Classification according to ICD-10

M80 – Osteoporosis with pathological fracture
M81 – Osteoporosis without pathological fracture
M82 – Osteoporosis in diseases classified elsewhere
ICD-10 online (WHO version 2006)

Osteoporosis (v. AltGr. Οστεον “Bones” and πωρος “hard”) is a common old-age disease of the bone that it breaks (fracture) is more vulnerable. Also known as bone loss disease is characterized by low bone mass and the overly rapid reduction of bone substance and structure. The increased fracture susceptibility may affect the entire skeleton.

At the disease, almost half of the 70-year-old (women at least twice as often as men), but it can be linked to calcium deficiency or other diseases, even in recent years.

Common consequences of osteoporosis are fractures. Sorted by frequency, these are:

1. Vertebral-dips (sintering)
2. Hip-related femur fractures (including neck leg fracture)
3. Wrist-related fractures spokes (distal radius fracture)
4. Upper head fracture (subcapitale Humerusfraktur)
5. Pelvic fracture

There is an increased susceptibility to other fractures.

Causes

The bone is rough in the first 30 years to life (in the youth is bone structure), reached a peak and then falls in the later years of life slowly again. Osteoporosis usually occurs from a lack of bone formation at an early age and / or an accelerated degradation in later times. Reasons may be:

* Familiar predisposition (relatives with osteoporosis)
* Lack of sex hormones (by an imbalance between bone formation and bone resorption causes the loss of bone mass) in this group also includes postmenopausal osteoporosis and a part of osteoporosis in men
* Malignant diseases of the bone marrow, plasmacytoma, metastases or the primary in a rapid decrease in bone density reflected
* Hyperthyroidism, excessive cortisol produced by the adrenal cortex (Cushing’s Disease)
* Disorders of the parathyroid
* Nutrition error, so lack of calcium and vitamin D (calcium gives the bone its strength and vitamin D regulates the absorption of calcium from the diet)
* Pernicious anemia, vitamin B12 deficiency
* Folic acid deficiency
* Underweight
* Lack of exercise, because the movement occurring at maximum force (especially when jumping, or for additional training with appropriate weights) the bone and, especially, will increase bone strength (Mechanostat)
* Tobacco smokes
* Excessive alcohol consumption
* Regular use of certain medications, such as high oral cortisone (including for the treatment of autoimmune diseases) or heparin (to inhibit blood clotting). This danger is when unfractionated heparin is significantly higher than that of low molecular weight heparin.
* Meat empires, gemüse-/obstarme diet seems to be ungüstig. It is a relationship of bone metabolism with the acid-base budget is suspected.
* Consumption of phosphatic Cola beverages could present a risk, however, a strong correlation between cola consumption with a low-calcium diet.

Diagnostic

For diagnosis, the bone density measurement is used, where the T value is determined. This is a statistical value, a comparison of the measured bone density value with the population of young adult women and a statement on the possible risk of breakage. To measure the bone mineral density (BMD – engl. For bone mineral density) are different techniques available: The most common is the dual X-ray absorptiometry (DXA or DEXA – engl. Dual-energy x-ray absorptiometry). It is also based on the definition of the WHO and with their help, the T-value is determined. Another method is the quantitative computed tomography (QCT or pQCT) dar. The measurement of bone density by ultrasound, known as quantitative ultrasound (QUS) is highly controversial and only in very few cases at all meaningful. The significance for DXA and QCT, however, is well documented. The measurement of bone density is not for the early performance of the statutory funds; the insured must pay for themselves, if no accident without fracture (fatigue fracture) on suspicion of osteoporosis before the measurement is available.

Disease course and prognosis

Osteoporosis is a first course of disease imperceptibly, but in the case of fractures, particularly among the elderly, a high disease burden (pain, to bed, sometimes lasting immobilization) means.

We distinguish between primary and secondary osteoporosis. For much more frequent primary osteoporosis includes postmenopausal (or postklimakterische) Osteoporosis and age osteoporosis (Involution sosteoporose). Secondary osteoporosis occurs, inter alia, as a result of metabolic disorders or hormonal disorders.

It is estimated that approximately 30% of all women after the menopause osteoporosis in primary cancer. For men, from the 70th Age the age of osteoporosis is equally frequent clinical picture. Typical features of osteoporosis are a decrease in bone mass and deterioration of bone architecture and as a result a decrease in bone stability. This leads to an increased risk of fractures. Fractures in osteoporosis are especially at the vertebral bodies of the spine, the femoral neck and wrists. The healing of fractures in osteoporosis is not disturbed; the time frame is the same as in non-diseased humans. The consequences of the fractures may be particularly in elderly and sustained by subsequent diseases such as pneumonia or pulmonary embolism deaths.

Treatment options and prevention

Living

Physical activity protects against bone loss. In addition to sunlight promotes adequate vitamin D production in the skin.

Nutrition

To prevent bears an increased calcium intake of about 1-g / day (based therapy DVO).

As part of the therapy based international guidelines recommend also taking vitamin D (ergo-and cholecalciferol, but not metabolites, such as alpha-1-or 1.25-dihydroxy-vitamin D). Heavy consumption of alcohol and tobacco should be avoided.

Pharmacotherapy

Following the guidelines of the DVO is recommended:

* Bisphosphonates (alendronate, risedronate and Ibandronat, (trade name Fosamax ®, FOSAVANCE ®, Bonviva ® and Actonel ®)
* Selective Estrogen Receptor Modulators (SERM) raloxifene (trade name Evista ®) (only for the prevention of vertebral fractures)

Or

* Parathyroid hormone (parathyroid hormone, trade name Preotact ® and Teriparatide = Parathormonanalogon for special indications, trade name Forsteo ®)
* Strontium (admission of Protelos ® since 2004, and the bone density measurements show the deposition of strontium higher values, but for the course assessment in practice is not relevant). We are strontium ranelate for the longest controlled clinical investigations.

Also in use, but not recommended by the DVO

* Calcitonin, barely used, the benefit is poorly documented. Furthermore, it is usually cause severe symptoms in allergy treatment.
* STH (growth hormone) demonstrated no benefit, possibly problematic side effects.
* Fluorides (obsolete; developed hard but brittle bones, the stability is not better)
* Estrogens have been criticism of the hormone replacement therapy only limited use for this indication.
* Vitamin D metabolites such as 1-alpha-or 1.25-dihydroxy-vitamin D (usefulness in postmenopausal osteoporosis is not clearly documented, expensive, problematic side effects; 1.25-vitamin D (Calcitriol) is effective and indicated in certain bone diseases framework of advanced renal disease).

Since October 2007, in Europe and the Bisphosphonates zoledronic acid for treatment of osteoporosis admitted. It is used as a once yearly infusion applied. In preparing the current guidelines for osteoporosis, this approval was not yet available.

Prevention of fractures

An effective method to osteoporotic hip fracture prevention, the use of hip protectors.

Alternative Medicine

For the prevention or treatment of osteoporosis, there are various methods of alternative medicine, but no evidence of scientific effectiveness criteria could provide. The treatment of these processes is also unlikely to take health insurance.

* Basic nutrition and the intake of salt mixtures bases. An acidification of the body will, according to supporters of this treatment method with increased bone loss, as calcium salts as buffer substances are used. It is the renunciation of coffee, black tea, alcohol, cola and lemonade drinks, animal protein (meat, sausages, fish), fast food and ready meals, most dairy products, sugar, sweeteners, sweets, white flour and Weissmehlprodukten, peanuts, Brazil nuts, etc. Recommended and a säurehemmende or alkaline-forming food veordnet, consisting of some vegetable and fruit juices, herbal tea, vegetables and leafy salads and fruit.
* Magnetic Therapy: pulsating electromagnetic fields to stimulate bone formation.
* Vibration training – including bio-mechanical stimulation (BMS): it was originally used to treat Russian cosmonauts developed to treat the person stands on a plate, in a frequency range from 20 to about 50 Hz and vibrates through the Dehnreflex cause muscle contractions. These forces are designed to stimulate bone growth (Mechanostat), first; individual scientific studies on this subject, eg:

Economic aspects

With around 2.5 to 3 billion euros in direct and indirect medical costs in Germany has osteoporosis, a large national economic weight. Therefore it was used by the World Health Organization (WHO) on the list of top ten diseases set.

By critics is that the revaluation of osteoporosis in recent years by the pharmaceutical industry was driven to a market for new drugs would create (Disease Mongering). Other hand, it is only since about 1985 to reliably measure bone density. Only now is it possible that disease before the occurrence of fractures adequately capture.