Symptoms
In osteoporosis, bones become weak, porous, and brittle and undergo structural changes. Even minor stresses can lead to a fracture, especially of the vertebrae, femoral neck, and wrists. Fractures pose a risk to the elderly and can lead to pain, hospitalization, surgery and disability. In the worst cases, they are even life-threatening. Other possible consequences include a decrease in body size and deformities (e.g., round humps). Incidentally, early osteoporosis often remains asymptomatic, i.e. does not cause any symptoms. These only occur after a fracture.
Causes
Osteoporosis occurs when the processes that break down bone outweigh the processes that build bone. The result is reduced bone mass and disruption of the bone’s microarchitecture. Bone loss is common in old age, in post-menopausal women, and may also be promoted by numerous diseases. Drugs can trigger osteoporosis as an adverse effect, especially glucocorticoids when taken long-term. Risk factors for developing osteoporosis include:
- Age: from 30-40 years of age, bone density continuously decreases.
- Female gender, menopause (postmenopausal osteoporosis).
- Heredity: family history
- Insufficient intake of calcium, vitamin D and proteins.
- Sedentary lifestyle, not enough physical activity.
- Stimulants: smoking, alcohol, coffee
- Drugs: glucocorticoids, thyroid hormones (overdosed), antiepileptic drugs, cytostatics, antidepressants.
- Low body weight (BMI < 20 kg/m2)
- Previous fractures
- Secondary causes: Numerous diseases, e.g., hyperthyroidism, Cushing’s disease, diabetes mellitus, rheumatoid arthritis.
Diagnosis
Diagnosis is made in medical treatment primarily by measuring the bone density of the hips, vertebrae and forearm.
Prevention
- Physical activity, sports
- Covering the need for calcium and vitamin D through diet or supplements.
- Reduce the risk of falls, assistive devices, hip protectors.
- Be careful with psychotropic drugs such as the benzodiazepines, they increase the risk of falls
- Reduce stimulants
Drug treatment
Calcium plays is essential for building bone and is used for prevention and treatment. It is available in the form of various salts and is often administered in the form of chewable, lozenges or effervescent tablets. Calcium should not be taken at the same time as bisphosphonates because it reduces their absorption. Vitamin D plays a crucial role in calcium balance. It increases absorption from the intestine and decreases excretion by the kidneys. Vitamin D is often given as a fixed combination with calcium and in the form of cholecalciferol. In addition to calcium and vitamin D, vitamin K2 as a dietary supplement can also have a positive effect on bone. Bisphosphonates inhibit bone resorption by inhibiting osteoclasts. Depending on the active ingredient, daily, weekly, monthly or trimonthly administration is possible. When taking them, the instructions in the package insert must be followed exactly. Bisphosphonates must not be co-administered with food or calcium because their already very deep absorption is further reduced:
- Alendronate (Fosamax, generic).
- Ibandronate (Bonviva, generics)
- Risedronate (Actonel, generics)
- Zoledronate (Aclasta, generics)
Other drugs
Hormone replacement therapy:
- Estrogens, progestins
- Tibolone (Livial)
SERM:
- Bazedoxifene (Conbriza).
- Raloxifene (Evista)
Parathyroid hormones:
- Teriparatide (Forsteo, biosimilars).
Calcitonin receptor agonists:
- Salmcalcitonin (Miacalcic) – not indicated for postmenopausal osteoporosis.
Anabolic steroids:
- Nandrolone (Deca-Durabolin)
Monoclonal antibodies:
- RANKL inhibitors: denosumab (Prolia).
- Sclerostin inhibitors: romosozumab (Evenity).
Strontium:
- Strontium ranelate (Protelos, not commercially available in many countries).
Alternative medicine (selection):
- Calcoheel, Osteoheel
- Weleda building lime
- Schuessler salts e.g. No. 2, 9
- Base powders and tablets