ORIGINAL PAPER Health Professional’s Guide to Rehabilitation of the Patient with Osteoporosis Francis J. Bonner Jr. Æ Mehrsheed Sinaki Martin Grabois Æ Kathy M. Shipp Æ Joseph M. Lane Robert Lindsay Æ Deborah T. Gold Æ Felicia Cosman Mary L. Bouxsein Æ James N. Weinstein Rollin M. Gallagher Æ L. Joseph Melton III Richard (Sal) Salcido Æ Stephen L. Gordon Ó National Osteoporosis Foundation 2003 Note to Readers This guide is a summary reference on the rehabilitation principles that should be applied in the treatment and prevention of osteoporosis. As this guide addresses pri- marily rehabilitation issues required by osteoporotic fracture or low bone mass, the health professional is directed to the National Osteoporosis Foundation’s companion piece, Physician’s Guide to Prevention and Treatment of Osteoporosis (‘Physician’s Guide’), for other treatment approaches. Rehabilitation and exercise are often viewed as a means to improve function, such as activities of daily living (ADL) for patients. Psychosocial factors also impact strongly on functional ability and the general health of the osteoporotic patient. The information in this guide is based on scientific evidence from basic research, consensus from an expert panel convened by the National Osteoporosis Foun- dation (NOF), clinical studies, and randomized con- trolled clinical trials. The small number of randomized trials points to the need for more of them in the future. The majority of the studies on rehabilitation approaches and exercise recommendations related to osteoporosis are based on studies among white peri- menopausal women. Clearly, osteoporosis affects men and non-white women as well. It can also affect younger as well as older individuals with certain chronic conditions and medication use. Until we have additional data, recommendations for these other populations should be on an individual basis. The committee believes that the guidelines have universal application in terms of recommending life-long, safe activities and exercises for all people. This guide’s recommendations are not intended as rigid standards of practice, but must be tailored for use by physicians in consultation with their patients. Executive Summary Osteoporosis affects more than 10 million people with an additional 34 million people at-risk with low bone mass [1]. Rehabilitation has an important role, additive to that of general medical and nutritional intervention, in the treatment of osteoporosis. Based on an analysis of current research and consensus development, experts convened by the NOF developed this guide to assist health professionals to understand the principles of re- habilitation and their applications to osteoporosis. In addition, these general principles may be applied in re- commending exercise in the prevention of osteoporosis. Summary of Major Rehabilitation Recommendations • Follow recommendations in the NOF’s ‘‘Physician’s Guide’’ regarding prevention and treatment of os- teoporosis. • In addition to current medical status, nutritional status and medication use, evaluate and consider the patient’s physical, functional, psychological and social status before prescribing a rehabilitation program. • Understand and practice the general principles of therapeutic exercise defined in this Guide. • Provide training for the performance of safe move- ment and safe activities of daily living, including transfers, lifting and ambulation in populations with or at high risk for osteoporosis. • A life-long activity and exercise lifestyle, starting in childhood, helps to build the highest possible bone mass and to reduce losses of bone mass later in life. • As long as principles of safe movement are followed, walking and daily activities, such as housework and gardening, are practical ways to maintain fitness and bone mass in older populations and people of any age Osteoporos Int (2003) 14 (Suppl 2): S1–S22 DOI 10.1007/s00198-002-1308-9