Osteoporosis is an underestimated disease. The bone density decreases over a longer period of time, but it often only becomes noticeable with a fracture. The good news: Bone loss can be treated with healthy nutrition, exercise and medication. And so that no osteoporosis develops at all, it can be prevented in a targeted and everyday manner.
Osteoporosis is a chronic bone disease that affects the entire skeleton. The bone loss occurs especially in the second half of life and is characterized by a reduced bone mass and changes in the bone tissue. As a result, the bones become more unstable and tend to break. These already occur with everyday loads or "simple" falls.
The tricky thing about osteoporosis is that there are no symptoms for a long time. So she is often diagnosed only after a broken bone. After a first fracture, the risk of renewed fractures increases significantly.
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Forms of osteoporosis differ according to the cause
A primary osteoporosis is when the bone loss is not caused by other diseases. The risk of developing osteoporosis increases significantly with age: the loss of bone substance is often due to less exercise and exposure to the sun, as well as a lack of calcium and vitamin D, which are important for the bones.
In addition, the risk increases in women, especially after menopause: during the menopause, the estrogen level drops, which in turn leads to a decrease in the amount of bone. In this case, one speaks of postmenopausal osteoporosis. But men with very low testosterone levels are more likely to develop osteoporosis. Because sex hormones support bone building.
Secondary osteoporosis is triggered by other diseases or certain medications:
- inflammatory rheumatic diseases such as rheumatoid arthritis
- Gastrointestinal diseases, including lactose intolerance, Crohn's disease or ulcerative colitis
- Metabolic diseases, for example an overactive thyroid, adrenal or parathyroid gland
- Long-term use of drugs that negatively affect bone metabolism
The most common form of secondary osteoporosis is cortisone-related osteoporosis. It mainly affects younger people and leads to fractures of the ribs, femoral neck and vertebrae.
Some risk factors of osteoporosis can be influenced
There are certain factors that increase your risk of bone loss. The doctor can clarify the risk factors and determine whether a pathological change has already occurred by measuring the bone density.
Age: According to a rule of thumb, the risk of breakage doubles with every decade of life.
Gender: Women have a four times higher risk of osteoporosis than men: their bone structure is usually easier and with the onset of menopause, estrogen production decreases significantly. This also changes the bone structure, so that the bone density decreases.
Weight: Very slim or underweight women with light bones are more prone to osteoporosis.
Inheritance: Suffered Even the mother, grandmother or another blood relative of osteoporosis, the personal risk is greatly increased.
Lifestyle factors: Little exercise, an unbalanced diet, smoking and alcohol can impair bone health and promote the development of osteoporosis.
Diseases: Certain diseases can have a negative impact on bone health. Eating disorders such as anorexia or bulimia favor the development of osteoporosis as well as chronic inflammatory diseases (rheumatoid arthritis, Crohn's disease) or disorders of the hormone production of the thyroid, parathyroid or adrenal glands.
Cortisone: The active ingredient and its derivatives endanger bone stability if a dose of at least 7.5 mg is taken daily for three to six months.
Calcium deficiency: Bones consist largely of calcium. Too little food intake significantly increases the risk of osteoporosis, because calcium deficiency reduces bone mass.
Vitamin D deficiency: This vitamin is not only necessary for the incorporation of calcium in the bones, but also promotes the interaction of nerves and muscles and thus reduces the tendency to fall.
Back pain as the main symptom
The bone loss goes unnoticed for a long time. The most noticeable symptoms are pain or fractures due to the decreasing bone density. A vertebral body is often affected – the fracture manifests itself as acute back pain, which occurs suddenly and is violent. After a few weeks, the pain subsides and can go away completely. However, the underlying osteoporosis often remains undetected because the back pain is attributed to another cause, such as tension or intervertebral disc problems. From the age of 50, osteoporosis should always be considered in the event of sudden, severe back pain.
Another quality of pain is triggered by rapidly successive vertebral body factors with rapidly progressing bone loss – doctors call this "high turnover osteoporosis". Bleeding can occur here, which causes intense bone pain by stretching the periosteum. Pain can also occur when adjacent spinous processes of vertebrae touch after the vertebral bodies "sink in" as a result of one or more fractures.
Breaks in vertebral bodies, usually the horizontal cover plates of the vertebra, reduce the body size. If it has decreased by more than four centimeters compared to the size entered in the passport at the beginning of adulthood, this can be an indication of osteoporosis.
"Widow's hump" is a sign of bone loss
The formation of so-called wedge vertebrae often results in a curvature of the spine (kyphosis) in the further course. The so-called "widow's hump" arises as an externally visible symptom of advanced osteoporosis. The counterpart to the arched back is a bulging belly due to the shortened spine. The bottom ribs approach the iliac crest. These changes also hinder the breathing and functioning of the internal organs.
Another externally visible sign of advanced bone loss is the so-called fir tree phenomenon. It can be seen on the patient's undressed torso when viewed from behind. There are folds of skin that run like the branches of a fir tree from the spine to the left and right to the flanks. They arise because the skin does not shrink when the body size decreases.
First steps to diagnose osteoporosis
As part of the basic diagnosis, the doctor collects the medical history (anamnesis). In addition, he uses special tests to check muscle strength and coordination, thereby gaining an impression of the tendency to fall. The comparison of the current body size with that entered in the passport shows whether vertebral body collapses have occurred.
Bone density measurement is the focus of diagnostics
The central method for diagnosing osteoporosis is a special X-ray examination, the low-radiation bone density measurement. The measurement takes place on the lumbar spine and on the hip. The T-value indicates the deviation of the measured bone density of a patient from the statistical mean of the bone density of young adults. If the T-value is at least -2.5, this is considered osteoporosis. If one or more fractures are added without an adequate trigger, doctors speak of manifest osteoporosis.
Other diagnostic procedures:
- Ultrasound examination to determine the bone density
- X-ray of the spine to detect vertebral body collapse
- Blood test (calcium, phosphate, certain enzymes) to rule out other diseases
What treatment options are there for osteoporosis?
Special osteoporosis medications are required if the risk of broken bones is high. In people who have a reduced bone density but no additional risk factors, the bone loss must be very pronounced so that drug therapy is justified.
Even if the disease is already advanced and there is a first vertebral fracture, a lot can still be achieved through consistent therapy. Medications often significantly reduce the risk of broken bones within a few months. As the probability of further fractures is highest in the first months after a fracture, therapy should be started immediately.
Drug therapy for osteoporosis
The available osteoporosis medications differ mainly in their effect on bone building and breaking down. Bisphosphonates, which primarily reduce bone loss, are most commonly used to treat bone loss. If vertebral body fractures have already occurred, additional pain therapy is usually required.
Various substances for lowering the risk of fractures are suitable for women after menopause. These include bisphosphonates, estrogen and derivatives of the body's own parathyroid hormone as well as strontium ranelate, which at least in experiments also promotes the new formation of bones.
Men can be treated with bisphosphonates or a parathyroid hormone derivative. The same applies to patients with cortisone-related osteoporosis.
Other therapy modules: muscle training, nutrition, fall prevention
Regardless of the drug treatment, special basic measures are recommended to reduce the risk of fractures.
Strength training and balance: With increasing age, it is important to compensate for the natural loss of muscle strength and to train the sense of balance. Strength training and thera bands, jumping rope or balance exercises (tai chi or exercises such as the one-legged stand) are suitable for this.
Prevent falls: Sources of danger for a fall should be banished as much as possible from the home environment. Avoid loose lamp cables, raised carpet edges or objects that restrict the freedom of movement.
Greater gait safety: Good lighting, sturdy footwear and regularly adjusted and cleaned glasses ensure better gait safety. Functional training in osteoporosis support groups can also help.
Diet change: For strong bones, make sure you get enough calcium (1,000 mg per day) and exercise enough in the sun to boost vitamin D production.
Prevent osteoporosis by strength training
The compression forces caused by weights compress the entablature. This stimulus conveys the information that the bone should be strengthened in order to be able to withstand. In addition, the bone, which can withstand the tensile and bending forces exerted by the muscles, must subsequently increase the bone mass. Strength training should be done twice a week and should ideally be supplemented by endurance sports such as walking and balance exercises.
Proper nutrition against bone loss
With a balanced diet, the need for calcium and with regular exercise outside in the sun, the need for vitamin D can be covered well. Plenty of plant-based foods, fruit and whole grains, milk and milk products, fish and poultry, meat once or twice a week and mineral water as a drink should be served on the table.
Avoid using nicotine, alcohol, coffee, fat, sugar and salt in large quantities, as they promote calcium excretion from the body. Foods containing oxalic acid are also unfavorable for bone health because they slow down calcium absorption from food. For example, oxalic acid is found in strawberries, rhubarb, aubergines, spinach and chocolate – it is best to only enjoy these foods in moderation and, if possible, always in combination with a calcium source. For example, you can eat strawberries or rhubarb cakes with a dollop of cream or yogurt.
Diet rules: How to eat healthy and fit
Checklist: For strong bones
avoid Underweight. Overly slim women are at higher risk of bone loss.
Take around daily 1,000 milligrams of calcium to yourself, but a maximum of 1,500 milligrams per day. Milk and milk products are particularly rich in calcium. Calcium-rich mineral water also makes an important contribution. If you don't like milk: legumes, nuts, kernels and many vegetables are also good sources of calcium.
Make sure you have sufficient Vitamin B12 intake (in animal products or as a dietary supplement for vegetarians and vegans) and Folic acid (in green leafy vegetables and whole grains).
Refrain from Nicotine.
Exercise Muscle strength, coordination and balance. In this way you can improve your standing and gait security and strengthen your bones.
avoid Falls. Make sure you have good footwear and eliminate stumbling blocks in the apartment.
Exercise at least every day half an hour outdoors. Make sure that sunlight gets on your face and arms – because sunlight can produce vitamin D in your skin. The vitamin is important for the storage of calcium in the bones.
Check with your doctor Taking and dosing medicationwhich can promote osteoporosis and / or falls and are used for depression, diabetes, epilepsy, increased gastric acid production and some other diseases.