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Healthy bones: what is osteoporosis?

 

Did you know that the skeleton makes up about 20 per cent of your body weight?[1] No wonder, because your skeletal system is ultimately responsible, together with your muscles, for carrying your entire body weight from A to B in an upright posture – all day long.

Osteoporosis, also known as bone loss, is a disease that increases the risk of bone fractures. Parts of the body where osteoporosis often occur are the lumbar spine, the neck of the femur and the radius in the wrist. 

It is critical to note that in the United Kingdom over three million people are affected by osteoporosis[18] – and unfortunately, as is often mistakenly assumed, this health issue is not purely a symptom of old age.[2] People with osteoporosis suffer from bone fractures more easily, even during everyday movements such as standing or walking. These fractures can be accompanied by long-lasting consequences such as chronic and acute pain, which severely limit the quality of life of those affected.

We’re here to give you tips on why it is important to promote healthy bones, explaining how exactly our bones are built, what happens in your bones when you suffer from osteoporosis, the possible causes of osteoporosis and current osteoporosis treatment options.

What is osteoporosis?

The term is derived from the Latin words osteo’, meaning bone’, and poros’, meaning hole’. With osteoporosis, bones become porous, they provide less support and break more easily – but why?

Bones are not just stiff and rigid structures, but they are living tissue made up of hard and elastic parts. Inside the bone, bone formation and degradation take place continuously. With osteoporosis, the balance of building up and breaking down bone is thrown out of kilter, reducing bone mass and increasing the risk of bone fractures.[3]

Since the first microfractures (small cracks, fractures) usually occur inside the bone, many people affected do not notice for a long time that they are suffering from osteoporosis. These fractures mean that the overall stability of the bone decreases and thus the risk of a fracture increases overall.[4, 5]

Did you know that a clear sign of osteoporosis is the widow’s hump. This is where the spine is strongly curved, either because the individual vertebral bodies have slumped together or because compression fractures – that is, fractures caused by the effect of pressure, have occurred.

Elderly lady holds yoga mat

Osteoporosis is also divided into primary and secondary osteoporosis:[3]

  • Primary osteoporosis: The majority of people affected have this form of the disease, where no specific cause is found. There are known factors that increase the risk of osteoporosis (for example, age), but they are not necessarily the triggers for the disease. There is also a distinction between type 1, postmenopausal osteoporosis, and type 2 senile osteoporosis.
  • In secondary osteoporosis, bone loss is caused by another disease. These include, for example, diabetes mellitus and hyperthyroidism. Certain medications, such as glucocorticoids, can also increase the likelihood of osteoporosis. However, only about five per cent of patients are affected by this form of osteoporosis.[7]

    What is the main cause of osteoporosis?

    Osteoporosis develops gradually and discreetly. This is why many sufferers only notice it when the first serious bone fracture occurs. It can take up to ten years for this fracture to occur – in less than 25 per cent of those affected, bone loss is discovered and treated in time.[5]

    Bone mass reduces with age; this is quite normal. On average, the rate at which boss mass is lost is about 0.5 to one per cent per year. In people with osteoporosis, however, this value is significantly higher – in some cases, up to six per cent of the bone mass is lost.[8]

    When it comes to osteoporosis, a distinction is also made between the preliminary stage of osteoporosis and severe osteoporosis, which is already recognisable through bone fractures. The decisive parameter here is bone structure, measurable among other things by bone density, which is measured with the T-value, a unit indicating the bone density of a person. Normal, healthy bones (the values of healthy 30-year-olds are used as an example here) have a T-value of more than –1. Further classification includes the following:[9]

    • Osteopenia (T-value –1 to –2.5): Preliminary stage of osteoporosis.
    • Preclinical osteoporosis (T-value < –2.5): no fractures are present yet
    • Manifest osteoporosis (T-value < –2.5): first vertebral fractures with no apparent cause (for example, due to everyday movements)
    • Severe manifest osteoporosis (T-value < –2.5): Bone fractures, also outside of the spine, often in the femoral neck or forearm

    Manifest osteoporosis in particular can mean severe limitations for sufferers. Those affected often suffer from pain and may have to undergo operations or long rehabilitative treatments.

    How are osteoporosis and menopause connected?

    The sex hormone oestrogen, the function of which is – among others – to protect bone health in women, decreases significantly when women reach menopause. This decline in oestrogen can cause bone loss. This is why the chance of developing osteoporosis grows when women reach menopausal age – for some women, the rate of bone loss can be quick and severe.[19]

    Hormone therapy is an option for women to help them control and relieve their menopausal symptoms – and some of these therapies can help treat bone loss. These therapies should be discussed in advance with a doctor or physician. To read more about this sex hormone and how important it is for our health, visit our Health Portal article on oestrogen deficiency and menopause.

    Did you know that some women experience bone loss quicker than others? A woman’s bone density can decrease by up to 20 per cent in the five to seven years following menopause.[19]

    Can osteoporosis be prevented?

    Risk factors for osteoporosis include age and gender. About 30 per cent of all women and 20 per cent of all men develop bone loss over the course of their lives.

    The good news is that there are also factors that you can influence yourself. The following circumstances can also increase your risk:[6]

    • Not enough exercise
    • Nutrient deficiency (for example, calcium or vitamin D)
    • Oestrogen deficiency
    • To much caffeine, alcohol or nicotine

    You can also ensure that you receive an optimal supply of calcium and vitamin D and strengthen your muscles and bones with sufficient exercise.

    Coffee intake could increase the risk of osteoporosis; pouring coffee into a cup

    Bone health supplements: vitamin D

    Vitamin D helps absorb calcium in the blood and incorporate it into bones. These processes are enormously important for your bone stability.[6]

    Vitamin D is produced by our skin when it is exposed to the sun’s rays. Across the globe, however, many people are deficient in this vitamin, especially in the dark winter months. This is why it is important to ensure that your vitamin D levels are optimal – especially if you spend a great deal of time indoors. Whether you take a daily walk or some vitamin D supplements to reach ideal vitamin levels, your bones will thank you in the long run!

    Gain more insights into vitamin D deficiency symptoms and how to prevent a deficiency in our dedicated Health Portal article. If you suspect that you may suffer from vitamin D deficiency, the easiest plan of action is to take a vitamin D test to rule out or confirm a deficiency.

    Does calcium help with osteoporosis?

    About 99 per cent of our body’s total calcium is found in our bones, where it provides stability. However, some calcium also circulates in our bloodstream. If there is a calcium deficiency in our blood, the missing mineral is drawn from the bones and used for metabolic processes. This affects the stability and hardness of our bones. Therefore, it is important to eat consciously and make sure your calcium levels are sufficient.[10]

    Professionals advise adults to consume 700 milligrams to 1,200 milligrams of calcium daily. You can meet this requirement through a balanced diet. Spinach and broccoli in particular are rich in this mineral, but cow’s milk, yogurt and cheese also contain calcium.[11]

    Did you know that mineral water is a good source of calcium? By drinking mineral water, you not only supply your body with this important mineral, but also keep yourself hydrated at the same time.[10, 11] However, not all mineral water is the same – for example, calcium-rich mineral water is labelled as such if it contains more than 150 milligrammes per litre.[12]

    Other nutrients are also important for promoting strong bones. These include, for example:

    If you have a confirmed nutrient deficiency, it may be beneficial for you to take certain supplements for a period of time until your nutrient levels are optimal again. Browse though our supplements collections to explore the wide range of products we have to offer.

    How does exercise affect osteoporosis?

    Too little exercise is not good for our bodies and, among many other things, also affects bone strength. Exercise affects the body’s ability to process calcium: exercise stimulates our entire metabolism, and also specifically bone metabolism. As a result, calcium is better deposited in your bones, which improves your bone hardness and stability.[14, 15]

    The important thing here is that when you choose to exercise, you make sure that pressure and force are applied to your bones. It is only through this application of force that metabolism is stimulated. Sports that are easy on the joints, such as swimming, do not promote calcium storage in our bones. Strength training, especially with weights, is very good. Jogging or Nordic walking, light gymnastics, training with your own body weight or even cycling can also be beneficial.

    Exercise can help prevent bone loss

    Osteoporosis treatment: what can I do?

    Studies found that about 40,000 fractures could be avoided if osteoporosis sufferers received more comprehensive treatment and medication.[16] In any case, you should seek medical treatment – which then has many components. Regular exercise and strength training are not only preventive measures, they are also central to osteoporosis treatment. If you have an increased risk of bone fractures due to bone loss, you should also reduce the risk of injury and other accidents in everyday life.

    Which medications are used in osteoporosis treatment?

    These medications, along with exercise and diet, are often used to treat osteoporosis:[17]

    • SERM: Selective oestrogen receptor modulators (SERMs) are especially for affected postmenopausal women. Due to a lack of oestrogen produced after menopause, bone mass decreases. SERMs mimic the effect of the sex hormone oestrogen and thus counteract the loss.
    • Bisphosphonates: Bisphosphonates slow down the existing degradation processes of the bones.
    • Calcium and vitamin D: Calcium in particular is easy to include in your diet. However, since vitamin D and calcium are essential for bone metabolism both together and separately, you can also take appropriate supplements after consulting your doctor.
    • Parathormone: This medication promotes the activity of osteoblasts – that is, the cells that are involved in the remodelling processes and the development of bone tissue.

    What is osteoporosis – at a glance

    What are bones?

    There are about 206 bones in your body that enable movement and posture. Bones also perform a number of other important tasks – for example, they protect your internal organs, are responsible for blood formation and store many minerals and nutrients.

    What is osteoporosis?

    When it comes to osteoporosis, bone mass decreases and the bones become more porous. The disease is therefore also called bone loss.

    People with osteoporosis have a higher risk of bone fractures. The lumbar spine, the neck of the femur and the radius of the wrist are particularly at risk.
    The risk of osteoporosis increases with age, and women are affected more often than men.

    Can osteoporosis be prevented?

    A lot of exercise, especially strength training, stimulates the metabolic processes in the bones and helps prevent osteoporosis. You should also ensure you receive enough important vitamins for bones and nutrients, especially calcium and vitamin D.

    Reducing your consumption of caffeine, nicotine and alcohol and, as a woman, keeping an eye on your oestrogen levels (especially during and after  menopause) could help you prevent osteoporosis from becoming an issue.

    How is osteoporosis treated?

    Osteoporosis is usually treated through targeted strength training and exercise therapy.

    At the same time, depending on the severity of the disease, you can improve your bone strength with medication or vitamins for bones (for example,  vitamin D).

    Sources

    [1]          National Cancer Institute, Introduction to the Skeletal System, available at https://training.seer.cancer.gov/anatomy/skeletal/, accessed on January 11, 2021.

    [2]          D. Ä. G. Ärzteblatt Redaktion Deutsches, Epidemiologie der Osteoporose – Bone Evaluation Study, Deutsches Ärzteblatt, January 25, 2013, available at https://www.aerzteblatt.de/archiv/134111/Epidemiologie-der-Osteoporose-Bone-Evaluation-Study, accessed on January 11, 2021.

    [3]          osteoporose.de, Was ist Osteoporose (Knochenschwund)? Osteoporose.de, October 10, 2020, available at https://www.osteoporose.de/osteoporose, accessed on January 11, 2021.

    [4]          Osteoporose Selbsthilfegruppe Dachverband e.V., Knochenstruktur – was geschieht im Inneren der Knochen? Osteoporose Selbsthilfegruppe Dachverband e.V., October 10, 2020, available at https://www.osd-ev.org/osteoporose/knochen/struktur/, accessed on January 11, 2021.

    [5]          Osteoporose Selbsthilfegruppe Dachverband e.V., Stoffwechselkrankheit Osteoporose, Osteoporose Selbsthilfegruppe Dachverband e.V., October 10, 2020, available at https://www.osd-ev.org/osteoporose/einfuehrung/, accessed on January 11, 2021.

    [6]          Prof. Dr. R. Bartl, Osteoporose? Was Sie wissen sollten. Was ist Osteoporose für eine Krankheit? Osteoporose Selbsthilfegruppe Dachverband e.V., October 10, 2020, available at https://www.osd-ev.org/osteoporose/osteoporose-wissen/, accessed on January 11, 2021.

    [7]          Riegel, C. Hormonelle Veränderungen bei Männern mit Osteoporose mit speziellem Interesse bezüglich des Hypophysen-Hypothalamus GH/IGF-1-Systems, 2009.

    [8]          Prof. Dr. med. O.-A. Müller, Was ist Osteoporose?, Internisten im Netz, August 18, 2017, available at https://www.internisten-im-netz.de/krankheiten/osteoporose/was-ist-osteoporose/, accessed on January 12, 2021.

    [9]          Osteoporose.de, Osteopenie & weitere Osteoporose-Formen, Osteoporose.de, available at https://www.osteoporose.de/osteoporose/formen, accessed on January 12, 2021.

    [10]       Osteoporose Selbsthilfegruppe Dachverband e.V., Calcium: Der wichtigste Knochen-Baustein, Osteoporose Selbsthilfegruppe Dachverband e.V., October 10, 2020, available at https://www.osd-ev.org/osteoporose/knochen/calcium/, accessed on January 19, 2021.

    [11]       gesundheitsinformation.de, Wie kann ich meinen Kalziumbedarf decken? gesundheitsinformation.de, November 14, 2018, available at https://www.gesundheitsinformation.de/wie-kann-ich-meinen-kalziumbedarf-decken.html, accessed on January 19, 2021.

    [12]       Mertel K., Bugaj, J. Calciumaufnahme 1, Netzwerk Osteoporose e. V., 2020, available at https://www.netzwerk-osteoporose.de/fachbeitraege/ernaehrung/calciumaufnahme-1/, accessed on January 29, 2021.

    [13]       Pharmazeutische Zeitung, Sturzrisiko im Alter: Vorsicht vor hohen Vitamin-D-Dosen, Pharmazeutische Zeitung, 2016, available at https://www.pharmazeutische-zeitung.de/2016-01/sturzrisiko-im-alter-vorsicht-vor-hohen-vitamin-d-dosen/, accessed on January 19, 2021.

    [14]       Osteoporose Selbsthilfegruppe Dachverband e.V., Belastung stärkt den Knochen. Warum? Osteoporose Selbsthilfegruppe Dachverband e.V., October 10, 2020, available at https://www.osd-ev.org/osteoporose/knochen/belastung/, accessed on January 19, 2021.

    [15]       Janz, K. F., Letuchy, E. M., Burns, T. L., Gilmore, J. M. E., Torner, J. C.,  Levy, S. M. Objectively measured physical activity trajectories predict adolescent bone strength: Iowa Bone Development Study, Br. J. Sports Med., vol. 48(13), p. 1032–1036, July 2014, doi: 10.1136/bjsports-2014-093574.

    [16]       Ström O., et al Osteoporosis: burden, health care provision and opportunities in the EU: a report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA), Arch. Osteoporos., vol. 6, p. 59–155, 2011, doi: 10.1007/s11657-011-0060-1.

    [17]       medi GmbH, Osteoporose: Diagnose und Therapie | medi, available at https://www.medi.de/gesundheit/diagnose-therapie/osteoporose/, accessed on January 19, 2021.

    [18]       National Health Service (NHS) “Overview: Osteoporosis” available at https://www.nhs.uk/conditions/osteoporosis/#:~:text=Osteoporosis%20affects%20over%203%20million,as%20a%20result%20of%20osteoporosis, accessed on 13 April 2021.

    [19]       National Osteoporosis Foundation What Women Need to Know, available at https://www.nof.org/preventing-fractures/general-facts/what-women-need-to-know/, accessed on April 8, 2021

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