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The silent disease osteoporosis

As part of the normal ageing process our bones lose density. However, when this decrease in bone strength and density is significant, and more than the average person of the same age, it can weaken your bones and make them more likely to easily break. This decrease in density does not happen overnight, so many patients do not recognise the time when they need to take action. An early osteoporosis test prevents this and, thanks to early detection, makes it possible to start therapy before it's too late and maintain the health and stability of the bones for as long as possible.

 

Bone density decreases with osteoporosis

Bone loss: Left: healthy, Right: osteoporotic.

These will break at the slightest strain.

Osteoporosis: Second deadliest disease after lung cancer

Total years of life lost by disease in Europe (excerpt)

Who is affected?

It is estimated that over 3 million people in the UK currently suffer from osteoporosis and over 500,000 will receive hospital treatment for fragility fractures. Osteoporosis usually occurs in those over the age of 50 years, and is more common in women than men, typically one in three women will suffer with the disease and one in five men. 

Which symptoms can occur?

Osteoporosis usually develops slowly. At first, those affected therefore generally have no complaints. Only as it progresses do they experience pain, for example back pain and knee pain. They are often not recognised as the first symptoms of osteoporosis.

How is osteoporosis detected?

Traditionally, osteoporosis is diagnosed with the help of an X-ray image, known as a DXA scan which measures your bone density. Images are taken of both the hip and base of the spine and your bone density is compared to that of a healthy young adult. In addition, your doctor might calculate your future risk of breaking bone using an online fracture risk assessment calculator.  Osteoporosis only shows up on the X-rays when it has already reached a considerable stage. Unfortunately this means that many patients start therapy very late and therefore they have a poor prognosis of being able to live symptom-free in old age. For this reason, osteoporosis is often mistakenly associated with older people.

World innovation from Kiel

The manufacturer of the test is an innovative medical diagnostics company. It won the "Germany - Land of Ideas" award in 2017 for its outstanding achievements. The development of the new and radiation-free diagnostic procedure was funded by GEOMAR Helmholtz Center for Ocean Research Kiel and the Helmholtz Association Berlin together with UKSH Kiel. The clinically tested and certified procedure is a world first as it does not require radiation.

Ways to prevent osteoporosis

If the signs point to osteoporosis, it is possible to do a lot of good for your own body by changing your behaviour and diet. The best forms of exercise to strengthen your bones are weight bearing and the higher the impact the better (eg; jumping, dancing, racket sports, baseball, volleyball). In addition to this you also need to ensure you are doing muscle strengthening exercises such as pilates, yoga, tai chi or weights in the gym as strong muscles support the skeleton. A healthy, balanced diet rich in vitamin D and calcium will ensure you are getting a broad range of vitamins and minerals to support your bone health. 

Possible treatment approaches

Have you been diagnosed with osteoporosis and are wondering what to do next? Only your doctor can discuss your personal treatment options, however, we will introduce you to some common medicines and treatment measures.

What is osteoporosis?

Osteoporosis is more common that many people realise; over 3 million people in the UK suffer from the disease which affects approximately one in three women and one in five men. The stage before osteoporosis is called osteopenia and this is where your bone density is lower than the average for your age but not sufficiently low enough to be classed as osteoporosis. The disease, where bones lose their strength and are more easily susceptible to fracture, typically occurs from the age of 50 and mainly affects women after the menopause. 

Bone density decreases with age. This bone loss is a normal ageing process and does not usually cause any symptoms. However, if certain additional risk factors are added, too much bone substance is lost and osteoporosis develops. These factors are explained on these pages.

What happens with osteoporosis?

Our bones are constantly being remodelled to adapt to changing requirements. Until about the age of 35, more bone mass is normally built up than broken down. From the age of 35, bone resorption (ie bone loss) then gradually predominates and accelerates with age. Healthy older people lose about 0.5 to 1 percent of their bone mass per year.

Causes of osteoporosis: Menopause

Osteoporosis can have different causes and be triggered by different factors. Hormones are to blame for brittle bones in about 70 percent of cases. As the production of oestrogen decreases in women during the menopause, this has a negative effect on bone metabolism, because the oestrogens inhibit the cells that break down bone. The balance of bone breakdown and bone formation that regenerates healthy bone is tipped and more bone mass is lost. Incidentally, women who had their first period relatively late as teenagers or went into the menopause very early are particularly at risk for osteoporosis. Women who have not had children or whose ovaries have been removed are also at increased risk of osteoporosis.

In 30 percent of cases, osteoporosis develops as a secondary disease of another (long-term) illness such as asthma, hyperthyroidism, kidney problems or chronic inflammatory bowel disease.

Asthma can trigger osteoporosis.

It is much more sensible to check the risk of osteoporosis when entering the menopause rather than waiting for warning signs. The earlier a dangerous decrease in bone density can be diagnosed, the greater the chances of reducing the risk of disease with therapy and preventative measures. Risk tests on the internet, for example at https://osteolabs.co.uk/online-risk-test, are a first step towards a diagnosis. They give a good indication of whether a visit to the doctor and further examinations make sense.

Other diseases that can trigger osteoporosis:

  • Long-term glucocorticoid therapy, e.g. in bronchial asthma or rheumatoid diseases.
  • Hyperthyroidism
  • Hyperparathyroidism (primary hyperparathyroidism)
  • Kidney diseases with increased calcium excretion or vitamin D metabolism disorders
  • Adrenal problems with increased cortisol levels
  • Chronic inflammatory bowel diseases such as Crohn's disease or ulcerative colitis

Rheumatoid arthritis can also trigger osteoporosis

Patients with rheumatoid arthritis, a chronic inflammation of the joints, have an increased risk of developing osteoporosis. This is because the rheumatic inflammation itself reduces bone density through various reinforcing mechanisms. The same applies to arthrosis, a joint disease that is often accompanied by severe pain. Arthrosis occurs when the joint cartilage is irreparably damaged by chronic overuse. This is also referred to as joint wear and tear.

Unfortunately, osteoporosis cannot yet be cured. However, careful prevention can prevent the disease from developing in the first place. Timely treatment, in turn, can slow down the progression of the disease and prevent complications.

 

 

Risk of osteoporosis: Thin people more at risk

Two thirds of all osteoporotic fractures are suffered by women.

Slim, petite or even underweight people are more at risk. More body weight seems to protect the bones. The menopause and old age favour osteoporosis. People who do not get much fresh air and therefore only form vitamin D sparsely are also among the risk groups, as are patients with metabolic diseases.

Other factors that can lead to osteoporosis

Besides diseases and the hormonal changes of the menopause, there are a number of other factors that can promote the development of osteoporosis. However, these triggers can be reduced through a healthy diet rich in vitamins and a balanced lifestyle with plenty of exercise in the fresh air. Even if a temporary illness confines you to bed, you can strengthen your body and bones again afterwards through gentle exercise and abstinence from alcohol and cigarettes.

Prolonged bed rest can promote osteoporosis

A bone fracture increases the risk of further fractures

A bone fracture in old age can have serious consequences. Women in whom osteoporosis occurs as a result of the menopause suffer vertebral fractures particularly frequently. First bone fractures statistically occur around 6-12 years after the last menstrual period. Age-related osteoporosis, which can affect both men and women, often results in fractures of the neck of the femur (hip).

Lifestyle risk factors for osteoporosis

The general rule is: reduce stimulants - or avoid them altogether - and make sure you eat a healthy diet rich in vitamins for osteoporosis.

These factors can contribute to osteoporosis:

  • Several weeks of strict bed rest
  • General lack of exercise
  • Lack of exposure to daylight
  • Malnutrition (especially calcium and vitamin D)
  • Fizzy drinks and fast food (form more acids in the body)
  • Excessive consumption of coffee and alcohol (which increase acids in the body)
  • Smoking
  • Laxative abuse

Typical osteoporosis symptoms

Initially, degradation of the bones is usually painless and without any noticeable symptoms. When osteoporosis becomes apparent, it is usually already in an advanced stage. Nevertheless, there are a few possible warning signs.

 

 
  • Acute and chronic back pain
  • An increasing hunchback (widow's hump)
  • Overlong arms (they look that way because the osteoporosis patient is getting smaller and smaller - the widow's hump is to blame)
  • The ribs touching the pelvis (caused by the hunchback)
  • Fir tree phenomenon (oblique skin folds at the back)

If you recognise these signs, you should take an osteoporosis risk test, for example our risk test here. Because with an early diagnosis, you can counteract bone loss. However, osteoporosis cannot be cured.

 

Diagnostics: Bone density measurement in osteoporosis

Bone density measurement is a recognised diagnostic procedure to detect osteoporosis. The diagnosis is positive if the bone density in the evaluation is significantly lower than in healthy people of the same age. Traditionally this measurement is taken using a DXA scan which is a special bone density scan used to measure bone mineral content and mass. However, there are alternative test procedures that do not require you to expose yourself to X-rays. For example with the osteoTest | home and osteoTest | med , urine and blood samples are sufficient to evaluate and calculate the bone density using high-precision mass spectrometers and extensive computer evaluation.

On a DXA scan, the result of the bone density measurement is given as a so-called T-score. Osteoporosis is present when the bone mineral density is 2.5 standard deviations below the statistical mean of healthy women before menopause. A T-score of 0 corresponds to the bone density of a young and healthy adult between the ages of 20 and 30.

According to the current recommendations of the World Health Organization:

  • a T-score up to -1 standard deviation as normal
  • a T-score between -1 and -2.5 standard deviation as reduced (osteopenia)
  • a T-score equal to or less than -2.5 standard deviation as osteoporosis

Early detection prevents bone fractures

Osteoporosis often remains undetected for a long time. It is only when a fracture occurs that people take notice. Yet constant back pain, for example, can be an alarm signal for anyone over 60. Our bones form the basis for the shape and structure of the human body. If the skeleton weakens, it first affects the back. Arthrosis can also be a warning signal. You can quickly and easily check your risk of developing osteoporosis with a short test on the internet.

If you notice such warning signs, it is worth visiting your doctor to investigate whether you are suffering from osteoporosis. The doctor will talk to you to find out if you have any risk factors for osteoporosis. If several risk factors come together, the doctor will probably take a bone density measurement.

During the consultation, a few basic questions are asked to determine the risk.

Among other things, they clarify:

  • Whether the patient moves a lot
  • What (s)he eats
  • How much time (s)he spends in the fresh air
  • Whether there is a family history of osteoporosis
  • Whether the patient smokes
  • Whether (s)he regularly drinks wine or other alcoholic beverages
  • Whether (s)he has another disease that can cause osteoporosis

Alternative test methods with blood and urine

Osteoporosis only shows up in imaging procedures when it has already reached an advanced stage. The radiation-free diagnostic procedure in the form of a blood and urine test, such as the osteolabs early test, identifies the risk of developing osteoporosis much earlier. It determines the calcium ratios in the bones. In addition, the osteoTest | med uses laboratory values of creatinine, cystatin C and eGFR to assess kidney function and optionally determines the body's vitamin D supply. All values together allow early detection of risk of developing osteoporosis at a time when no trace of the disease can yet be seen in imaging procedures such as a CT scan. 

After a positive diagnosis and following the start of therapy, bone density should be checked every one to two years. The earlier a diagnosis the sooner treatment can be started and progression of the disease can be slowed and fractures can be prevented or at least delayed.

Osteoporosis prevention

Osteoporosis means a decrease in bone tissue in addition to the loss of calcium in the bones. Therefore, everything that strengthens the bones serves as prevention.

A change in diet is also recommended, particularly becoming lighter and deacidifying. If you eat a lot of meat and sweets, you are feeding your body "digestive waste" in the form of acids. But over-acidification of the body has its price. To buffer these acids, the metabolism uses calcium, so the demand increases and can no longer be met from food. To restore the acid-base balance in the body, it uses the calcium deposits in the bones. If you pay attention to an alkaline diet and avoid acid-forming substances, you can slow down the onset of osteoporosis.

How to slow down bone loss

  • Give up smoking
  • Drink less coffee
  • Move more: gymnastics, swimming, hiking
  • Make sure you have a good supply of vitamin D
  • Eat a calcium-rich, alkaline diet

Intestinal cleansing with lactic acid bacteria helps the body to better absorb calcium, which is in short supply. Sauerkraut, kefir, apple cider vinegar or ready-to-use preparations from the pharmacy ensure improved digestion. The intestinal mucosa actively absorbs minerals and makes them available to the body. Bone loss can thus be slowed down. Vitamin therapy is also recommended. Vitamin D and vitamin K have proven to be effective.

Fall prevention

Since no one knows how fragile their bones really are, you should avoid the risk of falls if possible. In addition to targeted training of muscles and sense of balance, you can also strengthen coordination and sure-footedness in everyday life. Climb stairs as often as possible, walk short distances and take regular walks. For safety's sake, you should also remove any tripping hazards in the home environment - for example, slippery runners, creases in the carpet, loose cables or uneven doorsteps.

Carpets increase risk for trips and falls.

Osteoporosis nutrition: The small daily ration of calcium

Source: GU Mineralstoffe
Amount Calcium content
1 Glass of milk 240 mg
50 g Gouda 410 mg
2 Slices of wholemeal rye bread (100 g) 43 mg
100 g Kale 212 mg
200 g Swiss chard 206 mg

Calcium, at around 1kg, is the largest quantity of mineral in the body. 99 percent of calcium is firmly built up in bones and teeth. The body is constantly building up, breaking down and rebuilding our bones. This regeneration of the bones as well as the absorption and excretion of calcium is controlled by hormones in the parathyroid gland. If the calcium level in the blood drops, the body quickly mobilises calcium from the skeleton, increases calcium absorption from the intestine and excretes less calcium. With this mechanism, the metabolism counteracts a calcium deficiency, but it cannot prevent it permanently.

 

 
Healthy eating is an important contribution.

If the typical osteoporosis risk factors come together, the bone substance is at risk. Within the framework of osteoporosis treatment, one will therefore always try to optimize the supply of the building material calcium. In osteoporosis, bone density can also be improved by targeted exercise training.

 

 

Which medicines can be used?

Bisphosphonates are the most common group of osteoporosis drugs. There are complex differentiations in effect, combination and administration as well as different active substances within the group.

The main effect of bisphosphonates is to inhibit the activity of cells that break down bone. The resulting natural reconstruction of healthy bone tissue leads to an increase in bone mass and fewer bone fractures. This group of substances, the bisphosphonates, is most commonly used today for the treatment of osteoporosis and is available in the form of tablets (taken daily, weekly or monthly), as an injection or infusion solution.

 

The biophosphonates include:

  • Alendronat
  • Risedronat
  • Ibandronat
  • Zoledronat

They support the natural rebuilding of bone tissue.

 

From conservative to minimally invasive treatment

Osteoporosis therapy depends on the stage of the disease: In the early stages, conservative treatment with behavioural changes and/or medication is often sufficient to slow down the progression of the disease. Medications that slow down bone loss or promote bone formation are used. So-called bisphosphonates are usually used. Bisphosphonates inhibit the activity of osteoclasts, which are responsible for bone loss. At the same time, they stabilise the architecture of the bone cells, reduce the porosity of the bone cortex and increase the mineral content in the bone. The optimal duration of therapy is one to three years, depending on the severity of osteoporosis and how quickly bone density returns. During the repair phase (especially in the first 12 months of therapy), the bone gaps are filled with new bone tissue. Treatment with medication is useful if bone fractures have already occurred or the risk of bone fractures is high. This is the case, for example, if the bone density is very low or if various risk factors for bone fractures come together.

Medicines or naturopathy

Patients with only a slightly increased risk of bone fractures or only a slightly reduced bone density (osteopenia), may feel it is worth weighing up the advantages and disadvantages of treatment with medication and first try conservative therapy with more exercise and a healthy osteoporosis diet.

Physiotherapists can help people with osteoporosis to reduce pain

Hydrotherapy, i.e. baths or casts, electrotherapy to stimulate blood circulation and muscle activity, and heat applications are also recommended. Those who have had good experiences with naturopathy can also use it for osteoporosis. Acupuncture, homeopathy, phytotherapy with willow bark, devil's claw, frankincense or nettle as well as enzyme therapy with Wobenzym or Phlobenzym have proven successful here.

Treating vertebral body fractures with vertebroplasty and kyphoplasty

If the vertebral bodies are already very badly affected, the doctor will offer vertebroplasty and kyphoplasty. This involves injecting artificial bone cement into the vertebral bodies, which then hardens and supports the bone tissue. In the past, this displaced healthy spongiosa, i.e. the sponge tissue, but today highly viscous (rubbery) bone cement is injected into the vertebral body. This is distributed in a fan shape between the healthy, intact cancellous bone, enclosing it and straightening the vertebra. In this way, classic osteoporosis drugs such as the above-mentioned bisphosphonates can continue to act on the bone bellows of the affected vertebra.

 

Help for damaged bones can be provided by a minimally invasive procedure such as kyphoplasty

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