Osteoporosis

When bones become porous

Osteoporosis - Osteoporosis

What is osteoporosis (bone loss)?

Osteoporosis – also known as bone loss – is a metabolic disease of the skeleton where the bones lose their strength. They become porous. The disease can cause bone fractures – especially in the spine and femoral neck.

According to the World Health Organisation (WHO), osteoporosis is one of the most serious diseases of our time. In Germany, one out of every four women and a total of 6.3 million people over the age of 50 are affected. In total, there are more cases than of breast cancer, stroke and heart attack diseases. In Germany, around 885,000 people are diagnosed with osteoporosis each year.1

The major challenge for doctors and patients is to make the diagnosis quickly. If osteoporosis is diagnosed at an early stage it can be treated effectively; however, a complete cure is not possible. 

Various measures such as exercise and a healthy diet (vitamin D and calcium) also help to prevent osteoporosis. 

The precursor of osteoporosis is called osteopenia (reduction of bone density). Osteopenia can be kept at a constant level with regular medical check-ups. In the event of progression to osteoporosis, the doctor can initiate appropriate therapy.

Causes: How does osteoporosis develop?

We see bones as rigid, solid structures that hardly change. In fact, however, a healthy body has a constant balance between the decomposition and formation of bone substance. Hormones, vitamins and other messenger neurotransmitters in the body control these “remodelling measures”. Formation predominates up to approximately the age of 30. If more bone mass is broken down than is newly formed, bones lose strength and become more susceptible to fractures. This is the point where the gradual process of osteoporosis can begin.

Doctors can determine bone loss by measuring bone density.

Osteoporosis is divided into two different forms, primary and secondary osteoporosis. 

Primary osteoporosis:

Primary osteoporosis:

Approximately 95 percent of all bone loss disorders are primary osteoporosis.

Type I osteoporosis:
Type I osteoporosis often occurs in postmenopausal women (postmenopausal osteoporosis). The vertebrae of the spine are particularly susceptible to fractures.

Type II osteoporosis: 
In the case of type II osteoporosis, the first bone fracture typically occurs after the age of 70 (senile osteoporosis). In addition to the vertebrae, long bones of the thigh and arm are also affected.

Risk factors for the development of primary osteoporosis:

  • Hereditary disposition
  • Hormones (late first and early last menstrual period)
  • Inactivity
  • Long periods of bed rest
  • Being underweight
  • Low-calcium or high-phosphate diet (e.g. fast food, soft drinks)
  • Consumption of things such as alcohol, coffee and cigarettes

Secondary osteoporosis:

Secondary osteoporosis:

Secondary osteoporosis occurs as a result of certain pre-existing conditions or as an undesirable side effect of certain medication. These include:

  • Anti-inflammatory drugs for the treatment of asthma or rheumatism (cortisone)
  • Hormonal disorders such as hyperthyroidism
  • Tumour diseases

Risk factors for the development of secondary osteoporosis:

  • Anti-inflammatory drugs for the treatment of asthma or rheumatism (cortisone)
  • Thyroid hormones in too high doses
  • Coumarin derivatives (Marcumar)
  • Chronic food intake abnormalities, e.g. due to diseases of the pancreas, intestines, liver and kidneys
  • Hormone disorders, such as hyperthyroidism or diabetes mellitus (diabetes)
  • Tumour diseases

Recognising osteoporosis: Symptoms and signs

How can we detect osteoporosis? A prompt diagnosis is crucial in order to immediately start therapy if necessary. It is therefore advisable to have a regular check-up with your doctor and have your first symptoms checked for osteoporosis. The elderly in particular should be aware of their body’s signals and consult a doctor if bone loss is suspected. Bone density measurement provides information about the condition of the bones. If you have these symptoms, please consult your doctor as they may indicate bone loss.

  • Decrease in physical height and signs of hunchback development
  • Severe, chronic pain in the area of the spine or sternum
  • Bone fractures without recognisable causes, e.g., vertebral fractures caused by one’s own body weight

How to prevent osteoporosis

How to prevent osteoporosis - How to prevent osteoporosis

There are various ways to preserve bone structure and bone mass for as long as possible. Preventive measures should also be taken by young people to minimise the risk of osteoporosis later on in life. Important factors for healthy bones are:

  • Exercise and moderate muscle training. Specific exercises help to strengthen the various muscle groups and limit bone loss.
  • A healthy and balanced diet with sufficient vitamins, calcium and proteins.

The combination of physical activity and appropriate nutrition supports the health of bones and muscles.

Osteoporosis Therapy

40,000 bone fractures could be prevented in Germany if people with osteoporosis or a risk of fractures received adequate pharmaceutical treatment.3

Therapy with various elements can contribute to significantly improving patients’ quality of life. Osteoporosis therapy consists of various elements and should be conducted according to the guidelines of the umbrella organisation of the Deutschsprachige Wissenschaftliche Osteologische Gesellschaften e.V. [German-Speaking Scientific Osteological Societies] (DVO).4 Effective osteoporosis therapy comprises several steps:

Medication for the treatment of osteoporosis

The following medication is used to treat bone loss:

SERMs

SERMs (Selective Oestrogen Receptor Modulators): If there is an insufficient level of the hormone oestrogen after menopause, then bone mass is reduced. SERMs mimic the effect oestrogen has on the bone. They act exclusively on the oestrogen binding sites of bones. Therefore, there is no risk of breast cancer or cardiovascular disease. 

Bisphosphonates

Bisphosphonates: They inhibit the cells responsible for bone degradation and thus slow down the process. 

Calcium and vitamin D

Calcium and vitamin D: Calcium is the main constituent of the mineral bone substance. It should only be taken as a supplement if the recommended amount of calcium is not provided in the daily diet. Vitamin D promotes the absorption of calcium from food and supports its incorporation into the bones. 

Parathyroid hormone / teriparatide

Parathyroid hormone / teriparatide: Stimulates the formation and activity of osteoblasts. Osteoblasts are cells that are responsible for the formation of bone tissue during bone remodelling. 

Painkillers

Painkillers: Fractures cause pain. Vertebral fractures, which are particularly common in osteoporosis, restrict mobility. Therefore, the pain must first be treated with appropriate medication. 

Sport and exercises for osteoporosis – exercises to strengthen the muscles and promote mobility

Exercise is an important part of the treatment of osteoporosis. Targeted physiotherapy and physical treatments, developed in collaboration with physiotherapists and doctors, help to strengthen the muscles and promote mobility and coordination.

Sport and exercises for osteoporosis - Sport and exercises for osteoporosis

Exercise therapy – especially strengthening the back and abdominal musculature – should be conducted consistently.   
Specific back orthoses with bio-feedback supports the spinal column and promotes muscle formation. In addition to physiotherapy exercises, some sports are particularly beneficial for patients suffering from osteoporosis:

- Hiking
- Nordic Walking
- Cross-country skiing
- Swimming
- Dancing

The ideal approach is to combine different kinds of sport to improve strength and endurance. More muscle mass means a better prognosis for the quality of the bone. 
Outdoor exercises are especially effective: As sunlight stimulates the formation of vitamin D in the skin. 

Important: Osteoporosis patients should consult their doctor beforehand about all possibilities.

Strength training promotes muscle and bone formation in osteoporosis

Strength training trains the muscles and thus releases positive stimuli for the build-up of bone mass. Body posture can be improved at the same time. Strengthening ensures that muscle interaction becomes more coordinated and harmonious. A workout on exercise machines clearly shows how the different weights and repetitions lead to different training results.

The Spinomed back orthosis also has a supporting effect when used correctly. The belt system and the back splint exert pulling forces on the pelvic and shoulder area. This allows users to unconsciously tighten their muscles and straighten their upper body. Spinomed is recommended in the DVO guidelines for the treatment of osteoporosis.3

Training plan for osteoporosis

The ideal approach is to combine different kinds of sport. The result is more muscle mass, a better outcome for bone quality, fitness and higher stability. Discover the right movement concept for you and have fun with it. But be sure to consult your doctor before training.

Functional treatment – with back orthoses

Due to the close link between muscles and bones, the loss of bone and muscle mass often occurs simultaneously.

Existing fractures of the spine should therefore be treated not only with medication, but also with aids (functional therapy). Fractures cause pain and lead to further muscle loss due to movement restrictions. Modern aids achieve a straightening of the spine and train the muscles at the same time.

In the past, patients with fractures of the spine caused by osteoporosis were often immobilised by a rigid corset, which resulted in further muscle loss. It is now known that, in addition to medicinal treatment, muscle activity plays a crucial role in bone formation.

Products by medi: Osteoporosis therapy with back orthoses

Osteoporosis-related spinal fractures cause pain, further movement restrictions and often lead to progressive muscle loss. Back orthoses are modern aids to straighten the spine and to train the muscles.

The DVO recommends the use of spine-straightening orthoses.4 The explicit recommendation is based on the high quality of the clinical studies. The two studies on Spinomed and Spinomed active5,6

  • show that the back and abdominal musculature are strengthened by up to 73 and 56 percent respectively,
  • a reduction of the tendency to fluctuate by up to 25 percent,
  • a reduction of the kyphosis angle by up to 11 percent,
  • a reduction of pain by up to 47 percent,
  • improved physical comfort by up to 18 percent and
  • improved pulmonary function by up to 19 percent.

The osteoporosis specialist Professor Helmut W. Minne and medi have jointly developed the Spinomed and Spinomed active orthoses. The Spinomed orthosis is designed like a backpack. The body-variant Spinomed active can be worn inconspicuously under clothing. All Spinomed back orthoses are based on the principle of bio-feedback.

Health personnel will make the diagnosis and can prescribe compression stockings, e.g. from medi if necessary.

Your medical retailer will fit them individually for you.

Sources

Epidemiologie der Osteoporose: Bone Evaluation Study, Deutsches Ärzteblatt 2013,4, 52 ff.
2 Hadji P et al. Dtsch Arztebl Int 2013;110(4):52–57. 
3 Ström O et al. Osteoporosis: burden, health care provision and opportunities in the EU: a report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos 2011;6:59-155.
4 DVO. Prophylaxe, Diagnostik und Therapie der Osteoporose bei postmenopausalen Frauen und bei Männern. 2017. Published on: www.dv-osteologie.org/dvo_leitlinien/dvo-leitlinie-2017 (last accessed 06.06.2018).
5 Pfeifer M et al. Die Wirkungen einer neu entwickelten Rückenorthese auf Körperhaltung, Rumpfmuskelkraft und Lebensqualität bei Frauen mit postmenopausaler Osteoporose. Eine randomisierte Studie. Am J Phys Med Rehabil 2004;83(3):177-186.
6 Pfeifer M et al. Die Wirkungen von zwei neu entwickelten Rückenorthesen auf Rumpfmuskelkraft, Körperhaltung und Lebensqualität bei Frauen mit postmenopausaler Osteoporose. Eine randomisierte Studie. Am J Phys Med Rehabil 2011;90(5):805-815.

The human body

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Back brace for the treatment of osteoporosis

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