Understanding Osteoporosis: Causes, Symptoms, and Treatments

Understanding Osteoporosis: Causes, Symptoms, and Treatments

According to the World Health Organization (WHO), osteoporosis (bone loss) is one of the ten most common chronic diseases worldwide. Around six million people are affected in Germany, most of whom are women. Osteoporosis is a typical age-related disease of the bones – which can sometimes have fatal consequences. These consequences include broken bonesoperations, being bedridden for a long time and the need for care. In the following, we inform you about osteoporosis’s causes, symptoms, consequences and treatment.

Definition: What is Osteoporosis?

Osteoporosis is a chronic bone disease in which bone density is reduced due to disrupted formation and breakdown processes. This makes them porous and brittle.

To better understand this short definition, one should know how the renewal of the bone substance in the body typically works: Bones consist of bone tissue and various minerals stored in the bone tissue and stabilize it. The most important minerals are calcium and phosphate.

The bone mass in the body is constantly being built up and broken down: Where the skeleton is under more significant stress, more bone substance is built in. Where the stress is less, it is broken down. A particular type of cells, the so-called osteoblasts and osteoclasts, are responsible for this.

Usually, building and breaking down processes in the body are in balance. However, if this balance is disturbed, there can be a more significant reduction in bone mass – which is why osteoporosis is also popularly known as bone loss. The result is unstable and, above all, brittle bones.

Causes of Osteoporosis

Different causes are fundamental in the development of osteoporosis. First, it is essential to differentiate between primary and secondary osteoporosis.

Primary Osteoporosis

Women, in particular, are often affected by primary osteoporosis: around a third to a quarter develop the disease after menopause, and it becomes more common with age. The reason is primarily the decrease or failure of the production of the female hormone estrogen during menopause – around 50.

Most women lose valuable bone when sex hormone levels drop. This has to do with estrogens controlling calcium absorption in the bones, which is the most crucial bone-building block.

But age-related bone loss begins very slowly and goes unnoticed much earlier, from the mid-30s. Underweight women, in particular, can also develop osteoporosis at a younger age since their estrogen levels are usually permanently low.

Bone loss is more common among women who don’t have children and who went through the menopause early. Here, too, the lower estrogen level plays a role.

Primary osteoporosis also includes senile osteoporosis, which can occur in men and women as they age. This is because the likelihood of an imbalance in the formation and breakdown of bone mass increases with age. Senile osteoporosis tends to develop more slowly than osteoporosis associated with estrogen deficiency.


Secondary Osteoporosis

This form of osteoporosis is less common than primary osteoporosis. It occurs as a result of other diseases or the use of medication. Causes of secondary osteoporosis include:

  • Chronic Kidney Disease: The body can absorb less calcium in chronic kidney disease—the calcium level in the blood drops. To compensate for this loss, calcium phosphate is released from the bone tissue and released into the blood using a specific hormone (parathyroid hormone). This destabilizes the bones. For this reason, osteoporosis can also develop as a result of chronic kidney failure.
  • Chronic inflammatory bowel diseases:  In the case of chronic inflammatory bowel diseases, certain peptide hormones (interleukins) are released by the body. These can indirectly promote bone resorption.
  • Long-term therapies with medication: Certain medications, such as cortisone or antiepileptics, promote bone resorption and inhibit bone formation.

In addition, osteoporosis can also be caused, for example, in the sense of an occupational disease through occupational contact with toxic substances such as cadmium.

A unique form of transient osteoporosis

Transient osteoporosis occurs primarily in the hip joint area. They appear suddenly and often radiate to the groin and thighs. The pain usually worsens with exertion and improves when lying down.

In contrast to osteoarthritis of the hip, mobility is not restricted. In contrast to “classic” osteoporosis, the triggers for the symptoms are accumulations of water in the bones, which can be caused by disturbed blood circulation.

Since the disease often improves on its own after a few months, transient osteoporosis is treated by relieving the bones with the help of crutches and painkillers.

It is essential to have the clinical picture scrutinized to be able to rule out more serious diseases with similar symptoms, such as osteonecrosis of the femoral head.

What other factors promote osteoporosis?

In addition, the following risk factors can influence the development of osteoporosis:

  • Calcium deficiency or vitamin D deficiency: The lack of calcium destabilizes the bone tissue. A vitamin D deficiency can also lead to less calcium being absorbed from the intestine.
  • Smoking:  The link between smoking and osteoporosis is not fully understood. If necessary, nicotine can hurt estrogen levels and blood circulation and thus also bone formation.
  • Heavy alcohol consumption:  The links between alcohol consumption and osteoporosis also require further investigation. Alcohol likely inhibits bone formation and vitamin D metabolism. In addition, more calcium is excreted through the consumption of alcohol.
  • Lack of exercise: If there is a lack of exercise, the bone metabolism is less stimulated.
  • Hereditary predisposition: There may be an increased risk of osteoporosis if close family members already have it.


Osteoporosis: symptoms and course

Usually, the bone-degrading and bone-building cells are in balance. However, in the case of osteoporosis, this perfectly coordinated interaction is disturbed – degradation predominates. As a result, the bones are no longer so resilient: they become increasingly porous, and the risk of a bone fracture increases drastically.

But how do I know if I have osteoporosis? What is fatal is that the changes in the bones often do not cause any symptoms or complaints for a long time and are only discovered late due to the complications. Possible consequences include:

  • Back pain Vertebral deformities and vertebral fractures initially cause back pain. Since the reasons for these symptoms can be varied, those affected often do not have the causes clarified by a doctor at an early stage. You should, therefore, always consult a doctor if you experience severe and persistent back pain.
  • Hunched back (“widow’s hump”): As the disease progresses, the body size decreases, and a hunchback can form. The reason for this is, in turn, increased vertebral body fractures.
  • Wobbling or falling out teeth: The periodontium and the ossified root cavities of the teeth can also be affected by bone loss.
  • Fractures of the neck of the femur occur mainly after a long period of osteoporosis and in older people. Femoral neck fractures are often associated with complications and permanent pain. Over 90 per cent of those affected by a femoral neck fracture have reduced bone density.

The further the disease progresses, the more pain osteoporosis can cause. In the final stages of untreated osteoporosis, even the slightest stress, such as stumbling, coughing, turning in bed, and even lifting a cup, can cause a bone fracture. Those affected can hardly straighten up because vertebral fractures severely damage the spine.

If you suspect osteoporosis, our test can provide further information. Early diagnosis can be crucial in treating osteoporosis. Over 65 per cent of all cases are not diagnosed early and are therefore not treated appropriately.

How long can you live with osteoporosis?

As with many diseases, it depends on the severity of the damage that has already occurred at the time of diagnosis.

Left untreated, osteoporosis can significantly reduce life expectancy. However, if therapy is given as early and effectively as possible, the life expectancy of those affected can be extended. Therefore, early diagnosis and correct treatment are crucial when osteoporosis is suspected.

Diagnosis: What examinations are carried out?

To diagnose osteoporosis, the doctor will first ask about symptoms such as pain, changes in body size and other medical history (anamnesis). This includes, for example, whether other family members already have osteoporosis or whether there is an underlying disease in which certain medications are used that can promote the development of osteoporosis.

A physical examination follows this. The patient’s weight and height are measured.


Check mobility

Mobility is also checked. The so-called “chair rising test” or the “timed up on go test” are often used for this purpose:

  • The chair-rising test measures the time it takes for a person to get up from a chair five times in a row without using their arms. The time should be a maximum of ten seconds.
  • The “Timed up and go” test measures the time it takes a person to get up from a chair, walk ten feet, turn around, and sit back down. If a walking aid is used in everyday life, it may also be used here. The time required for this test should be at most ten seconds. Otherwise, other factors must be checked. Limited mobility is likely if it takes more than 30 seconds to complete the test.

If the physical examination provides evidence of osteoporosis, laboratory tests and X-rays of the thoracic and lumbar spine may be carried out to examine bone density.

bone densitometry

The best way to determine bone fragility is bone density measurement (osteodensitometry) or Dual Energy X-ray Absorptiometry (DXA). This is a relatively low-radiation X-ray technique.

Bone densitometry determines whether bone mineral levels typical of osteoporosis are present. These so-called T-values  ​​are then compared with average values ​​of 30-year-old people of the same sex. It, therefore, indicates the deviation from the average value, which is why a minus sign precedes it. In addition, the value is compared with the average values ​​of healthy men or women of the same age. This is the so-called z-value.

If the T-value is within a range of -1 to -2.5, there is a preliminary stage of osteoporosis, a so-called osteopenia. From a value of -2.5, one speaks of osteoporosis.

Bone density measurement can also be used as a preventive screening method but is only paid for by health insurance companies if there is a fracture and a reasonable suspicion of osteoporosis.

If you have a potentially increased risk of bone loss, talk to your doctor to see if they think further tests are needed. These include, for example, ultrasound examinations, blood tests or quantitative computer tomography (QCT).

treatment of osteoporosis

What can you do about osteoporosis? The following medications are used to treat osteoporosis:

  • Calcium and vitamin D3 tablets are part of the primary therapy used to strengthen bones.
  • Bisphosphonates: They are said to reduce the risk of fractures. Bisphosphonates are now also available as an injection for the treatment of osteoporosis. This has the advantage that taking tablets every day is unnecessary. An example of a bisphosphonate is alendronic acid.
  • Calcitonin:  This hormone can positively influence the calcium and phosphate balance in the body.
  • Painkillers: Drugs such as diclofenac are used to counteract the pain associated with osteoporosis.
  • Fluoride preparations: Whether these have a positive effect on the treatment of osteoporosis is now controversial.

Estrogen therapy can also be initiated in younger women; however, it may have side effects such as an increased risk of uterine cancer.

Physiotherapy and physical therapy, such as massages heat or cold therapy, support drug treatment. Regular exercise sessions also help. Walking or swimming are particularly suitable. A doctor or therapist can help you choose the right sport.

If there is an increased risk of falling, bone protectors such as hip protectors can also be used. Broken bones are treated surgically.


Can osteoporosis be cured?

Osteoporosis is currently not curable. Only the course of the disease can be delayed. However, with the proper diet, sufficient exercise and appropriate drug treatment, there can be significant improvements in the symptoms.

prevent osteoporosis

A healthy lifestyle can help prevent osteoporosis. A healthy diet with sufficient calcium and magnesium from a young age is the basis for solid bones.

If you also move a lot, your bones will be more stable in old age. Above all, exercise in the fresh air can help prevent osteoporosis since sunlight can increase the production of vitamin D in the body.

Even if bone loss has already been determined, those affected can often improve significantly with physical exercise and a balanced diet. Exercise and sport strengthen skeletal muscles and are extremely important for developing and maintaining bone mass.

I was running, cycling, swimming, or targeted strength training to strain the bones. As a result, more bone substance is built up.

Calcium and vitamin D: nutrition and osteoporosis

The mineral calcium is essential for bone formation. Make sure your diet contains enough calcium. The German Society for Nutrition (DGE) recommends 900 milligrams of calcium daily for adults. Calcium is mainly found in milk and milk products.

You can use kalebroccolispinach, almonds, hazelnuts and figs if you dislike them. Postmenopausal women who don’t take hormones need even more calcium because the body also can’t use the calcium from food.

What shouldn’t you eat if you have osteoporosis? There are foods to avoid if you have osteoporosis. Phosphates are “calcium thieves” in sausage and cola, for example. Excessive consumption of caffeinated drinks, too much salt, and dietary fat can also damage bone structure. Excessive consumption should, therefore, be avoided, but these foods are not prohibited. Phosphate is even an essential source of energy. Severe deficiency can lead to epileptic seizures or coma.

For the body to incorporate calcium into the bones, vitamin D is needed. It is formed in the body under the influence of sunlight. A sufficient formation of this vital vitamin is already achieved with a daily half-hour walk. Alternatively, there are also pharmacy preparations containing vitamin D and calcium. Whether taking these preparations can prevent osteoporosis is now considered controversial.

In addition to nicotine consumption, increased alcohol consumption is also suspected of impairing bone formation. Limit these stimulants as much as possible to prevent the weakening of the bones.


Safety tips for unstable bones

Anyone who has osteoporosis should, above all, avoid risky situations and risk factors in order not to expose themselves to unnecessary danger. Additionally, the following tips can help keep people with osteoporosis safe:

  • Reduce excess weight.
  • Get regular exercise.
  • Try to avoid falls: use flat, non-slip shoes, no carpet runners in the apartment, good lighting, and railings when climbing stairs.
  • Don’t lift heavy weights.
  • Get vision corrections done to reduce the risk of falls.

If you heed these tips and pay attention to proper nutrition, sufficient exercise and appropriate drug therapy, you can do a lot to help osteoporosis progress more mildly.

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