Osteoporosis

Osteoporosis is also known as bone atrophy. It is normal that bone density declines with age. However, bone density reduces more rapidly in some people than in others. When it falls below a certain level, it is a case of osteoporosis. Older people are particularly affected. The decline in bone mass begins earlier in women than in men. 

People with osteoporosis are at 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 then lead to more serious complications than at a younger age.

However, those affected should not take too much care or over-protect themselves physically because of reduced bone density. If someone is less active, the risk of falling, for example, and thus also of breaking a bone, tends to increase. In fact, the main cause of broken bones amongst older people is falling. Activity, in contrast, strengthens the bones and muscles, improves balance, and therefore protects against falling.

For the bones to remain stable, people can do things for themselves: being active, taking on plenty of calcium, and not smoking are good ways of preventing osteoporosis. Whether it is a good idea to take any additional medication to strengthen the bones depends on the person's age and other risk factors for broken bones.

Osteoporosis can often go undetected for a long time. But there are also sometimes visible indications of the condition. For example, the spine may sink slightly – this makes the person affected a little smaller.

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 it may cause back pain. Many people do not even notice these breaks, however.

Sometimes the person affected only notices the osteoporosis when they get a painful broken bone. Along with the vertebral bodies, breaks in the hand joints, ribs, upper arm bones, pelvis, and hips are typical.

Our skeleton supports the body and protects the inner organs. Along with muscles, tendons, ligaments and joints, it gives the body its mobility.

The inside of our bones is made up of a framework of fine trabecula. The framework is constructed like a sponge and is called spongiosa. When a lot of the trabecula degenerate, osteoporosis occurs. In this case, the hollows become larger and the bone density reduces. However, how much this weakens the bones depends on a range of factors. For example, the fine structure of the bone plays a key role.

In girls, bone density increases to the age of 15, and in boys until 20, when it reaches its maximum. After the age of 30 bone mass reduces constantly.

Due to hormones, bone atrophy begins at around the age of 50 in women. Before the menopause the female sex hormones (estrogens) regulate 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
• cortisone (taking it for a long time)

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

A study by the Robert Koch Institute shows that 3 percent of men and 13 percent of women aged between 60 and 69 say they have been diagnosed with osteoporosis.

Not every case of osteoporosis brings with it a broken bone. However broken hip bones, in particular, can have serious consequences. It is almost exclusively older people who suffer from these: around 6 to 7 in every 1,000 people over the age of 65 break their femoral neck each year.

Some things can be done to prevent osteoporosis and broken bones. To strengthen the bones it helps to take on plenty of calcium. There is a lot of calcium, for example, in milk and dairy products, green vegetables, and certain mineral waters. Regular exercise and not smoking are also preventive. Vitamin D is also important: to get enough, the body needs sunlight (UV rays) to help it produce vitamin D.

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

Studies show that food supplements with calcium and vitamin D bring no benefits for most people. On the contrary: they can even increase the risk of kidney stones. So medical associations do not recommend them to be taken routinely to prevent broken bones.

However, food supplements can be useful for people in need of care and less mobile people, because they usually spend little time in the sun and may also no longer be sufficiently active.

A fracture of the bone at the neck of the femur, in particular, can have serious consequences. Very many older people never fully recover from this type of break. Osteoporosis can, indeed, contribute to breaks like these, but falls are the main risk of a broken hip. So for older people it is particularly important to prevent falls.

Certain medications can also increase the risk of falling. A chat with the doctor can clarify which side-effects medications can have and whether all the medication being taken is really necessary. It is a good idea to draw up a list of medications in preparation for the 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 – as an optional medical service (IGeL) – bone density measurement (osteodensitometry) to detect osteoporosis early on. However, there is no reason for women below the age of 65 who have no risk factors to do this, and it would also involve exposing the body to X-rays. The results might also be harmful if the patient then exercises less for fear of breaking a bone.

However, a bone density measurement may be useful for women with risk factors for osteoporosis, if treatment with drugs is being considered. In such cases, the statutory health insurance providers also cover the costs.

As yet there is no meaningful study of the potential advantages and disadvantages of screening for men.

Osteoporosis is sometimes detected by accident – for example if the upper body is x-rayed for other reasons and breaks are detected in the vertebral bodies.

Bone atrophy may also be detected, for example, due to a surprising broken bone, i.e. if falling from a normal standing position causes a break. In these cases, a doctor can often make the diagnosis already after a talk and a physical examination. 

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 so-called T-score. A T-score of 0 equates to the bone density of a young, healthy adult aged between 20 and 30.

However, the risk of broken bones cannot be reliably predicted just by using a bone density measurement. Other factors play a role, apart from bone density. These include, for example, the inner framework of the bone and the load capacity of the bone substance. The risk of a broken bone also depends on other factors and on a person's health in general.

Regular exercise and taking on enough calcium and vitamin D are important for those affected.

Specific drugs aimed at slowing down bone degeneration or promoting bone formation can also be used against osteoporosis. These are usually so-called bisphosphonates. If a person has already had broken bones or is at high risk, therapy using drugs is useful. 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.

People, in particular, whose risk of broken bones is not very heightened or whose bone density is only slightly reduced (osteopenia) should seriously weigh up the pros and cons of therapy with drugs.

Where vertebral bodies break due to osteoporosis, vertebroplasty is sometimes offered. This is a minimally invasive surgical procedure in which artificial bone cement which then hardens is injected into the vertebral bodies. Robust studies, though, show that this type of therapy alleviates the complaints no better than a sham procedure. Vertebroplasty can have side-effects, however. So these days this treatment is advised against. Neither is there any evidence that kyphoplasty, another procedure for stabilizing vertebral body breaks, alleviates the symptoms of osteoporosis.