Osteoporosis - Early diagnosis and treatment

Loss of bone? Widow's Hump? What used to be considered old-women's disease is now widespread. Around eight million people in Germany suffer from osteoporosis, one third of whom are men. The disease remains undetected for many a long time. Therapy should begin at an early stage in order to avoid consequential damage.

What is osteoporosis?

Bones are not static structures but living structures that are subject to a permanent dynamic. Only through a finely tuned interaction between bone-building and bone-degrading cells can they withstand the daily demands. With age, there is an increasing loss of bone density. This is a completely natural process. In people suffering from osteoporosis, however, the balance is disturbed and bone loss is accelerated. As a result, the bones become porous and brittle during the course of the disease. They lose their strength and stability, so that fractures (fractures) or vertebral fractures can occur even with everyday loads or slight falls. In the late stages, even a severe cough or sneeze can cause a fracture. The resulting chronic pain restricts mobility and severely impairs the quality of life of those affected at an advanced stage.

If osteoporosis has already resulted in a fracture, it is also referred to as "manifest" osteoporosis. The term "osteopenia" refers to a preliminary stage of osteoporosis in which bone density has already been reduced.

Causes and risk factors

In osteoporosis, a distinction is made between the primary and secondary form. Primary osteoporosis accounts for approximately 95 percent and occurs without any discernible cause. However, it is known that certain risk factors promote the breakdown of bone tissue. This primarily includes age and the associated decrease in female and male sex hormones (estrogen and testosterone). The disease is therefore particularly common in postmenopausal women (postmenopausal osteoporosis). In men, a decrease in testosterone levels in old age also promotes the onset of osteoporosis. An unhealthy lifestyle with increased alcohol and nicotine consumption, lack of exercise and poor nutrition also promotes bone loss.

Secondary osteoporosis arises as a result of various diseases with metabolic or hormonal imbalances. These include diabetes mellitus, hyperthyroidism or chronic inflammatory diseases, anaemia and renal dysfunction. However, drugs such as "cortisone" or a pronounced lack of nutrients can also trigger secondary osteoporosis.

Symptoms and consequences of osteoporosis

Osteoporosis is also known as the "silent thief on the bone", since the breakdown of bone substance usually develops slowly and remains without noticeable symptoms for a long time. Sometimes it takes more than 10 years to be diagnosed. One should always become clairaudient if bone or vertebral fractures have occurred as a result of minor injuries or even for no apparent reason. Frequently affected are fractures near the hip (femoral neck fracture), fractures of the upper and lower arm or vertebral body fractures.

Visible external signs only appear when one or more vertebrae have already collapsed. The affected persons lose height, the distance between the pelvis and ribs is reduced by half and the characteristic round back (widow's hump) is formed. If bone loss is already more advanced, sufferers often report persistent, stinging back pain and limited movement as a result of static changes in the area of the spine and the resulting muscle tension. The breathing function can also be impaired as a result of the round back.

Diagnosis of osteoporosis

Even the slightest suspicion of osteoporosis should be checked with a specialist immediately. The diagnosis includes a thorough examination of the patient's anamnesis and family history, a physical examination and various laboratory tests. Bone density measurement is another important component of osteoporosis diagnostics.

Bone density measurement

During bone density measurement (osteodensitometry) the mineral density of the bone is determined. It provides information on the structure and strength of the bone and thus determines the risk of fracture. There are various methods for bone density measurement, the most precise of which is so-called dual X-ray densitometry (DXA). In the process, so-called T-values are determined. If these are 2.5 units below the norm for the respective age group, osteoporosis is present.

Therapy of Osteoporosis

The aim of the treatment is to inhibit accelerated bone resorption and thus to avoid further possible fractures. Early treatment plays a decisive role in preventing bone and vertebral body fractures and in maintaining or improving the quality of life.

Basic therapy: Bone-healthy nutrition and sufficient exercise
The basic therapy for osteoporosis always consists of an adequate supply of calcium and vitamin D. If the supply cannot be ensured through nutrition or sun exposure, the additional administration of appropriate preparations is recommended. But not only calcium is important for the bones. There are many other nutrients such as vitamin K, vitamin C, folic acid, magnesium or zinc, which also play an important role. We therefore recommend a balanced diet with plenty of fruit and vegetables, fish and cereals. Food and luxury foods that damage the bone substance, such as alcohol and nicotine, but also foods containing phosphate and oxalate (cola drinks, processed cheese, canned foods and sausages) should be severely restricted or avoided. Equally important for bone health is regular exercise, targeted muscle building and balance training to reduce the risk of falling.

Special osteoporosis medication
If there is a high risk of bone fractures, treatment with special osteoporosis drugs is also recommended, which inhibit bone resorption or promote bone formation. Bisphosphonates are most commonly used to counteract further bone resorption by slowing the activity of bone resorbing cells. In contrast, treatment with parathormone can have a bone-building effect.

Conservative therapy or surgery for vertebral fractures?
Whenever possible, a vertebral fracture as a result of osteoporosis should be treated conservatively. The conservative treatment provides for sufficient pain relief with painkillers and gentle, step-by-step mobilization, taking into account back-friendly behavior. A stabilizing and upright corset may be very useful. X-ray controls are used to check whether the vertebral fracture has healed during treatment or whether post-sintering has occurred with an increase in the resulting malposition. If, despite the medication, the patient cannot be mobilised due to pain, surgery is advisable. There are two different methods:

Kyphoplasty
Kyphoplasty is a relatively low-risk procedure for stabilizing the vertebral body and thus combating pain. Two balloons are introduced into the vertebral body via two small skin incisions and gradually filled with contrast medium. In this way the vertebra can be slightly erected and the bone inside the vertebra is compressed and "compressed" around the balloon. Then you let the balloon collapse again and remove it. The resulting cavity is filled with liquid bone cement, which hardens within a few minutes. In this way, the vertebral fracture can be erected and stabilized and the pain caused by the fracture subsides quickly. Now it is much easier to mobilize the affected person.

Vertebroplasty
Vertebroplasty is the precursor method of kyphoplasty. In vertebroplasty surgery, the cement is injected into the collapsed vertebral body immediately after the patient has been positioned. In contrast to kyphoplasty, no erection takes place with the help of a balloon. The risk of cement extravasation is slightly increased.

In osteoporotic vertebral fractures, a combination of screws and rods can also be inserted minimally invasively, i.e. via small incisions, which erects and supports the vertebral fracture from behind like a framework. The minimally invasive surgical technique reduces the surgical trauma and thus facilitates the later mobilisation of the most elderly patient.