Osteoporosis, Hip Fracture and TurboSonic Whole Body Vibration Therapy®

Osteoporosis is a silent disease that affects 35% of post menopausal white women. (1) From age 50 to age 90, the risk of hip fracture in white women increases 50-fold. The first symptom most often being a fracture. Of all the fractures related to osteoporosis, fracture of the hip has the gravest consequences. The mortality rate in patients with hip fracture is 12–20% higher than in persons of similar age and gender who have not suffered a fracture.(2) Morbidity associated with hip fracture including decreased activity and inability to be self sufficient results in another 20% of the injured eventually being committed to long term care. This often leads to a downward spiral in physical and mental health. The cost both personally and financially is a tremendous burden to society. Direct cost is between $12-$18 billion a year and indirect cost billions more. (1)

Bones are alive and dynamic. Bones consist of a scaffold of elastic tissue on which minerals are deposited to give it its strength for structural support. They are constantly in a state of remodeling. The remodeling does not change the shape of the bone but is intended to repair damage caused by repeated stresses the bone sustains. Bones typically develop small cracks and deformities will occur in areas of cell damage. This creates a constant demand for repair. Remodeling is the process that repairs and replaces these areas of damaged bone. Remodeling also prevents accumulation of too much old bone, which can lose its resilience and become brittle. Osteoclasts are special cells that breakdown old bone and creates a surface for new bone to be replaced. Osteoblasts are another class of special cells that lay down the new bone in orderly layers that add strength and elasticity to the matrix. This process is regulated by mineral and hormonal balance along with mechanical strain. New bone is created in response to stresses placed on the bone. Gravitational forces along with tension from muscle contraction are the stimulus that causes osteoblasts to create new bone. When the mechanical force of the muscles declines, bone mass and strength also declines.

According to the North American Menopause Society, bisphosphonates are considered to be first-line therapy for the treatment of postmenopausal osteoporosis. This gold standard medical approach results in a 6-8% improvement of bone density over 3 years. Unfortunately the bone will be denser but is of inferior quality. Bisphosphonates are drugs that inhibit osteoclast cells. As a result, bone density is increased secondary to diminished bone breakdown. Such medications have no impact on the osteoblastic rebuilding activity. Therefore the minute cracks and damaged area are not repaired. Over time, the bone becomes more dense and brittle, with little reduction in fracture rate. Once Fosamax is taken up in bone, it takes over 10 years for half of it to decay. ( )

In the four year Fracture Intervention Trial: that was randomized, double-blind, placebo-controlled 4432 patients study, Fosamax did not demonstrate a clinically significant reduction in hip fractures. It has been reported that Fosamax increases bone mineral density, but it also may increase fractures of the foot, pelvis, ankle, and hip.(42)

The efficacy (43) for prevention of non-vertebral fractures has not been

demonstrated.

Weight-bearing exercises are widely regarded as the best way to load the bone and prevent osteoporosis. Most women believe that walking will provide enough stimuli to create a protective benefit. However, a study led by Paul M. Mayhew, recently published in The Lancet, reported that the part of the hip bone most likely to fracture does not receive adequate mechanical load by walking. This is especially important because the most common way to fracture the hip is by a sideways fall. So the sense of security of preventing fracture by walking is now being seriously questioned. Another approach is to train elderly individuals with strenuous load-bearing exercises. In elderly individuals, those type of exercises are not the easiest to perform and may actually increase the risk for injuries.(19) This makes it very difficult to implement a safe method to stimulate appropriate bone remodeling.

Researchers at the University of Cambridge found hip fragility directly related to the incidence of fracture. In particular, fracture rate increases because of decreased mechanical loading of the upper, outer portion of the neck of the hip. This results in that portion of the bone becoming thinner and less capable of withstanding stressful shocks.

TurboSonic Whole body Vibration Therapy is a novel way to specifically train the hip musculature in an appropriate non traumatic manor stimulating healthy remodeling. TurboSonic Whole body Vibration Therapy performed for a period of 6 months utilizing frequencies from 8-11 Hertz has demonstrated a 12% improvement in bone density of the hip measured by DEXA scan. The training requires the individual to stand on a platform that displaces in a perfectly vertical direction, mimicking gravity. The platform moves with varying frequencies and displacements. The patient performs both two-legged and one-leg squats. The platform plate will move with varying displacements which can vary the G force intensity. This evokes reflexive muscle contractions of various intensities which improves strength, balance and synchronizes muscle contractions. There were no reported vibration-related side effects.

It can be inferred from the mechanism of stimulus that this WBV training created a more vibrant and strong hip. The bone has increased its density and elasticity due to both the mechanical stresses transmitted to the bone and also from increased muscle activity of the hip musculature. The thigh muscles were contracted at rates of 480 to 660 times per minute, while bringing the femur musculature from flexion into extension. The Turbosonic Vibration Therapy Trainer allows the therapist to regulate the frequency and intensity of the platform plate’s displacement resulting in a gradual, easily tolerated, but not overtaxing training.

The training regimen presented here offers a state-of-the-art, high tech, non-toxic, non-invasive way to stimulate the body’s own natural healing responses to not only heal and restore its own bone mineral density, but also as a way of preventing fractures from occurring in those people who might otherwise be prone to develop the condition.

The bone density increase of 12% at 24 weeks of TurboSonic Whole Body Vibration Therapy is greater than the 1.5% gain in (hip) BMD observed with antiresorptive agents at the 6-month time point. (21,22) thus supporting the potential clinical relevance of TurboSonic Vibration Therapy Training.

This initial case report suggest that further controlled studies of this novel, high tech, therapeutic method should be performed.

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39:Low-level, high-frequency mechanical signals enhance musculoskeletal development of young women with low BMD. Gilsanz V, Wren TA, Sanchez M, Dorey F, Judex S, Rubin C.20:41–52 JOURNAL OF BONE AND MINERAL RESEARCHVolume 19, Number 3, 2004 Published online on December 22, 2003; doi: 10.1359/JBMR.0301245

© 2004 American Society for Bone and Mineral Research

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