Preventive aspects of mobility and functional disability.

Among bone and joint diseases, frequent causes of disability include (a) fractures from falls and osteoporosis, (b) osteoarthritis of hips, knees, and lumbar spine, (c) painful feet, (d) back pain, and (e) intractable rheumatoid arthritis. Risk factors for falling may arise from factors intrinsic to the patient and from hazards in the environment. The prevention and management of osteoporosis are controversial. Most experts endorse the use of estrogens in postmenopausal women and the need for continuing physical activity, particularly walking, in both elderly men and women. To preserve independent living, conservative management of osteoarthritis of hip, knee, and low back consists of properly balancing rest, non-weight-bearing exercises, and the use of walking aids. In rheumatoid arthritis, the clinician should emphasize (a) exercises to maintain range of motion and (b) muscle strength, both to prevent flexion contractures and to maintain the ability to carry on activities of daily living.