What are some rare causes of osteoporosis

Osteoporosis: early detection and treatment of bone loss

Status: 02/23/2021 5:22 p.m.

In Germany, it is estimated that every fourth person over the age of 50 suffers from osteoporosis. However, the disease often goes undetected: for years, many sufferers have not noticed anything about the loss of bones.

Osteoporosis makes bones porous and can break them. A total of around eight million people are affected by an increased breakdown of bone mass. However, experts assume that only ten percent of those affected who are treated with bone or vertebral fractures due to osteoporosis in a clinic also receive the correct diagnosis. For many, the fractures are only operated on and they are sent back home without researching the cause. Those affected therefore know nothing about their illness. You keep coming up with new fractures and, as with the previous ones, are only operated on. And even if the diagnosis of osteoporosis has been made, the therapy is often not specific enough. Only 20 percent of patients with osteoporosis are properly provided with therapies and medication. Many sufferers do not get more than vitamin D. But osteoporosis treatment has to be more specific and, above all, start much earlier - before fractures occur.

The Osteoporosis Action Alliance has now been founded so that the disease can be recognized earlier and more quickly and also treated well. Professional associations and societies want to ensure that the disease is brought more into focus. Experts assume that up to 50 percent of the more than 700,000 osteoporotic fractures per year could then be avoided. Those affected would not have to go to the clinic, chronic pain and restricted mobility in an advanced stage could be prevented.

Changes in bone metabolism are the cause of bone loss

Bones consist of a protein structure in which the minerals calcium and phosphorus are stored - this gives them their hardness. However, even with adults, they are not fully grown and ready, but are constantly being remodeled. The remodeling work on the bone tissue is carried out by special hormone-controlled cells (osteoblasts and osteoclasts). Until about 30./35. At the age of 16, the compression of the bone predominates, followed by bone resorption. In osteoporosis, the cells that break down bones (osteoclasts) are significantly more active than the cells that build up bones (osteoblasts): The breakdown takes place too quickly, the bone becomes porous.

The main reasons for accelerated bone loss include a lack of exercise and a lack of vitamin D. Without the vitamin that is formed in the skin when exposed to sunlight, the organism cannot channel calcium into the metabolism.

Risk factors for osteoporosis

Alcohol abuse and nicotine impair bone metabolism, as do certain medications such as gastric acid blockers and cortisone. In rheumatoid arthritis and other rheumatic diseases, bone loss often accelerates because the inflammation activates bone loss. An often overlooked cause of osteoporosis in elderly patients with an underactive thyroid can be an overdose of the thyroid hormone L-thyroxine. Since the need for thyroid hormones decreases with age, the dosage of this lifelong therapy must be checked from time to time.

If the bones become porous at a young age (juvenile osteoporosis), there is a defect in the so-called wnt1 gene. One third of osteoporosis cases are hereditary. There are also a number of risk factors.

osteoporosis-Risk factors in women:

  • The last menstruation was more than ten years ago
  • The interval between the first and last menstruation is less than 30 years (late first menstrual period or early menopause)
  • Menstruation has stopped once for over a year
  • Anti-hormone treatment has been / is being used (for example, for breast or ovarian cancer)
  • At least one parent had a fracture of the femur

osteoporosis-Risk factors in men:

  • The person concerned is older than 70 years
  • Anti-hormone treatment has been / is being carried out (for example, for prostate cancer)
  • There is a testosterone deficiency

osteoporosis-Risk factors for both sexes:

  • Taking at least 7.5 mg of cortisone per day for more than three months
  • A bone has already been broken once without a serious accident or injury
  • Overweight today or in the past for a long time
  • Smoking, alcohol, too little exercise
  • Diseases such as: Crohn's disease, ulcerative colitis, diabetes, rheumatism, overactive thyroid or parathyroid glands, anemia and kidney dysfunction
  • Taking many drugs at the same time
  • Use of oral steroids for bronchial asthma or other obstructive pulmonary diseases

Symptoms of Osteoporosis

The following signs indicate accelerated bone loss:

  • You should be prudent at the latest when bones break out of nowhere, without great force being applied. Doctors speak of low-energy fractures. Vertebral bodies can even break completely unnoticed and without pain. Radius fractures are also very typical: The spoke breaks on the wrist - often without a serious fall
  • Acute, persistent back pain
  • Loss of size by more than four centimeters within a year
  • Very low body weight or unwanted weight loss of more than ten percent
  • Reduction of the rib-pelvic distance to less than two fingers wide

Diagnosis of bone loss

Women aged 60 and over and men aged 70 and over should have their risk of osteoporosis clarified, as well as who belongs to one of the risk groups mentioned. With a bone density measurement (DXA), osteoporosis can be diagnosed within 20 minutes. Small doses of X-rays shine through the lumbar spine and the femoral neck. The bone density determined by the DXA measurement is given as the so-called T-value. It describes by how many units the measured bone density deviates from what has been assumed as the standard for a 30-year-old person.

If the T value is between 0 and -1, the bone density is normal. If the T value is between -1 and -2.5, one speaks of reduced bone density (osteopenia). Osteoporosis is present if the T value is -2.5 or less. If there has already been one or more fractures, one speaks of overt osteoporosis.

The health insurance company usually only pays for a bone density measurement if the diagnosis of osteoporosis has already been made. Experts criticize this, because the examination is an important tool to determine osteoporosis and thus save bones. For self-payers, the measurement costs around 50 to 60 euros. A bone density measurement by ultrasound - as it is often offered by gynecologists as an IGel service - is not suitable for the systematic early diagnosis of osteoporosis.

Treatment of Osteoporosis: Multimodal Approach

Various drugs are used to combat bone loss. A calcium-rich diet and regular physical exercise outdoors are also extremely important - also for prevention. If osteopenia or osteoporosis has been diagnosed, the bone density measurement should be repeated every two years and the medication setting should be checked regularly.

Diet: Calcium and Vitamin D for Strong Bones

Calcium-rich food helps with osteoporosis: natural yogurt with raspberries, broccoli with chives quark, whole-grain bread with cottage cheese.

The body must be supplied with at least 1,000 milligrams of calcium every day - doctors recommend a daily dose of 1,300 milligrams for bone loss. Calcium is found in many foods, especially in low-fat dairy products, but also in nuts and seeds, in dark green vegetables, berries, kiwi and dried fruits, and in some types of mineral water.

Vitamin D can hardly be obtained in sufficient quantities from food, but our body can produce it itself under the action of natural UV light and even store vitamin D reserves in the liver. In Germany, however, solar radiation is only sufficient in the summer half of the year. So exercise in the fresh air every day in summer, and vitamin D should be supplemented with a supplement in winter.

Exercise improves bone density

Movement plays a central role anyway in order to improve bone density again. Above all, the mechanical shock load that stimulates bone formation is important. For younger people, for example, jumping rope is suitable, for older people forced climbing stairs or walking - or targeted strength training under supervision in the fitness studio. Targeted exercise therapy strengthens muscles and bones at any age.

Osteoporosis: treatment by Medication and syringes

There are also special drugs that intervene in bone metabolism. In addition to calcium and vitamin D supplements, so-called bisphosphonates are primarily prescribed. They inhibit osteoclast activity and thus bone breakdown.

If this effect is insufficient, doctors can now also use genetically engineered antibodies that disrupt the formation, function and survival of osteoclasts. In this way, bone loss can be stopped and maybe even reversed a little.

Another therapeutic approach is the activation of the osteoblasts with a genetically engineered active ingredient from the group of parathyroid hormones. It is injected once a day to stimulate bone formation and also ensure that bone-strengthening calcium is better absorbed from food or medication.

Experts on the subject

Prof. Dr. Ralf Oheim, Senior Physician
National Bone Board (NBB) at UKE
National Center for Rare Musculoskeletal Diseases (NCBD)
Institute for Osteology and Biomechanics
Lottestrasse 59
22529 Hamburg
www.uke.de

Prof. Dr. med. Andreas Kurth
Head of Orthopedics and Trauma Surgery
Head of the regional trauma center
Community hospital
Mittelrhein gGmbH
Koblenzer Strasse 115-155
56073 Koblenz
www.gk.de

Dr. A.-Katharina Doepfer
Specialist in orthopedics and trauma surgery, pediatric orthopedics
orthoGroup - orthopedics in the west of Hamburg
Eidelstedter Platz 1
22523 Hamburg
(040) 57 19 87 19
www.ortho-group.de

additional Information
Action alliance for osteoporosis
www.aktionsbuendnis-osteoporose.de

OSD Osteoporosis Self-Help Groups Dachverband e.V.
March 18th Street 23 a
99867 Gotha
(03621) 51 25 81
www.osd-ev.org
Patient guideline

 

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