What is osteoporosis?
Bone appears to us as a rigid, firm substance that hardly changes at all. But in a healthy body there is, in fact, a constant balance between a breakdown and building up of bone substance. However, if more bone is broken down than new bone is produced, we lose bone substance. This is when osteoporosis begins. Our bones lose their strength and are more susceptible to fractures.
Damaged vertebral bodies collapse. This leads to permanent deformities such as the typical "dowager's hump", a form of rounded back that is purely attributable to the loss of bone mass. Severe pain in the spine or the breastbone is a danger sign of pathological bone loss. It indicates that one or more vertebral bodies have already broken.
Osteoporotic fracture
Osteoporosis is treatable
Osteoporosis is mostly diagnosed in women – after the menopause – and also frequently in people who have been treated with cortisone for many years. Osteoporosis costs our public health system several billion pounds – a princely sum. The World Health Organization (WHO) has classified osteoporosis world-wide as one of the ten most significant diseases of our time.
But, as daunting as these figures and facts are, osteoporosis is treatable. There are, for example, back braces that straighten the spine and can be integrated seamlessly in everyday living. They give patients some of their quality of life back.
Cells perform hard graft
Bone appears to us as a rigid, firm substance that hardly changes at all after the growth phase has ended. But the appearance is deceptive. In reality, bone substance is constantly being built up and broken down in our bodies. Bone cells are tirelessly busy replacing worn-down substance with new bone. Hormones, vitamins and other messenger substances in the body control these "refurbishment programmes".
The build up of bone predominates until we are about 30. Thereafter, we lose a small percentage year after year. The sex hormone deficiency in women in the menopause accelerates this breakdown substantially.
Signs and symptoms
There are signals that help make an early diagnosis. These include loss of height with advancing age. Bones may sometimes even break without any recognisable cause. This may be difficult to imagine at first, but some patients suffer broken ribs simply from coughing. Or even minor tumbles result in hip or wrist fractures.
Another indicator of osteoporosis is the so-called "dowager's hump" (rounded back). When continuous pain in the lumbar and dorsal spine then starts, these can all be signs of osteoporosis. Therefore, it is advisable to consult a doctor at an early stage to clarify the situation.
Risk factors and causes
- Primary osteoporosis: Primary osteoporosis accounts for about 95% percent of disorders that involve the loss of bone mass. Type I osteoporosis primarily affects women after the menopause. The first bone fracture occurs about eight to ten years after the last menstrual period. The vertebral bodies in the lumbar spine are particularly susceptible. In type II osteoporosis, the first bone fracture doesn't occur until after the age of 70. Women account for most of the patients (two thirds). Besides the spine, the long bones in the thigh and arm are also affected. The risk factors for the onset of primary osteoporosis are familial predisposition, hormone status (later onset of the first menstrual period and earlier menopause) and certain lifestyle habits (little exercise, bed-ridden for a long period, a low calcium or phosphate-rich diet such as fast foods, cola, sausages; "consumer poisons" such as alcohol, coffee and cigarettes, underweight)..
- Secondary osteoporosis: Secondary osteoporosis develops as the result of certain disorders or as undesirable side effects of a number of drugs. Risk factors for the onset of secondary osteoporosis are anti-inflammatory drugs for the treatment of asthma or rheumatism (cortisone), high dose thyroid hormones, coumarin derivatives (Marcumar), chronic disorders of dietary uptake, e.g. due to diseases of the pancreas, the intestine, the liver and the kidneys as well as hormone imbalances such as an overactive thyroid or diabetes mellitus and tumours.
Preventing osteoporosis
Now for the good news: there are preventive measures that even young folk should take to heart to counteract the risk of losing bone mass. The keyword is diet: eat or drink at least 1,000 milligrams calcium every day.
Sounds simple, but what foods is calcium actually in? The bone mineral is to be found in, among other things, milk products and fish. Our body also needs vitamin D for the calcium to reach the bones. The body synthesises this vitamin itself whenever sunlight falls on the skin. But vitamin D can also be taken as tablets.
Furthermore, physical exercise is important. Moderate muscle training is very good for our skeleton. And another tip: if you are perhaps already an osteoporosis patient, get rid of everything around you that you could fall over.
How can osteoporosis be treated?
Since every fifth patient suffers a new bone fracture within 12 months after the first fracture, rapid action is required.
Treatment of osteoporosis is very wide-ranging and follows a guideline.
It requires an interdisciplinary approach, i.e. co-operation between several specialists. As a rule, the bone specialist (osteologist) prescribes medicines that prevent the breakdown of bone and strengthen bone formation. Orthopaedic surgeons or neurosurgeons concern themselves with fractures and any possible surgical interventions. Rule of thumb: contact an orthopaedic specialist or osteologist for all questions you may have about recovery.
Medication
The following groups of drugs are used for the treatment of loss of bone mass:
Calcium and vitamin D form the basis of prevention and treatment. Calcium constitutes the largest part of the mineral bone substance. Vitamin D promotes the dietary uptake of calcium, supports the incorporation of calcium in the bones and improves muscle function.
Bisphosphonates inhibit the cells that are responsible for breaking down bone. This slows bone breakdown and the bone mass increases, which can considerably lower the risk of further fractures of the vertebral column and limbs.
Selective oestrogen receptor modulators (SERMs): The most common cause of osteoporosis in women is the lack of the hormone oestrogen after the menopause. In the absence of oestrogen, the breakdown of bone mass increases. However, although oestrogens can prevent the further breakdown of bone, they do, at the same time, increase the risk of breast cancer and cardiovascular diseases and are therefore not recommended for the treatment of osteoporosis. Oestrogen receptor modulators, on the other hand, act on the oestrogen binding sites in the bone, but not on those in the breast or uterus, and can thus be used for treatment.
Calcitonin is a hormone that is synthesised in the thyroid gland. It reduces the release of calcium and phosphate from bone mass. At the same time, it stimulates the deposition of the two substances in the bones. It acts similarly to hormone replacement therapy with oestrogens, which is why it can also be used as an alternative in cases where oestrogen therapy is not indicated. This active substance can also be used by men.
Painkillers: fractures cause pain. The vertebral body fractures that often occur with osteoporosis particularly limit mobility. Therefore the pain must first be treated with appropriate drugs. Back braces support medicamentous pain control by decompressing the affected vertebral bodies.
Fluorides have long been used in the treatment of osteoporosis. They accumulate in the bone mass thus leading to higher bone density, which is more strongly pronounced in the spine than in other bones. Treatment with fluorides should not be given for longer than three years.
Physical exercise
Physical exercise plays an important role in the treatment of osteoporosis. Even in the case of an existing vertebral fracture, specific physiotherapy exercises and physical treatment planned in co-operation between the physiotherapist and the doctor help strengthen the muscles and the patient to quickly become mobile again. Medication and a back brace relieve the pain.
It is essential to continue the mobilisation treatment even after the fracture has healed. While doing so, it is particularly important to train back muscle endurance. Special back braces with biofeedback support the spinal column and help increase muscle mass. Besides exercises from and with a physiotherapist, there are a number of sports that are particularly suitable for patients with osteoporosis: hiking or power walking, cross-country skiing, swimming, dancing.
Training out of doors is particularly effective. Because, besides training the muscles with physical exercise, sunlight stimulates the synthesis of vitamin D in the skin.
Strength training
Physical exercise
Weight training builds up the muscles and thus generates positive stimuli to build up bone mass. At the same time, posture improves. The Spinomed back brace supports the back just like a training machine.
The strap system and the back brace exert tension forces on the pelvic and shoulder areas. This causes users to unconsciously contract their muscles for a more erect posture of the upper body. Spinomed is recommended in the guidelines of the DVO (German osteology umbrella organisation) for the treatment of osteoporosis. Strengthening the muscles co-ordinates the interplay between the muscles for more harmonious movements. Weight training with machines illustrates particularly clearly how the different doses of weights and repeat lifts lead to different training outcomes:
1. High weight – fewer lifts
This combination to overcome the maximum weight exerts the most effective stimulus on the bones. It is best suited for countering accelerated bone loss.
2. Low weight – many lifts
Lifting a low weight many times specifically trains endurance. The positive influence on everyday activities and general fitness soon becomes clear.
3. Moderately heavy weight – rapid repeat lifts
A training combination of moderately heavy weights and rapid repeat lifts optimises muscle performance, balance and co-ordination. The effect is a better sense of balance to prevent falls.
It's all in the mixture
It is ideal when the various types of training are varied to improve all forms of strength. More muscle mass, better prognosis for bone quality, fitness and more confidence when moving around are the rewards. Discover your own exercise concept and the fun you'll have with it. Make sure you ask your doctor before you start training.
Functional treatment – with back braces
Due to the close link between muscle and bone, loss of bone and muscle mass always occur at the same time.
Therefore, once fractures have occurred in the spine, treatment with drugs must always be accompanied by treatment with medical devices (functional treatment), because fractures cause pain and further loss of muscle mass due to restricted mobility. Modern medical devices straighten up the spine and train the muscles at the same time.
While patients with osteoporotic vertebral fractures were often immobilised in rigid corsets in the past, this encouraged the loss of muscle mass. Today it is recognised that, besides treatment with medication, muscle activity is decisive for increasing bone mass.
medi has developed the orthoses Spinomed and Spinomed active together with Prof. Helmut W. Minne MD to promote mobility in patients with osteoporosis. These are orthopaedic devices that straighten the vertebral column, while simultaneously training the muscles. The Spinomed orthosis is as easy to put on and take off as a rucksack. The Spinomed active, a body variant, is practically invisible under clothing.