What is osteoporosis?

Osteoporosis is an age disease of the bone. The name derives from the Greek 'osteo' for bone and 'poros' for the pore, the hole – literally translated as 'porous bone'. We all know that our bodies are held by the bones, while muscles are responsible for our movement. From the age of 35 on, the calcium content of our bones decreases constantly. More bone tissue is broken down than built up. Bone density decreases causing bone loss. The skeleton is now more susceptible to fractures (fractures). Vertebral fractures develop most commonly, followed by a femoral fracture in percent. In addition to osteoporosis, vertebral fractures may arise under other circumstances.

Frequency - osteoporosis is the most common disease in old age

Osteoporosis is one of the most common diseases in old age. Women are more affected than men. During menopause, the hormonal change accelerates the natural degradation of the bone. It is estimated that 30% of all women and 20% of men suffer, sooner or later, from osteoporosis. Osteoporotic bone fractures affect more women than breast cancer, stroke and heart attack together. In numbers, this means that by the age of 50, one out of two women has a bone fracture caused by osteoporosis.

At least every sixth to seventh woman between 50 and 60 years (over 15 percent) suffers from osteoporosis. After 70s, it affects over 45%. In men, the disease takes much more time - on average, osteoporosis occurs only ten years later. According to WHO estimates, the number of people affected by this chronic bone disease will double worldwide in 20 years.

Causes - so dangerous is estrogen deficiency, which often starts after menopause

There are several causes, influences and risk factors that promote bone resorption and thus accelerate the development of osteoporosis. Genetic factors play also an important role. The bones become porous, making them less stable. If the bone tissue in the body is no longer stable, harmless everyday situations can lead to a vertebral fracture which can affect mainly thoracic but also lumbar spine. In these areas a great weight rests on the vertebral bodies. For the excessive bone loss physicians mainly distinguish between these causes:

The most common form is the postmenopausal osteoporosis, it happens as a result of estrogen deficiency and as a consequence it affects women beyond the menopause period. Estrogen is an endogenous messenger that controls the female cycle and one of his tasks is to protect the bones.

The second most common form is the senile osteoporosis, which is essentially the result of decades of age-related bone resorption. Osteoporosis is rarely caused by other diseases – in that case it would be called secondary osteoporosis.

In addition, there are a number of risk factors - these include: lack of exercise, underweight (body mass index below 20), smoking, excessive alcohol intake, calcium deficiency, vitamin D deficiency and some blood disorders.

Multiple vertebrae affected: Dowager’s hump

Osteoporosis often develops unnoticed. Symptoms are not that clear: some patients suffer more from back pain others report a feeling of weakness in the back. Few, however, associate these symptoms with bone disease until – (often) through a harmless tripping or abrupt movement – the porous bones break. Usually it is not a single break, but a slow interior collapse, many small micro fractures of the "fine bone trabeculae". In a healthy bone, the supporting structure (trabeculae) is much denser while the diseased one presents the fine trabeculae thinned out and partially broken.

The symptoms of osteoporotic vertebral fractures, however, are mostly clear; pain can go from being moderate to be severe at the level of the fracture, and sometimes it can cause immobility, at the same time and with each breath, it can possibly radiate to the ribs or lumbar region. Partial paralysis may be present as an indication of spinal cord injury. Even a rapid loss of body height by several centimeters serves as an indication of osteoporosis fractures.

In stable vertebral fractures, the trailing edges of the vertebrae are still intact – and thus the overall structure stable. The spinal canal with the spinal cord running in it, is not restricted. This group usually includes osteoporosis fractures that occur spontaneously or after minor accidents and stress. In the longer term, however, the forces acting on them (for example due to body weight) often lead to a wedge-like deformation of the affected vertebral body, which consequently loses considerable height at its front.

If several vertebrae are affected, the back curves, causing in the more pronounced form a visible "Dowager’s hump", which is often associated with severe pain.

For diagnosis, bone density measurement is important

Osteoporosis is often recognized only when it is already too late for preventive measures: when fracture is happened already. The reduction of the bone substance is not painful after all. Pain sets in, however, when the first bone fractures develop with advanced bone loss. At the beginning of a possible diagnosis of osteoporotic vertebral fracture, there should be a detailed patient interview (anamnesis). The doctor (neurosurgeon, orthopedist, surgeon or traumatologist) will then order an in-depth physical and neurological examination. This may be the first evidence that there is a vertebral fracture. After the doctor has made a suspected diagnosis on the basis of his investigation, he orders imaging procedures.

With the help of an X-ray, computed tomography and / or MRI (magnetic resonance imaging), the doctor can look at the vertebral fracture and also clearly recognize what type of fracture and what extent it actually is. On this basis, doctor and patient decide on the further treatment of the vertebral fracture.
 
Bone density measurement is the most important and most common procedure for diagnosing osteoporosis. The corresponding method has a name: DXA osteodensitometry. X-rays are used to measure the density of the lumbar vertebrae and thighbone. A T-score from 0 to -1 means: Bone density is normal. A value below it, means the opposite: the bone density is well below that of a healthy person.

Which treatment do you need?

Stable fractures heal in some cases with conservative therapy within 2-3 months, possibly supported by wearing a corset. With conservative therapies (for example medication) it is important to know that these are only suitable for stopping further bone loss or suppressing the pain. However, it remains uncertain whether the vertebral fractures will stabilize or worsen it. In addition, there is a risk of deforming the spine.

In this case and in case of an unstable fracture with nerve injury, interventions such as kyphoplasty, vertebral body replacement, stabilization measures with cementing and other therapeutic approaches should be taken into consideration. The aim of these interventions is to relieve patients from pain as soon as possible, to ensure a quick stabilization and resumption, to make their participation in life activities, to prevent further deterioration of statics and neurological deficits.
 
Your doctor will help you to find the perfect therapy. After a detailed consultation, in-depth neurological examination and MRI consultation and paying attention to some individual factors like your age, your general health condition, comorbidities, activities, etc., you will be advised with the therapy that has the highest chances of success and the lowest risks.

Prognosis - the importance of exercise and nutrition

Osteoporosis is not curable. However, certain precautionary measures and timely therapy can positively influence the course of the disease and slow its progress. Preventive measures should be taken at a young age to build up much bone mass as early as possible. Important pillars of prevention are physical activity and nutrition: Your diet should be rich in calcium, the main building block of the bones and Vitamin D which in turn promotes calcium storage in the bones.

The ideal is a daily intake of about 1000 to 1500 milligrams of calcium through milk, cheese, kale, whole grain cereals, legumes, and calcium-rich mineral water. Important: In order to absorb dietary calcium and build it into the bones, the body needs vitamin D. You should avoid risk factors such as smoking and alcohol.

Dr. med. Munther Sabarini

Author
Dr. med. Munther Sabarini
Specialist in Neurosurgery

Hans-Heinrich Reichelt

Co-author
Hans-Heinrich Reichelt
Chief Editor of Medizin für Menschen

The Avicenna Clinic in Berlin is always willing to help you

Since the year 2001, the Avicenna Clinic is based in Berlin. Our doctors have at least 25 years of international experience in their respective fields (neurosurgery, spinal surgery, anesthesia, and orthopedics).

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