The effect of non-pharmacological intervention on bone mineral density in patients with spinal cord injury: a systematic review
DOI:
https://doi.org/10.11606/issn.2317-0190.v28i1a173528Keywords:
Osteoporosis, Bone Density, Exercise, Electric Stimulation, Spinal Cord Injuries/rehabilitationAbstract
Objective: To evaluate the effects of non-pharmacological measures (exercise, orthostatism, electrical stimulation, gait training, vibrating platform and physical activity) in preventing loss or increasing bone mineral density in patients with spinal cord injury. Method: Systematic review using the Medline, Embase, Cochrane Library and Lilacs databases with research between 2009 and June 2019. Results: 801 articles were found from which 15 articles were selected, according to the inclusion and exclusion criteria: 8 Randomized Clinical Studies (RCT), 5 Intervention Studies and 2 Systematic Reviews. Conclusions: Evidence of the use of non-pharmacological therapies for the prevention and treatment of osteoporosis in SCI is weak and its studies contain numerous biases making definitive conclusions impossible. FES is the most studied modality. Its use can be beneficial for both prevention and treatment of bone loss. The results are observed with frequent use (5 weekly sessions) and associated with physical activities, especially those that promote greater muscular resistance. The delay in the loss of bone mass is limited to the application period, stopping after the end of the application. The association of electrostimulation and exercise seems to enhance the medication action, but more studies are needed to confirm this impression. Non-pharmacological interventions such as orthostatism, physical activities, gait training and electrostimulation are low-cost, low-risk , have few side effects and a numerous other benefits in the rehabilitation of SCI. Therefore, although we do not have consistent evidence of action on bone mass, they are strongly recommended.
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