Osteoporosis: definition, causes, symptoms and treatment

Osteoporosis, also known as bone loss, means a steady decrease in bone density. This increases the risk of bone fractures, especially in old age. Up until the age of 35, bone formation usually exceeds bone loss; after that the body gradually begins breaking down bone to a greater degree. Healthy older people lose around 0.5% of their bone mass each year. Osteoporosis patients, on the other hand, lose up to 6%.

Around 520,000 people in Switzerland are affected by osteoporosis, most of them older people. In women, osteoporosis often develops after the menopause.

Primary and secondary osteoporosis

Experts differentiate between primary and secondary osteoporosis. Primary osteoporosis occurs regardless of pre-existing conditions. It affects 95% of all osteoporosis patients. The secondary form is largely caused by certain illnesses. It accounts for only 5% of osteoporosis cases.

Primary osteoporosis has various causes:

• Post-menopause: Oestrogen regulates things like calcitonin and vitamin D, which are hormones that contribute to bone formation. A drop in oestrogen levels during menopause affects bone density. Many women therefore develop osteoporosis after the menopause.
• Old age: All people experience a loss in bone density as they age. This increases the risk of osteoporosis.
• Lifestyle: A lack of calcium and vitamin D has a negative effect on bone structure – especially from the age of 70. A diet rich in phosphates amplifies this effect. Lack of exercise also weakens bones by inhibiting their development and promoting deterioration.
• Genetic factors: Osteoporosis is more prevalent in some families. Researchers therefore suspect a link between osteoporosis and genetic predisposition.

Good to know: for men, the hormone testosterone plays an important role in bone metabolism. Age-related testosterone loss is less marked than the loss of oestrogen in women. This is why osteoporosis is less common in men.

The following risk factors apply to secondary osteoporosis:

• Diseases: Some diseases promote the development of osteoporosis. These include type 1 diabetes, rheumatism, anorexia, coeliac disease, Crohn’s disease, hyperthyroidism and bone tumours. Lactose intolerance can also promote osteoporosis in some cases.
• Medication: Certain medications can cause osteoporosis. These include cortisone, antiepileptics and some hormonal preparations.

The symptoms of osteoporosis vary widely. Often they only become apparent later in the course of the illness or in the end stage of osteoporosis. Possible symptoms include:

• Osteoporosis belly: Cases of advanced osteoporosis can be associated with damage to the spine, which causes both it and the abdomen to bulge outward. This results in the typical “osteoporosis belly” and a hunched back.
• Leg pain: Advanced cases often lead to osteoporosis pain in the legs.
• Jaw complaints: Osteoporosis also affects the jaw; for many people with osteoporosis, bone loss causes teeth to loosen and then fall out as the disease progresses.
• Finger pain: Osteoporosis can affect the fingers. Sufferers often have aching fingers and are less able to move them.
• Muscle pain: Many osteoporosis patients have muscle pain. This is usually caused by damaged vertebrae, which create tension in the back and neck muscles.
• Fir tree phenomenon: In some cases, osteoporosis sufferers get wrinkles on their back. These wrinkles extend from the middle of the back to each side and resemble the shape of a fir tree.
• Bone fractures: With osteoporosis, spontaneous bone fractures occur repeatedly without apparent cause. Seemingly harmless falls in old age can lead to serious injuries. The bones near the hip, the femoral neck, vertebrae and the upper and lower arms are particularly subject to fractures.

It takes various examinations to determine whether you are affected by osteoporosis. First, your doctor will discuss your medical history with you. You will go through past illnesses together and identify possible risk factors.

If osteoporosis is suspected, you will usually then have your bone density measured (dual X-ray absorption, or DXA scan for short). A specialist measures your bone density using low-dose X-rays – usually on the lumbar spine area or the hips. In general, the more radiation your bones let through, the lower your bone density. Your T-score indicates how much your bone density differs from that of a young, healthy person. The reference value is 0.

Good to know: in addition to the T-Score, there is also a Z-score, which compares your bone density with that of people of the same age and gender.

The bone density measurement is sometimes followed by further examinations:

• X-ray examination of the spine
• Evaluation of nutrient supply based on blood values
• Magnetic resonance imaging (MRI)
• Computed tomography (CT) scan

Osteoporosis treatment consists of several parts. They complement each other and are tailored to the individual patient.

Medical treatment of osteoporosis

Drug treatment for osteoporosis involves an injection, infusion or tablets:

• Osteoporosis injection: The osteoporosis injection contains the active substances denosumab or teriparatide. They may also contain bisphosphonates (e.g. alendronic acid or zoledronic acid). Depending on the active ingredient, osteoporosis injections have side effects such as elevated cholesterol levels, nausea or headaches.
• Osteoporosis infusion: Infusions also contain bisphosphonates. They sometimes cause side effects such as flu-like symptoms. In extremely rare cases they can cause necrosis (bone cell death) in parts of the jawbone.
• Osteoporosis tablets: Bisphosphonates are also available in tablet form. When taken orally, they may cause nausea, heartburn or diarrhoea.

Specialists often recommend ibuprofen or acetylsalicylic acid for managing pain in cases of bone loss. For very severe osteoporosis pain, they sometimes prescribe opiates.

Treating osteoporosis through nutrition

As a general rule, a balanced diet has numerous positive effects on the course of osteoporosis. It is particularly important that you get enough nutrients:

• Calcium: How much calcium should you consume per day if you have osteoporosis? Ideally 1000 to 1500 milligrams per day. Broccoli, spinach, cheese, cow’s milk and yoghurt are particularly high in calcium. In some cases, it helps to take calcium as a dietary supplement. The best way to find out is to consult your doctor.
• Vitamin D: Vitamin D helps the body absorb calcium from the intestines. Osteoporosis sufferers should ideally take 20 to 25 micrograms of vitamin D per day. Some foods are particularly high in vitamin D. These include salmon, tuna and chicken eggs. You should also make sure that you go outside regularly; your body needs sunlight to produce vitamin D.

Which foods should you avoid if you have osteoporosis? An excess of phosphate inhibits calcium absorption. Avoid foods rich in phosphorus, such as meat, sausages and soft drinks.

Sport and exercise for osteoporosis

In addition to medication and proper nutrition, physical activity is a key factor in dealing with osteoporosis. But which sports are suitable if you have osteoporosis? Walking (including Nordic walking), light jogging and functional training all help to build up bones. Functional training is based on very specific movements and trains several muscle groups and joints at the same time. Yoga promote a sense of balance which reduces the risk of falls. Important: if you’re doing yoga, avoid movements that cause excessive bending or twisting of the spine.

There are also practical osteoporosis exercises you can do at home:

• Osteoporosis exercise 1: Sit on a chair and stand up without using your arms. Repeat. For a more intensive variant, repeat without the chair; lower your hips to knee level and straighten up again. Only do this variant if someone is nearby or if you have something to hold onto (risk of falling).
• Osteoporosis exercise 2: Get down on your hands and knees. Extend your right arm forwards and your left leg backwards at the same time. Make sure your abdomen and back are straight. Hold this position for a moment and then repeat the exercise on the other side.
• Osteoporosis exercise 3: Stand straight and upright and fold your hands behind your head. Slowly push your elbows backwards. Hold this position for a few seconds. Repeat this exercise for a few minutes.
• Osteoporosis exercise 4: Stand in a door frame for this exercise. Raise your hands to shoulder height and press against the frame on both sides. Keep your posture as straight as possible.

Specific exercises for osteoporosis aren’t the whole story. Even small changes in your daily life can make a difference:

• Take the stairs instead of the lift.
• Try standing on one leg every now and then – when you’re cooking, cleaning your teeth or brushing your hair, for example.
• For short distances, avoid driving and walk instead.
• Walk on the balls of your feet every now and then.

Start preventing osteoporosis when you are young. In particular, make sure you:

• Eat a calcium-rich diet
• Get enough vitamin D
• Exercise regularly

You should also avoid nicotine, alcohol and soft drinks wherever possible and keep your weight up.

There are many ways to prevent osteoporosis and to enjoy life despite osteoporosis. With the support of a specialist, the right nutrition and sufficient exercise, you can strengthen your bones and stay active.