As of: October 23, 2023 9:40 a.m
Osteoporosis is a widespread disease: in Germany, around six million people are affected, especially women. But bone loss often goes undetected. What symptoms are there and what therapy can help?
Osteoporosis occurs in more than six million people in Germany, the majority of whom are female. According to studies, up to 45 percent of women over 60 are affected and 17 percent of men in this age group.
When the disease occurs, the density of the bones decreases and their quality also deteriorates. The bones become porous and break more easily. Many of those affected know nothing about their illness. Osteoporosis usually does not initially cause pain. Those affected often only notice this when the disease has progressed to such an extent that bones break. And even then, osteoporosis is not always recognized or treated properly.
The main symptoms of osteoporosis
Osteoporosis is tricky because it often initially occurs without symptoms and therefore goes unnoticed for a long time. You should pay attention at the latest when bones break. Doctors call fractures fractures. In people with osteoporosis, these often occur without much force; experts call these spontaneous fractures or fragility fractures. A fracture usually hurts. However, vertebral bodies can break unnoticed and without pain. Only as a result do those affected often develop persistent back problems. Fractures of the femoral neck and radius fractures are also very typical in osteoporosis: the spoke of the wrist breaks – often without a serious fall.
Other possible symptoms: osteoporosis stomach and hollow back
The following symptoms may be a sign of osteoporosis:
Loss of height of more than four centimeters within a year, typical body shape with: hunchback, osteoporosis tummy (bulging lower abdomen) and hollow back, reduction in the rib-pelvis distance, unsteady gait, shortening of the torso, persistent back pain
VIDEO: Help with osteoporosis (5 min)
Causes of osteoporosis: Changes in bone metabolism
Bones consist of a protein structure in which the minerals calcium and phosphorus are stored – this is what gives them their hardness. However, even in adults, they are not fully grown and finished, but are constantly changing. The remodeling work on the bone tissue is carried out by special hormone-controlled cells (osteoblasts and osteoclasts). Until around the 30th/35th. During the first year of life, the densification of the bone predominates, followed by bone loss. In osteoporosis, the cells that break down bone (osteoclasts) are significantly more active than the cells that build up bone (osteoblasts): the breakdown happens too quickly and the bone becomes porous.
Risk factors for osteoporosis
The two most important risk factors are gender and age: the disease mainly affects older women. If you have an early menopause, the likelihood increases. In addition, certain metabolic diseases increase the risk of osteoporosis – for example type 1 and type 2 diabetes and hyperthyroidism.
Chronic inflammatory bowel disease or rheumatoid arthritis are also associated with a greater risk of bone loss and fractures. The same applies to neurological diseases such as Parkinson’s or Alzheimer’s. Anyone who takes certain medications, such as cortisone or stomach acid blockers, also has a higher chance of developing osteoporosis and its consequences. But there are also risk factors that you have control over: alcohol and smoking have a negative impact on bone metabolism. Likewise, underweight and weight loss.
Bone density measurement for diagnosis
Osteoporosis is often an accidental finding – namely when an X-ray is taken for other reasons and the doctor finds bone fractures. Or when the spontaneous fractures mentioned above occur. But there is also a procedure that can be used to specifically diagnose osteoporosis: bone density measurement. The mineral salt content in the bones is measured using a special X-ray method (also called DEXA or DXA, an abbreviation for the English name “Dual Energy X-Ray Absorptiometry”). This allows conclusions to be drawn about the stability of the bones.
The rays are directed through the femoral neck or lumbar spine. They are weaker than in normal x-ray examinations. The more radiation the bones let through during the five to ten minute examination, the lower the bone density. The result is given as a T-value. With a T value between 0 and -1, bone density is normal. A T value between -1 and -2.5 is considered to have reduced bone density (osteopenia). A T value of -2.5 or less indicates osteoporosis. If there have already been one or more fractures, this is referred to as manifest osteoporosis.
The final diagnosis of osteoporosis always includes a medical history, a laboratory test (blood and urine), imaging tests (X-rays) and a physical examination. In the future there will be a calculator that can be used to determine individual risk.
Bone density measurement: When does health insurance cover the costs?
The health insurance company usually only pays for a bone density measurement if it is medically justified. This is the case, for example, if osteoporosis is suspected after a bone fracture. Illnesses such as diabetes or long-term use of cortisone preparations also represent such medical indications. In principle, the costs are covered if there is an increased risk of osteoporosis and treatment with medication is being considered.
In some practices, the measurement is also offered for early detection as a so-called individual health service (IGeL). Patients then have to cover the costs of around 50 euros themselves.
The benefit of such early detection is not without controversy: critics see a low bone density as a risk that those affected will simply move less in the future for fear of a fracture without discussing the results with a doctor – then the examination would even be counterproductive. However, studies with women over 65 have also shown that such early detection protects against bone fractures if, as a result, treatment is given with medication if necessary.
Prevention and treatment of osteoporosis
There are two components to therapy for osteoporosis: basic therapy, which also includes recommendations for diet and exercise, and specific drug therapy. Basic therapy is not only suitable for treating osteoporosis, but can also reduce the risk of osteoporosis.
Nutrition for osteoporosis: calcium, vitamin D and protein
Sufficient calcium intake is important for osteoporosis. According to the guidelines that doctors follow when treating, 1,000 milligrams daily are recommended. Calcium is found in many foods, especially in low-fat dairy products, but also in nuts and seeds, in dark green vegetables such as kale or broccoli, berries, kiwi and dried fruits, as well as in soy products and calcium-rich mineral waters.
Vitamin D is important so that calcium can be absorbed well by the body. Although vitamin D can hardly be obtained in sufficient quantities from food, our body can produce it itself under the influence of natural UV light and can even store vitamin D reserves in the liver.
In Germany the sunlight is not necessarily sufficient. The guidelines therefore provide the following: “Vitamin D should be supplied in a minimum amount of 800 IU/day with the diet or (…) through exposure to sunlight. Supplements should be taken if sufficient amounts cannot be achieved through diet and sunlight exposure.” In addition, people aged 65 and over with an increased risk of fractures should pay attention to a diet rich in protein – one gram per kilogram of body weight should be every day.
Exercise for bone loss: promote strength and coordination
Exercise plays a central role in health – and is also very important in osteoporosis: Experts recommend regular exercise – also as a prevention – to improve muscle strength, sense of balance, reaction speed and coordination. In addition to strength training, a vibration plate or balance training can also be useful. Good contact points for suitable activities are osteoporosis sports groups or self-help groups.
Treatment of osteoporosis with medication
If basic therapy is not enough, special medications can also be used. So far, active ingredients have been used that prevent bone loss, i.e. have an anti-resorptive effect. These include the so-called bisphoshonates and an antibody that disrupts the formation, function and survival of osteoclasts. In this way, bone loss can be stopped and possibly even reversed a little. In particularly severe cases, medications that have a direct bone-building effect (osteoanabolic) are now used.
Experts on the topic
Senior physician
Clinic for Rehabilitation Medicine
Carl-Neuberg-Strasse 1
30625 Hannover
Director of the Clinic for Trauma Surgery
Carl-Neuberg-Str. 1
30625 Hannover
Specialist at the Clinic for Trauma Surgery
Carl-Neuberg-Str. 1
30625 Hannover
Senior physician at the Center for Experimental Medicine
Institute of Osteology and Biomechanics
Martinistraße 52
20246 Hamburg
Director of the Institute for Osteology and Biomechanics
Martinistraße 52
20246 Hamburg
Further information
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