Osteoporosis (Bone Loss)

Osteoporosis (bone loss) is one of the ten most common chronic diseases worldwide, according to the World Health Organization (WHO). In Germany, around six million people are affected, most of them women. Osteoporosis is a typical age-related disease of the bones – which can have fatal consequences in some cases: These consequences include bone fractures, operations, prolonged bed confinement and the need for nursing care. In the following, we inform you about the causes, symptoms, consequences and treatment of osteoporosis.

Definition: what is osteoporosis?

Osteoporosis is a chronic disease of the bones in which the density of the bones is reduced as a result of disturbed processes of formation and degradation. As a result, they become porous and brittle. To better understand this brief definition, it is important to understand how the renewal of bone substance normally works in the body: Bones are composed of bone tissue and different minerals that are deposited in the bone tissue and stabilize it. The most important minerals are calcium and phosphate. The bone mass in the body is constantly being built up and broken down: Where the skeleton is subjected to increased stress, more bone substance is built up Where the stress is low, bone is broken down. A certain type of cell, known as osteoblasts and osteoclasts, is responsible for this. Normally, the building and breaking down processes in the body are in balance. However, if this balance is disturbed, there can be a greater reduction in bone mass – hence the popular name osteoporosis. The result is unstable and, above all, brittle bones. Structure in normal bones and in osteoporosis – iStock.com/corbac40

Causes of osteoporosis

Different causes are particularly crucial in the development of osteoporosis. First, it is important to distinguish between primary and secondary osteoporosis.

Primary osteoporosis

Women in particular are often affected by primary osteoporosis: About one-third to one-quarter develop the disease after menopause, and it becomes more common with age. The reason is primarily the decline or loss of production of the female hormone estrogen during menopause – around the age of 50. Most women lose valuable bone substance when the sex hormone level drops. This is due to the fact that estrogens control the absorption of calcium into the bones, and this is the most essential bone building block. However, age-related bone loss actually begins – very slowly and unnoticed – much earlier, from the mid-30’s. Underweight women in particular can also develop osteoporosis at a younger age, since their estrogen levels are usually permanently low. Furthermore, women who do not have children and who went through menopause early are more frequently affected by bone loss. Here, too, the lower estrogen level plays a role. Primary osteoporosis also includes senile osteoporosis, which can occur in men and women due to age. This is due to the fact that with increasing age the probability of an imbalance in the build-up and breakdown of bone mass increases. Senile osteoporosis usually develops more slowly than osteoporosis associated with estrogen deficiency.

Secondary osteoporosis

This form of osteoporosis is less common than primary osteoporosis. It occurs as a result of other diseases or the use of medications. Causes of secondary osteoporosis include:

Special form transient osteoporosis

Transient osteoporosis occurs mainly in the area of the hip joints. They occur abruptly and often radiate to the groin and thigh. The pain usually worsens with exertion and improves with recumbency. Unlike osteoarthritis of the hip, however, mobility is not restricted. In contrast to “classic” osteoporosis, the symptoms are triggered by water accumulation in the bones, which can result from impaired blood circulation. Since the disease often improves on its own after a few months, transient osteoporosis is treated by relieving the pressure on the bones with the aid of crutches and painkillers. Above all, it is important to have the condition examined carefully to rule out more serious conditions with similar symptoms, such as osteonecrosis of the femoral head.

What other factors promote osteoporosis?

In addition, the following risk factors may influence the development of osteoporosis:

  • Calcium deficiency or vitamin D deficiency: lack of calcium destabilizes bone tissue. Vitamin D deficiency can also result in less calcium being absorbed from the intestines.
  • Smoking: The relationship between smoking and osteoporosis is not yet fully understood. If necessary, nicotine can have a negative impact on estrogen levels as well as blood circulation and thus also on bone formation.
  • Heavy alcohol consumption: the relationship between alcohol consumption and osteoporosis also requires further investigation. It is likely that alcohol inhibits bone formation as well as vitamin D metabolism. In addition, the consumption of alcohol increases calcium excreted.
  • Lack of exercise: in the absence of exercise, bone metabolism is less stimulated.
  • Hereditary predisposition: There may be an increased risk for osteoporosis if close family members already have it.

Osteoporosis: symptoms and progression

Normally, the bone-degrading and bone-building cells are in balance. But in a disease of osteoporosis, this perfectly coordinated interaction is disturbed – the degradation predominates. As a result, the bones can no longer bear as much weight: they become increasingly porous and the risk of bone fracture increases dramatically. But how can I tell if I have osteoporosis? It is fatal that the changes in the bones often cause no symptoms or complaints for a long time and are only discovered late and as a result of complications. The possible consequences include:

  • Back pain: vertebral deformations and fractures initially cause back pain. However, because the reasons for this discomfort can be varied, affected individuals often do not seek medical attention early on to determine the causes. In severe and persistent back pain, you should therefore always see a doctor.
  • Hunchback (“widow’s hump”): as the disease progresses, the body size decreases and a hunchback can form. The reason for this are again increased vertebral fractures.
  • Wobbling or falling out teeth: the periodontium and the ossified root cavities of the teeth can also be affected by bone loss.
  • Femoral neck fractures: these occur mainly after prolonged osteoporosis and in older people. Femoral neck fractures are often associated with complications and lasting pain. More than 90 percent of those affected by a femoral neck fracture have reduced bone density.

The more advanced the disease, the more pain osteoporosis can cause. In the final stages of untreated osteoporosis, moreover, even the slightest stress can cause a bone fracture, for example, a slight stumble, coughing, turning over in bed and even lifting a cup. Affected people can barely stand up because the spine is severely damaged by vertebral fractures. If you suspect osteoporosis in yourself, our test can give you further clues. Early diagnosis can be crucial in the treatment of osteoporosis. More than 65 percent of all cases are not diagnosed early and therefore are not treated appropriately.

How long can you live with osteoporosis?

As with many diseases, it depends on the severity of the damage that has already occurred at the time of diagnosis. If left untreated, osteoporosis can significantly reduce life expectancy.However, with the earliest possible and most effective treatment, the life expectancy of those affected can be quite long. Early diagnosis and proper treatment are therefore crucial when osteoporosis is suspected.

Diagnosis: what examinations are done?

To diagnose osteoporosis, the doctor will first ask exactly about symptoms such as pain and changes in body size, as well as other medical history (anamnesis). This includes, for example, whether other family members already have osteoporosis or whether there is an underlying condition involving certain medications that may promote the development of osteoporosis. This is followed by a physical examination. This involves measuring the body weight and height of the affected person.

Mobility check

Mobility is also checked. The so-called “chair-rising test” or the “timed up an go test” are often used for this purpose:

  • The “chair-rising test” measures the time it takes a person to stand up from a chair five times in a row without using their arms to help them. The time should be a maximum of ten seconds.
  • The “timed up an go test” measures the time it takes a person to get up from a chair, walk three meters, turn around and sit down again. If a walking aid is used in everyday life, it may also be used here. The time required for this test should also not exceed ten seconds. Otherwise, other factors must be checked. If more than 30 seconds are needed to complete the test, a limited mobility is very likely.

If the physical examination provides evidence of osteoporosis, laboratory tests and x-rays of the thoracic and lumbar spine to examine bone density will follow, if necessary.

Bone Density Measurement

The best procedure to determine bone fragility is bone densitometry (osteodensitometry), or dual energy X-ray absorptiometry (DXA). This is a relatively low-radiation X-ray technique. With the aid of bone densitometry, it is determined whether values of bone mineral content typical of osteoporosis are present. These so-called T-values are then compared with average values of 30-year-old people of the same sex. It therefore indicates the deviation from the normal value, which is why it is preceded by a minus sign. In addition, the value is compared with average values of healthy men or women of the same age. This is the so-called Z value. If the T-value is within a range of -1 to – 2.5, a preliminary stage of osteoporosis, known as osteopenia, is present. A value of -2.5 or more is considered osteoporosis. Bone densitometry can also be used as a preventive screening method, but is only paid for by health insurance companies if there is already a bone fracture and thus a well-founded suspicion of osteoporosis. If you may be at increased risk for bone loss, talk to your doctor to see if he or she thinks further tests are necessary. These may include ultrasound exams, blood tests, or a quantitative computed tomography (QCT) scan.

Treatment of osteoporosis

What can be done to treat osteoporosis? Medications used to treat osteoporosis include the following:

  • Calcium and vitamin D3 tablets: they are part of the basic therapy and are used to strengthen bones.
  • Biphosphonates: they are thought to reduce the risk of bone fractures. Biphosphonates are now also available as an injection for the treatment of osteoporosis. This has the advantage of eliminating the need to take tablets every day. The biphosphonates include, for example, alendronic acid.
  • Calcitonin: This hormone can positively influence the calcium and phosphate balance in the body.
  • Painkillers: for the pain of osteoporosis, agents such as diclofenac are used.
  • Flouride preparations: whether these really have a positive effect in the treatment of osteoporosis, is now controversial.

In younger women, moreover, estrogen therapy can be initiated; however, this may have side effects such as an increased risk of uterine cancer. Physiotherapy and physical therapy, such as massage, heat or cold therapy, support the drug treatment. In addition, regular exercise sessions also help. Walking, hiking or swimming are particularly suitable.A doctor or therapist can help you choose the right sport. Bone protectors, such as hip protectors, may also be used if there is an increased risk of falling. Broken bones are treated surgically.

Can osteoporosis be cured?

At the current time, osteoporosis cannot be cured. Only the progression of the disease can be delayed. However, with the right diet, adequate exercise and appropriate drug treatment, significant improvements in symptoms can occur. Osteoporosis: 11 tips for strong bones

Prevent osteoporosis

A healthy lifestyle can help prevent osteoporosis. The basis for strong bones is a healthy diet with sufficient calcium and magnesium already in youth. If you also get plenty of exercise, you help to ensure that your bones are more stable in old age. Exercise in the fresh air, in particular, can help prevent osteoporosis, since sunlight can increase the production of vitamin D in the body. Even if bone loss has already been diagnosed, those affected can often achieve a significant improvement with physical exercise and a balanced diet. Exercise and sports strengthen skeletal muscles and are extremely important for the development and maintenance of bone mass. Running, cycling, swimming, or even specific strength training stresses the bones. As a result, more bone substance is built up.

Calcium and vitamin D: nutrition and osteoporosis.

Quite important for bone building is the mineral calcium. Make sure that your diet contains enough calcium. The German Nutrition Society (DGE) recommends 900 milligrams of calcium a day for adults. Calcium is found especially in milk and dairy products. If you don’t like these as much, you can turn to kale, broccoli, spinach, almonds, hazelnuts and figs. Post-menopausal women who don’t take hormones need even more calcium because the body can’t use calcium from food as well. Is there anything you should not eat if you have osteoporosis? In fact, there are also foods that should be avoided if you have osteoporosis. Phosphates are “calcium robbers” and are found in sausage and cola, for example. Excessive consumption of caffeinated beverages, too much salt and dietary fats can also be detrimental to bone formation. Excessive consumption should therefore be avoided – but these foods are not forbidden. Phosphate is even an important energy supplier. A severe deficiency can lead to epileptic seizures or coma. In order for the body to incorporate calcium into the bones, it needs vitamin D. It is formed in the body under the influence of sunlight. Sufficient formation of this important vitamin is achieved even with a daily half-hour walk. Alternatively there are also preparations in the pharmacy, which contain vitamin D and calcium. Whether taking these preparations can really prevent osteoporosis, however, is now considered controversial. In addition to nicotine consumption, increased alcohol consumption is also suspected of hindering bone formation. So limit these stimulants as much as possible to prevent weakening of the bones.

Safety tips for unstable bones

Those who suffer from osteoporosis should, above all, avoid risk situations and risk factors so as not to expose themselves to unnecessary danger. In addition, the following tips can help keep people with osteoporosis safe:

  • Reduce excess weight.
  • Exercise regularly.
  • Try to avoid falls: Use flat, non-slip shoes, no carpet runners in the home, good lighting, and use the banister when climbing stairs.
  • Do not lift heavy weights.
  • Have vision problems corrected to reduce the risk of falls.

If you take these tips to heart and pay attention to proper nutrition, adequate exercise and appropriate drug therapy, you can do a lot to ensure a milder course of osteoporosis.