Evidence based.
Medically proven.
The widespread disease osteoporosis
When a normal ageing process, which includes a decrease in bone strength and density, becomes a threat to health, it is called osteoporosis or bone loss. This 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 in time 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?
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, the so-called DXA procedure. This diagnostic method also has limitations: The physician has to make an interpretation of the X-ray image. Depending on the imaging, physicians come to different conclusions. In addition, a single X-ray is usually not sufficient for diagnosis. And osteoporosis only shows up on the X-rays when it has already reached a considerable stage. Because many patients therefore start therapy very late, 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
Ways to prevent osteoporosis
Possible treatments
You have been diagnosed with osteoporosis and are wondering what to do next? Only your physician can discuss a therapy with you individually. We will introduce you to some medicines and measures.
What is osteoporosis?
Osteoporosis is one of the top ten common diseases in Germany. The disease - also known as bone loss - typically occurs from the age of 50 and mainly affects women after the menopause. Men can also develop osteoporosis, but much later, often in their 70s.
Bone density decreases with age. This bone loss is a normal ageing process and does not usually cause any symptoms. If certain factors are added, too much bone substance is lost: Osteoporosis develops. These factors are explained on these pages.
What happens if you are affected by osteoporosis?
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 then gradually predominates and accelerates with age. Healthy older people lose about 0.5 to 1 percent of their bone mass per year.
Main reason: 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. If the production of oestrogen decreases in women during the menopause, this has a negative effect on bone metabolism, as 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.
It is much more sensible than waiting for warning signs to check the risk of osteoporosis when entering the menopause. The earlier a dangerous decrease in bone density can be diagnosed, the greater the chances of reducing the risk of disease with therapy and preventive measures. Risk tests on the internet, for example at www.osteolabs.dk/myrisk, are a first step towards a diagnosis. They give a good indication of whether a visit to the physician and further examinations make sense.
These diseases 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
According to the health insurance company Technikerkrankenkasse, around six million people in Germany suffer from osteoporosis. But only 40 percent of these patients are diagnosed with osteoporosis and receive appropriate treatment. Two thirds of all osteoporosis-related bone fractures are caused by women. Approximately 20-30 percent of all patients who suffer osteoporotic bone fractures are men. This is according to figures from the German Endocrinological Care Centre DEVZ.
Slim, petite or even underweight people are clearly 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. Because 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.
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.
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
In the beginning, the 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 warning signs that point to a danger.
- 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. Until now, this measurement was done using computer tomography, or CT for short. The CT measures several vertebral bodies with the smallest possible X-rays, and the measurement only takes a few minutes. However, there are alternative test procedures that do not require you to expose yourself to X-rays. Here, blood and urine samples are sufficient, for example in the osteoTest | home und osteoTest | med. The evaluation and calculation of the bone density is carried out by measuring devices (in the osteoporosis test, for example, by high-precision mass spectrometers) and an extensive computer evaluation.
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 struture 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 high time to go to the physician and have osteoporosis diagnosed. The physician will talk to you to find out if you have any risk factors for osteoporosis. If several risk factors come together, the physician will 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 he eats
- How much time he spends in the fresh air
- Whether there is a family history of osteoporosis
- Whether the patient smokes
- Whether he regularly drinks wine or other alcoholic beverages
- Whether 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, takes effect 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 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 with the start of therapy, osteoporosis should be checked every one to two years with a new bone density measurement. Physicians advise women over 50 to have early diagnosis so that treatment can be started in time. In this way, bone loss can be slowed down 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 worthwhile: becoming lighter and deacidifying are the buzzwords. If you eat a lot of meat and sweets, you are feeding your body "digestive waste" in the form of acids - alternative medicine refers to this as "slags". 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 (for example Paidoflor or Enterobact) 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.
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.
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.
You can find more information in the video "Preventing bone fractures" on the website of the Osteoporosis Network e.V.
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 bells, 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
Especially for patients with only a slightly increased risk of bone fractures or only a slightly reduced bone density (osteopenia), 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.
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 physician 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.
