1. Risultati della terapia medica e fisioterapia di trattamento nella Spa sulla forza muscolare e sulla mobilità del tronco in soggetti con bassa densità ossea Primarius Katarina S. Marković Primarius Katarina S. Marković Istituto per la cura e riabilitazione delle malattie reumatiche e cardiovascolari Istituto per la cura e riabilitazione delle malattie reumatiche e cardiovascolari "Niska Banja"

2. Results of Physical Treatment in the Spa and Medicamentous Therapy on Muscle Strength and Trunk Mobility in Subjects with Lower Bone Density Katarina S. Marković M.D. Katarina S. Marković M.D. Institute for treatment and rehabilitation of rheumatic and cardiovascular diseases “Niška Banja” Institute for treatment and rehabilitation of rheumatic and cardiovascular diseases “Niška Banja”

3. introduction introduction  the assessment of the muscle strength and trunk movability are especially significant in the prevention of falls and fractures, in patients with lower bone mineral density and may be of great importance in making a diagnosis and assessment of therapy effect, as well

4.  Spinal musculature functional damage measuring is obtained by: isokinetical, isometrical and isoinertial tests  Isostation B200 – is isoinertial dynamometer with three measurement axes, which monitors movements on fully natural base and used for examination of quantity of dysfunction

5. - construction of Isostation B200 made spine Th parts and pelvis movements unable - results are shown graphical by: 1. standard graph 2. motion range graph 3. combined parameters graph 4. repetition analyzes table – showing average values

6. graph shows functional amplitude of movements

7. global speed decreasing of extension – suspect of osteoporosis global speed decreasing of extension – suspect of osteoporosis

8. t esting protocol t esting protocol give snapshoot in general muscular potential examined body part showing especially values of muscular potentional especially of : left and right rotation, flections, extensions and left and right lateral flections give snapshoot in general muscular potential examined body part showing especially values of muscular potentional especially of : left and right rotation, flections, extensions and left and right lateral flections 1.Registration of maximal rotary movement moments of isometric contractions of isometric contractions

9. t esting protocol t esting protocol 2. measurement of movement range 2. measurement of movement range - First examine without load - This parameter is evaluated during dynamic reception examine with different loaded height

10. 3. dynamic repetition test with load 3. dynamic repetition test with load - muscle movement is composed of : - muscle movement is composed of : a) phases of acceleration a) phases of acceleration b) dynamic equilibrium – last very short only with constant movement b) dynamic equilibrium – last very short only with constant movement c) deacceleration phase c) deacceleration phase - Isostation B200 measures rotary moments in all phases of movement - Isostation B200 measures rotary moments in all phases of movement t esting protocol t esting protocol

13. Rebilitation  increase bone density and osteoblastic bone forming is possible only with the exercise load and  increase bone density and osteoblastic bone forming is possible only with the exercise load and Physical Treatment in the Spa Therapy  exercise alone is inadequate to maintain the spina trabecular bone in perimenopausal or postmenopausal women

16.  Institute ¨Niška Banja¨ made study of correlation between lumbosacral bone mineral density and muscles kineziology parameters  The objective of this studies is to investigate how much the application of (PTS) and medicamentous therapy, make intergroups differences, in muscle strength and trunk movability - subpopulation, she-patients with low bone mineral density  The objective of this studies is to investigate how much the application of Physical Treatment in the Spa therapy (PTS) and medicamentous therapy, make intergroups differences, in muscle strength and trunk movability - subpopulation, she-patients with low bone mineral density

17. representation of the study representation of the study  Methods: 125 postmenopausal women with low bone mineral density, were on defined regime: hydro, mud, kinezzy, magnet and bisphosphonate therapy, during the period of six months  Functional status of trunk musculature was determined by the apparatus Isostation B 200  The groups were made according ot T-scor, muscle strength and trunk movability, as well.

18. representation of the study representation of the study  measuring of bone mineral density was performed on Lunar DPX densitometer, at the some time anteroposterior scan of lumbal verebrae L1-L4 by the method of two energetic absorbtiometery by X-rays (DXA) was performed, the results were interpreted according to the accepted definition of OP accordinig to the WHO and according to the T-scor

19. representation of the study representation of the study  in the period of six months (PTS) was conducted twice  in the period of six months Physical Treatment in the Spa Therapy (PTS) was conducted twice  in the span of 3 months in duration from two weeks  involved the application of - mud therapy (LS part of the spine) - hydro therapy (bathing in the thermo-mineral water 20min.) water 20min.) - pulsed magnetic field (50Hz,10mT,30 min)

20. representation of the study representation of the study  kinezzy exercise were performed in the hall and the implied stretching exercises, balance and strength into a lying, sitting and standing position  kinezzy exercise were also outside and are implied are training of breathing exercises and general fitness, with a change in speed of motion and configuration terrain

21. representation of the study representation of the study  medicament therapy consisted of taking: - 1000 mg of calcium a day - coated tablet of vitamin D3 (1000 i.j.) - coated tablet of vitamin D3 (1000 i.j.) - bisphosphonates (Alendronat 10 mg)

22. distribution of patients in relation to age and bone density Age of life osteoporosa osteopenia br.%br.% 51 - 60 2822,4 35 28 61 - 70 4233,6 16 12,8 ≥ 7143,200 n* = 125 7459,251 40,8 n*- the total number of patients

23. results results  a group of 25 she-patients with average T-scor= -2,47±0,04 has been on PTS for six months T-scor= -2,47±0,04 has been on PTS for six months  PTS was included: hydro therapy (15 min. in thermo-mineral water), mud, pulsed magnetic field and kinezzy therapy,  this group had muscle strength increase and LS movability of 17,92%.

24. Maximum isometrically test increasemuscle strength and LS movability increase muscle strength and LS movability

25. results results  the similar results were achieved in the group of 50 she-patients with average T-scor=-2,57±0,09 who at the same period of time, beside the same had calcium and vitamin D3 intake T-scor=-2,57±0,09 who at the same period of time, beside the same Physical Treatment in the Spa Therapy, had calcium and vitamin D3 intake

26. Maximum isometrically test increasemuscle strength and LS movability increase muscle strength and LS movability

27. results  the third group consisted of 25 she-patients, they had the average T-scor=-2,68±0,08 and during the period of six months, beside PTS, calcium and vitamin D3, they also got bisphosphonates, as well  icrease if muscle strength and LS movability of over 35% were noticed

28. Maximum isometrically test increase muscle strength and LS movability increase muscle strength and LS movability

29. results  the control group, during the period of six months, did not have any therapy  In this group of 25 she-patients with average T-scor=-2,39±0,03 decrease of muscle strength and LS movability of 15,47%, were noticed

30. Maximum isometrically test decreasemuscle strength and LS movability decrease muscle strength and LS movability

31. CONCLUSION CONCLUSION  there is a high possitive correlation between muscle strength and trunk movability, at one hand and application of both balneophysical and medicamentous therapy, at the other hand, in she-patients with low bone mineral density, no matter the age nor the level of bone density  values of muscle strength and trunk movability were average: for trunk extensors 20%, for rotators 30% and for flexors even 36%

32. Acknowledgement Prim. Mirka Karadžić, M.D. Department of Rheumatology Department of Rheumatology Institute for treatment and rehabilitation of rheumatic diseases “Niška Banja” Prof. Aleksandar Dimić, M.D. Medical Faculty Medical Faculty The University of Niš, The University of Niš, Serbia Serbia