Tuesday , March 2 2021

Osteoporosis: Early Detection and Treatment of Bone Loss | NDR.de – guide



Status: 23/02/2021 17:22 hrs.

In Germany, it is estimated that one in four people over the age of 50 suffers from osteoporosis. However, the disease is often undetected: For years, many sufferers have not noticed the bone loss.

Osteoporosis makes the bones porous and can break them. A total of about eight million people are affected by an increased distribution of bone mass. However, experts estimate that only ten percent of sufferers treated for 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 home again without investigation into the cause. The victims therefore know nothing about their illness. You are constantly coming up with new fractures and, like the previous ones, you only need surgery. And even if the diagnosis of osteoporosis has been made, the therapy is often not specific enough. Only 20 percent of patients with osteoporosis receive the right therapy and medication. Many sufferers receive no more than vitamin D. But treatment for osteoporosis must be more specific and, above all, begin much sooner – before fractures occur.

That the disease can be recognized earlier and faster and also treated well, this is now the case Osteoporosis Alliance established. Professional associations and societies want to achieve that the disease is brought more into focus. Experts estimate that up to 50 percent of the more than 700,000 osteoporotic fractures per year could then be prevented. The affected would not go to the clinic high, chronic pain and limited mobility at 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 in adults, they are not mature and ready, but are constantly being rebuilt. The bone marrow remodeling work is performed by special hormone-controlled cells (osteoblasts and osteoclasts). Until about 30./35. At the age of 16, compression of the bone predominates, followed by bone loss. In osteoporosis, the cells that break down bone (osteoclasts) are significantly more active than the cells that build up bone (osteoblasts): the distribution 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 upon exposure to sunlight, the organism cannot channel calcium into the metabolism.

Risk factors for osteoporosis

Alcohol abuse and nicotine impair the metabolism of the bones, as well as certain medications such as stomach acid blockers and cortisone. In rheumatoid arthritis and other rheumatic diseases, bone loss often accelerates because the inflammation activates bone loss. A common cause of osteoporosis in elderly patients with an underactive thyroid gland may be an overdose of the thyroid hormone L-thyroxine. As the need for thyroid hormones decreases with age, the dosage of this lifelong therapy should be monitored from time to time.

When 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.

osteoporosisRisk factors in women:

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

osteoporosisRisk factors in men:

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

osteoporosisRisk factors for both sexes:

  • Take at least 7.5 mg of cortisone per day for more than three months
  • A bone has been broken once without a serious accident or injury
  • Obesity 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 renal dysfunction
  • Take many medicines at once
  • Take oral steroids for bronchial asthma like other obstructive pulmonary diseases

Symptoms of osteoporosis

The following signs indicate accelerated bone loss:

  • You must be careful in the end if bones break out of nowhere, without great force. Doctors talk about fractures with low energy. Vertebrae can even break completely unnoticed and without pain. Radius fractures are also very typical: The bacon breaks on the wrist – often without serious fall
  • Acute, persistent back pain
  • Loss of size by more than four inches within a year
  • Very low body weight or unwanted weight loss of more than ten percent
  • Reduce the rib-pelvic distance to less than two fingers wide

Diagnosis of bone loss

Women 60 years and older and men 70 years and older should clarify their risk of osteoporosis, such as who belongs to one of the mentioned risk groups. With a measurement of bone density (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 is assumed to be 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 when the T-value is -2.5 or less. If there have already been one or more fractures, one speaks of open osteoporosis.

The health insurance usually only pays for a measurement of the bone density if the diagnosis of osteoporosis has already been made. Experts criticize that, because the research is an important tool to determine osteoporosis and thus preserve bones. For self-payers, the measurement costs about 50 to 60 euros. Node density measurement by ultrasound – as is often suggested by gynecologists as an IGel service – is not suitable for the systematic early diagnosis of osteoporosis.

Treatment of osteoporosis: multimodal approach

Various medicines are used against bone loss. A calcium-rich diet and regular physical exercise in the open air are also very important – also for prevention. If osteopenia is diagnosed as osteoporosis, bone density measurements should be repeated every two years and the medication should be checked regularly.

Diet: Calcium and vitamin D for strong bones

There are three bowls of calcium-containing foods on a table.  © NDR

Calcium-rich foods help with osteoporosis: natural yoghurt with raspberries, broccoli with chives, folk corn with cottage cheese.

The body needs 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, beans, 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 during the summer half of the year. So exercise in the fresh air every day in the summer, and vitamin D should be supplemented in the winter with a supplement.

Exercise improves bone density

In any case, movement plays a central role in improving bone density again. The mechanical shock load that stimulates bone formation is particularly important. For younger people, for example, skipping ropes is suitable, for older people forced climbing stairs or walking – or deliberate strength training under supervision in the gym. Targeted exercise therapy strengthens muscles and bones at any age.

Osteoporosis: treatment by Medication and syringes

There are also special medicines that interfere with bone metabolism. In addition to calcium and vitamin D supplements, so-called bisphosphonates are prescribed in the first place. They inhibit osteoclast activity and thus bone degradation.

If this effect is not enough, doctors can now also use genetically engineered antibodies that disrupt the formation, function and survival of osteoclasts. This way, bone loss can be stopped and maybe even reversed a bit.

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 and should stimulate the formation of bones and also ensure that bone of bone strengthening is better absorbed from food or medication.

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