Symptoms of osteoporosis and treatment

Osteoporosis (bone loss) is a disease in which the protein and mineral density in the bone (BMD = bone mineral density) decreases, especially that of calcium.

Many people believe that milk, yogurt, cheese and dairy products are essential for strong and resilient bones; However, according to recent studies, the exact opposite is true.

Only children should drink milk, adults do not need this food to stay healthy, on the contrary: regular milk consumption can promote osteoporosis because it increases the pH in the blood (acidosis) and the body deprives the bones of calcium to normalize the pH.

It is generally believed that bones also have a rigid and solid structure inside, but they are formed from numerous bone balls (trabecula), which are vertical, horizontal and obliquely arranged mineral columns, between which there is a certain distance where the blood vessels run.

The internal bone structure also changes, the bone balls become thinner and some even completely absorbed.
Bone loss is a serious disease, bone tissue becomes unstable and brittle, so even a small amount of force can be enough to cause fractures.

It is a chronic and degenerative disease that worsens over time, but its course can be stopped and controlled with proper treatment.
Osteoporosis is a major problem today and will be exacerbated in the future due to the increasing life expectancy.

Osteoporosis is a huge burden for the health care system, because it causes numerous fractures and the care of elderly people with bone fractures is very treatment and care intensive.
The wrist, hip and vertebrae are the bones that most often break as a result of bone loss because they have a sponge-like bone substance, while the compact bones are less prone to injury.
Osteopenia is a precursor to osteoporosis; here the loss of calcium density is minimal and the risk of bone fractures is practically as high as in people with healthy bone structure.


Classification of osteoporosis

Primary osteoporosis (high-turnover osteoporosis)
Primary osteoporosis is an age-related disorder that usually occurs after menopause.

Primary type I osteoporosis occurs after menopause and is characterized by an excessive decrease in the bone balls (area in the middle of the bone).

Primary type II osteoporosis occurs mainly from the age of 70 and also affects the cortical component of the bone (compact outer layer), in which case the likelihood of fracture of the femur and wrist increases.
The low levels of female sex hormones (estrogen) in women and testosterone in men are the cause of this disorder.

Secondary osteoporosis (low-turnover osteoporosis)
About 64% of men with osteoporosis suffer from secondary osteoporosis.
In premenopausal women, the percentage is about 50% and after menopause between 20 and 30%.
Secondary osteoporosis is caused by diseases or medications.
Long-term use of cortisone-containing drugs is the most common cause of secondary osteoporosis in both men and women. This medication is used to treat many chronic diseases, such as rheumatoid arthritis, renal failure, lupus erythematosus, asthma, and chronic lung diseases such as chronic obstructive pulmonary disease (COPD).

Idiopathische juvenile Osteoporose
Die idiopathische juvenile Osteoporose ist selten. Sie tritt bei Kindern oder Jugendlichen zwischen 8 und 14 Jahren oder in schnellen Wachstumsphasen auf.
Es gibt keine bekannte Ursache für diese Art der Osteoporose, die sich durch eine verminderte Knochenbildung oder einen übermäßigen Knochenabbau charakterisiert.

Was sind die Ursachen für Osteoporose?

Die Hauptursache für Osteoporose liegt im Alter, besonders bei Frauen, weil in der Zeit nach den Wechseljahren (postmenopausale Phase) weniger weibliche Geschlechtshormone (Östrogene) produziert werden und somit mehr Knochensubstanz abgebaut als neu gebildet wird.
Wer frühzeitig in die Wechseljahre kommt, also noch keine 45 Jahre alt ist, bei dem wird die Osteoporose gravierender ausfallen, das passiert häufig nach Entfernung der Eierstöcke (Ovarektomie).
Bei älteren Menschen dauert es länger, bis sich neues Knochengewebe bildet, auch bei Männern; Knochenschwund beginnt bei Frauen ab 50 Jahren und bei Männern ab 65-70 Jahren.
Weitere Faktoren, die das Auftreten von Osteoporose begünstigen:

  • Ernährungsverhalten im Kindes- und Jugendalter: Wer als junger Mensch ein gutes Niveau an Knochenmasse erreicht hat, wird weniger oder später unter Osteoporose leiden. Das gilt besonders für junge Mädchen, die der schlanken Linie wegen lange nach einer strengen Diät gelebt und ihre Knochen unzureichend mit Nährstoffen versorgt haben, vor allem Magersüchtige. Eine einseitige kalziumreiche Ernährung mit Milch und Milchprodukten wirkt Osteoporose nicht entgegen, sondern kann sie sogar begünstigen.
  • Bettlägerigkeit: bei Inaktivität fehlt die Stimulation der für die Knochenbildung verantwortlichen Zellen (Osteoblasten), demzufolge wird mehr Knochengewebe abgebaut als aufgebaut.
  • Hormonmangel, vor allem Östrogen bei Frauen, Testosteron und Somatropin bei Männern, das Cushing-Syndrom, das einen hohen Cortisolspiegel mit sich bringt.
  • Vitaminarme Ernährung (Vitamin C und D).
  • Geschlecht – Männer erkranken selten an Osteoporose.
  • Glutenunverträglichkeit (verursacht eine verminderte Aufnahme von Kalzium und Vitamin D, außerdem charakterisiert sich Zöliakie durch das Auftreten von Autoantikörpern gegen das knochenstärkende Protein Osteoprotegerin).
  • Morbus Crohn und Colitis ulcerosa (verursachen eine Malabsorption des Darms).
  • Eine an tierischen Proteinen reiche Kost erhöht den pH-Spiegel im Blut.
  • Glutenunverträglichkeit.
  • Organische Erkrankungen, wie Zirrhose oder Sarkoidose.
  • Krankheiten des Skelett-Muskel-Apparates, wie die Glasknochenkrankheit (Osteogenesis imperfecta), rheumatoide Arthritis, Algoneurodystrophie.
  • Hypogonadismus (Funktionsstörung der Hoden).
  • Onkologische Erkrankungen, wie Sarkome.
  • Bewegungsarmut: eine vorwiegend sitzende Lebensweise ohne jegliche sportliche Aktivität.
  • Alter.
  • Vorzeitige Menopause oder Wechseljahre infolge eines chirurgischen Eingriffs.

Which substances and medications have an influence on osteoporosis?

Among the substances taken that favor the occurrence of osteoporosis are:

  • abuse of harmful substances, such as cigarettes and alcohol;
  • Cortisone;
  • antispasmodics (antispasmodics);
  • Long-term therapy with drugs such as heparin, ethanol, methotrexate, etc.

What are the symptoms of osteoporosis?

Osteoporosis usually develops painlessly and “silently,” but can lead to bone fractures or vertebral fractures.
In the advanced stages, anatomical changes in the spine may be noticeable, such as reduction in body size and the appearance of a round back (hyperkyphosis), because the vertebrae change shape (they resemble a wedge) or collapse.

Diagnosis and imaging of osteoporosis

An X-ray examination does not provide particularly precise information about bone density, because only a mineral loss of more than 30% is indicated.

A bone density measurement (osteodensitometry, DXA for short) examines the skeleton and especially the most frequently affected bones (femur, wrist, vertebrae).
The doctor will prescribe this diagnostic procedure to patients who have the following risk factors:

  • spontaneous fracture or multiple fractures;
  • postmenopausal estrogen deficiency;
  • hormonal changes, such as hyperthyroidism;
  • Taking medicines that have a negative effect on the metabolism of bones.

The examination is carried out using medical equipment that determines bone density and bone mass.
The device resembles an X-ray machine, but the radiation emission is extremely low, the examination is non-invasive and not painful.
The examination takes about 10 minutes. The patient inserts the affected part of the body into the device and the machine performs the measurement.
There is the conventional digital X-ray procedure, which uses only one X-ray source, and the dual X-ray absorptiometry procedure, DXA for short, which is similar to an X-ray.
In addition to bone density measurement, laboratory tests can also be helpful to find out if there is a predisposition to osteoporosis and whether the body is responding to taking the medication.
Blood and urine tests are mainly done to determine the levels of calcium, phosphorus, alkali phosphates and parathyroid hormone (PTH).

What treatment helps with osteoporosis?

Osteoporosis is a disease that is subject to the competence of different professionals, because the causes can be of different nature.
In conversation with the patient, the doctor is informed about his medical history and analyzes whether appropriate risk factors are present; a control of hormone levels will show whether postmenopausal hormone therapy is useful.
If the patient has suffered single bone fractures, spontaneous or multiple fractures, osteoporosis is to be regarded as a serious disorder.
vertebral fracture in the leather area can cause constant pain, restricted movement and breathing problems.
The doctor may prescribe drugs that inhibit osteoclasts (cells responsible for breaking down bones), such as phytoestrogens, or vitamin D, which, among other things, causes the intestines to absorb more calcium; magnesium supplements can also be helpful.
Today, drugs called biphosphonates are also used, which interact with hydroxyapatite and slow down or inhibit the activity of osteoclasts.

Is physical activity important in the treatment or prevention of osteoporosis?

Absolute! Physical activity is one of the most effective natural treatments for controlling and preventing osteoporosis; there are several reasons for this:

  • Balance and coordination skills are improved, thus reducing the risk of falling.
  • The calcium deposit in the bones is promoted, which thus develops a higher resistance to violence.
  • Improvement of the general state of health and strengthening of the heart and circulation.

Walking, dancing, gentle gymnastics and exercises for the spine are ideal in this context.
Depending on how far the bone loss has progressed, different activities are offered. In the initial phase or in osteopenia, slow jogging has a bone-strengthening effect, but should be avoided later because of the threat of femoral fractures.
Among the recommended sports are swimming and water aerobics , because they are performed without weight load, gravity is largely suspended, and thus neither the sense of balance nor the bones are strengthened.
Even when cycling, there is only a reduced load, so it may be the appropriate sport for knee or hip problems, but helps little with osteoporosis.

Anything that makes the muscles work against gravity helps strengthen the bone system; the ideal activity is therefore carried out “standing on its feet” in order to provide the bones with a mechanical stimulus that reacts with bone formation.
It is important to carry out physical activities regularly, at least 3x a week for half an hour, in order to achieve a good result and prevent bone fractures.

support corset for the back should be avoided because it relieves the spine and thus promotes the decrease in bone density.

How important is nutrition in the treatment and prevention of osteoporosis?

Diet plays a fundamental role in treating and preventing bone loss.
A lot of vitamin D is one of the most effective means of combating this condition.
Vitamin D suppliers are mainly fish, especially cod liver oil, but also meat, butter, fatty cheese and egg yolk.

Calcium metabolism is complex, bones play an important role in the balance of mineral salts and release alkaline calcium salts to limit an excess of acid in the blood.
It is important to have a nutrition program that maintains the neutral pH value in the blood, especially meat should be avoided.

Guidelines for the prevention of osteoporosis

According to the official recommendations of the Ministry of Health, osteoporosis can be prevented by:

  • Adequate calcium intake.
  • Balanced diet.
  • The daily ration of vitamin D for an adult should be 400-600 IU/day.
  • Regular exercise against gravity (walks, light weight lifting, climbing stairs) adapted to the child’s or advanced age.
  • Abstain from smoking and alcohol.
  • Treatment of the underlying disease that causes secondary osteoporosis.
  • Older people should prevent falls; helpful measures include the use of walking sticks and non-slip shoes, adequate lighting at home, no carpets (risk of tripping), installation of grab bars on stairs and other critical points.
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