Better Understanding Osteoporosis

World Osteoporosis Day occurs once every year. It was initiated by the British Osteoporosis Association in 1996. Its objective is to increase social awareness of osteoporosis and its prevention. In the meantime, informative events and campaigns about this type of bone loss take place year after year on 20 October in almost 100 countries worldwide (http://worldosteoporosisday.org/). What is osteoporosis anyway? How does osteoporosis develop? And what can patients do to prevent it or treat it?

Osteoporosis is considered a widespread disease. Currently osteoporosis is estimated to affect more than 200 million women worldwide, but according to the World Health Organization the number will increase. The WHO ranks osteoporosis among the ten most common chronic diseases of our time. The tricky part: It is often not recognised as such. According to the International Osteoporosis Foundation (IOF), less than a quarter of all cases are identified at an early stage and treated appropriately. What is the reason for this? Osteoporosis usually develops slowly and can be unremarkable and asymptomatic for many years. The diagnosis often only comes after a slight fall, for example, which resulted in bone fractures and would otherwise have remained without consequences.

The patient may thus already be suffering from reduced bone density before a fracture occurs. The fracture is only a late consequence.

Bones are not a dead substance. They consist of living tissue. This tissue builds up regularly in the course of our lives – but it also breaks down. This is actually a normal process. The bone mass increases until about the age of 30. Then the opposite happens: it decreases. This means that we lose more old bone mass than we produce.

But as soon as this natural balance is disturbed, the bone mass changes. Bone loss accelerates. Even slight strain or harmless falls – at least from other people’s point of view – may lead to bone fractures.

A preliminary stage of osteoporosis is osteopenia. It refers to a reduction of bone density, which is not as severe as in the later stage, so it is the midway point between healthy bones and osteoporosis. However, people suffering from osteopenia also have an increased risk of bone fractures.

Calcium deficiency, insufficient exercise and hormone-related illnesses can inhibit bone formation and stimulate bone resorption. Women are more frequently affected than men, especially after menopause due to the hormonal changes. In 30 per cent of women, the risk of bone loss increases during this stage of life. The metabolism in our bones is partly controlled by oestrogen and testosterone, the female and male sex hormones, as well as vitamin D and other hormones, for example produced by the thyroid gland. Starting at the age of 35, the female body produces less oestrogen. The consequence: It breaks down more bones than it builds up. If the body merely lost one per cent of its bone mass before menopause, the figure quickly rises to four per cent.

Some women lose almost 40 per cent of their bone mass between the age of 40 and 70. By contrast: for most men, the figure is just 20 per cent. However: Despite the proven link between oestrogen and osteoporosis, not every woman necessarily falls prey to it after menopause. Other factors also play a role.

The best case scenario is to prevent or treat osteoporosis before the first fracture, because it is very difficult to rebuild bone mass once it has been lost. Some of the risk factors can be mitigated by each individual, while others cannot.

Risk factors that cannot be influenced:

• Genetic traits
• Age-related drop in oestrogen or testosterone levels

Controllable risk factors:

• Low body weight
• Calcium and/or vitamin D deficiency
• Smoking
• Lack of physical activity
• Movement restriction or inability to move

Certain underlying disorders or drugs that increase the risk of osteoporosis can only be limited to a certain degree.

UThree treatment approaches have proven effective in preventing bone fractures:

• Pharmaceutical treatment as long-term therapy over several year
• Exercise, for example swimming and gymnastics
• Nutrition, including calcium-rich diets

Only a physician can determine which individual measure is suitable for a patient. Every treatment depends on the overall clinical picture of the patient.

Osteoporosis cannot yet be cured, but the bones can be stabilised to such an extent that no or no further bones break. The key is: The earlier prevention and treatment start, the better healthy bones can be preserved.