Osteoporosis

Decreasing bone density is a normal part of the aging process. However, bone density reduces more rapidly in some people than in others. When it falls below a certain level, it is due to osteoporosis.

Older people are particularly affected. The decline in bone mass begins earlier in women than in men.

People with osteoporosis are at an increased risk of breaking bones. For older people in particular, this can become a problem, as a broken bone does not heal as well in old age. A break can lead to more serious complications than at a younger age.

However, bone density alone can only reveal so much. Therefore, reduced bone density does not justify taking things easy physically. After all, movement strengthens the bones and muscles and improves a person’s sense of balance. This prevents falls, which represent the most common reason for bone fractures in older age. 

There are certain things that people can do for themselves to keep their bones stable. The following are all effective measures to prevent osteoporosis:

• being active
• spending plenty of time outdoors
• eating a calcium-rich diet
• not smoking 

A person’s age and other personal risk factors for broken bones will determine whether it makes sense to also take medication to strengthen the bones.

Often, the first indication of osteoporosis is a broken bone. Sometimes, there are also visible signs of the illness, such as a slight sinking of the spine, causing the person to lose a small amount of height.

In an advanced stage, the condition can cause a bent posture or a “hump” in the upper part of the spine.

This is caused by breaks (fractures) in the vertebral bodies. These cause the spine to slump slightly and may cause back pain. Many people do not even notice these breaks, however.

Along with the vertebral bodies, breaks in the hand joints, upper arm bones, pelvis, and hips are typical. Fractures of the femoral neck are particularly likely to have serious consequences. These mainly occur in people from the age of about 80 years, and can sometimes lead them to require long-term care.

The human skeleton supports the body and protects the internal organs. Along with muscles, tendons, ligaments and joints, it gives the body its mobility.

The inside of the bones consists of a structure of fine bundles of fibers known as trabeculae. When a lot of the trabeculae degenerate, osteoporosis occurs. The spaces in the trabecular framework then increase in size and bone density reduces. However, the degree to which the bones are weakened as a result also depends on the shape and density of the bone framework and its mineral content.

Bone density increases to the age of around 15 in girls and around 20 in boys, when it reaches its peak. After the age of 30, bone mass gradually reduces.

Due to hormones, bone atrophy begins at around the age of 50 in women. Up until the menopause, the female sex hormones (estrogens) slow the process of bone atrophy. During the menopause estrogen production falls and this protection is lost, so the bones lose mass more quickly.

Medical practitioners distinguish between primary and secondary osteoporosis. If no other reason for the bone atrophy is found, it is called primary osteoporosis.

In contrast, secondary osteoporosis occurs as a result of another condition or due to regularly taking certain medications.

There are various risk factors that can favor osteoporosis. Some factors can be influenced, others cannot.

The main risk factors for osteoporosis are:

• older age
• being female
• low weight (in relation to height)
• previous broken bone
• calcium deficiency
• vitamin D deficiency
• too little exercise
• heredity (osteoporosis in the family)
• smoking
• heavy alcohol consumption
• Long-term cortisone intake

It is impossible to say precisely how many people in Germany actually have osteoporosis and how many broken bones it causes.

In one large survey, around 10 percent of men and 20 percent of women aged 70 stated that they have been diagnosed with osteoporosis.

It is estimated that around 30 percent of fractures of the hip, spinal vertebrae and hand joints are associated with a severely reduced bone density.

Not every case of osteoporosis results in a broken bone. However, broken hip bones, in particular, can have serious consequences.

This usually affects those aged over 80 – around 1% to 2% of people in that age bracket suffer a fracture of the femoral neck within a year.

Some things can be done to prevent osteoporosis and broken bones:

• Eating a calcium-rich diet helps strengthen the bones. Calcium-rich foods include milk and dairy products, green vegetables, and certain mineral waters.
• Regular exercise and targeted training strengthen the muscles and bones, improve coordination and sure-footedness and reduce the risk of a fall.
• Avoiding smoking is another preventive measure.
• Vitamin D is also important – the body requires sunlight (UV rays) to help it produce the vitamin D it needs.

Further information about a calcium-rich diet can be found at gesundheitsinformation.de.

Studies show that food supplements with calcium and vitamin D have no benefits for most people. In fact, they may increase the risk of kidney stones. As a result, medical associations do not recommend that they be taken routinely to prevent broken bones.

Food supplements can be useful for people in need of care and less mobile people, who usually spend little time in the sun and often are no longer sufficiently active.

A fracture of the bone at the neck of the femur, in particular, can have serious consequences. Older people in particular are at risk of never making a full recovery from this type of break. While osteoporosis may contribute to breaks like these, falls represent the main risk. For this reason, it is particularly important for older people to avoid falls.

Certain medications can also increase the risk of having a fall. A chat with the doctor can clarify which interactions medications can have and whether the medication is even essential. It is a good idea to draw up a list of medications in preparation for this conversation.

For more information on preventing osteoporosis, for example on how exercise helps, and how to get enough vitamin D, go to gesundheitsinformation.de.

Some doctors offer a bone density measurement (osteodensitometry) for the early detection of osteoporosis as an individual health service on a self-payer basis.

However, there is no reason for women younger than 65 with no risk factors to avail of this service. The results may even be harmful if the patient subsequently exercises less for fear of breaking a bone.

If there is a medical reason for a bone density measurement, the health insurance provider will cover the cost. This applies, for example, if:

• osteoporosis is suspected after a bone is broken
• the person is at an increased risk of developing osteoporosis, e.g., after taking cortisone medication for an extended period
• treatment with medication is being considered

As yet, there have been no meaningful studies of the potential advantages and disadvantages of screening osteoporosis in young women, women with no risk factors, or men.

Osteoporosis is sometimes detected by chance – for example, if the upper body is x‑rayed for other reasons and vertebral fractures are detected.

Bone atrophy may also be detected, for example, due to an unexpected bone fracture – e.g., due to falling from a normal standing position. In such cases, a doctor can often diagnose osteoporosis after simply talking to the patient and physically examining them.

If no broken bones have yet occurred, the osteoporosis is not a condition but a risk factor for broken bones.

A bone density measurement (osteodensitometry) can detect whether the bone density has declined. With this procedure, an x-ray picture shows how many mineral salts the bone contains.

The result is given as a T-score. A T-score of 0 equates to the bone density of a young, healthy adult aged between 20 and 30.

According to the current definition of the World Health Organization:

• a T-score of 0 to -1 is normal
• a T-score of between -1 and -2.5 indicates reduced bone density (osteopenia)
• a T-score of -2.5 or lower indicates osteoporosis

However, the risk of broken bones cannot be reliably predicted just by using a bone density measurement.

Other factors apart from bone density play a role. These include, for example, the shape of the internal structure of the bone and its load capacity. The risk of a broken bone also depends on an individual’s general state of health.

For people with osteoporosis, regular exercise (outdoors where possible) and a sufficient intake of calcium and vitamin D are important.

Medication to treat osteoporosis

Specific medicine may be used to treat osteoporosis. It seeks to slow down bone atrophy or promote bone formation.

This medication usually consists of bisphosphonates. Their use is considered if a person has already broken bones or is at an increased risk of doing so. This is the case, for example, when bone density is very low or if a number of risk factors come together.

Someone who opts for treatment with drugs should usually take them for several years.

In particular, people whose risk of broken bones is only slightly increased or whose bone density is only slightly reduced (osteopenia) should seriously weigh up the pros and cons of therapy with drugs.

More information about treating osteoporosis can be found at gesundheitsinformation.de.

Surgery for vertebral fractures

If the vertebral bodies in the spine are fractures due to osteoporosis, vertebroplasty or kyphoplasty is sometimes offered. This involves injecting bone cement into the fractured vertebral body to stabilize it. However, reliable studies have shown that most people don’t benefit from the procedure.

Treatment with bone cement may help if the person is in very severe pain. The benefits and risks of such a treatment should be given careful consideration due to the potentially serious complications they can have.

Doctors who recommend treatment with bone cement must make their patient aware that they are entitled to a second opinion free of charge.

The decision aid from gesundheitsinformation.de can help people to make a decision about whether to have treatment with bone cement.