and rehabilitation, patients with osteoporosis should pay attention to safety protection. Choose a flat and non slip sports field, and wear appropriate protective equipment such as knee pads and wrist guards. Avoid high-intensity and high-risk sports, ensure standardized movements to prevent falls and injuries, and ensure sports safety.
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(3)
Improving lifestyle habits: quitting smoking and limiting alcohol consumption is crucial for maintaining bone health. Quitting smoking can reduce the damage of nicotine to bones and promote bone formation; Moderate alcohol restriction can prevent increased bone resorption caused by alcohol, maintain bone metabolism balance, and thus reduce the risk of osteoporosis. Adequate sleep is crucial for bone recovery. Good sleep can regulate hormones, promote growth hormone secretion, and aid in bone repair and calcium absorption. It is recommended to maintain 7–9 h of high-quality sleep every night to maintain bone health and slow down the process of osteoporosis. Maintaining the same posture for a long time, whether it’s sitting or standing, can put unnecessary pressure on the bones and accelerate the development of osteoporosis. Therefore, it is recommended to change positions and engage in simple stretching activities at regular intervals to alleviate bone burden and maintain bone health.
Osteoporosis knowledge scale scores
The Osteoporosis Knowledge Scale questionnaire was employed to assess osteoporosis understanding in both patient groups before treatment and at 6, 12, 18, and 24 months post-intervention. This questionnaire encompassed three domains: osteoporosis risk factors, exercise knowledge, and calcium knowledge, comprising a total of 26 items. Points ranging from 0 to 26 were allocated based on the accuracy of responses. Higher scores denote a greater level of osteoporosis knowledge, with a Cronbach coefficient ranging from 0.84 to 0.87, alongside content validity exceeding 0.8, and demonstrating high reliability and validity.
Osteoporosis self-efficacy scale scores
Self-efficacy levels were assessed using the Osteoporosis Self-Efficacy Scale before intervention and at 6, 12, 18, and 24 months post-intervention. This scale comprised two dimensions: exercise efficacy and calcium efficacy, totaling 12 items. Scores range from 0 to 10, with 0 indicating a complete lack of confidence and 10 representing maximum confidence. The total score ranges from 0 to 120. Higher scores indicate higher levels of self-efficacy, with a Cronbach coefficient ranging from 0.88 to 0.95, demonstrating high reliability and validity10.
Bone density
Bone mineral density (BMD) changes were evaluated using GE Lunar Prodigy/DPX-X BMD (General Electric Company, United States) in the imaging department of our hospital before intervention and at 6, 12, 18, and 24 months post-intervention. Measurements were taken at the lumbar 1–4 segments (L1-L4) and the left femoral neck. BMD was calculated accordingly11.
Laboratory indicator levels
Biochemical indicators of bone metabolism, including alkaline phosphatase (ALP), parathyroid hormone (PTH), and blood calcium (Ca), were assessed in both patient groups before intervention and at 6, 12, 18, and 24 months post-intervention.
Patient satisfaction with the intervention
Patient satisfaction with the intervention was evaluated using a self-developed “satisfaction survey questionnaire” administered within the hospital. The questionnaire comprised 25 items, each scored on a 4-point scale. Levels of satisfaction were categorized as very satisfied, satisfied, or dissatisfied, with a maximum score of 100 points. Higher scores indicate increased patient satisfaction with the intervention.
Statistical analysis
Data analysis in this study was conducted using SPSS 20.0 statistical analysis software (IBM, USA). Measurement data were presented as mean ± standard deviation (\(\bar\textx\) ± s), and inter-group comparisons were performed using one-way analysis of variance (ANOVA). Count data were expressed as percentages (%), and comparisons between groups were conducted using chi-square (χ2) analysis. A P-value of less than 0.05 was considered statistically significant.
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