Who has osteoporosis completely reversed
[mt_tabs style = "vertical"]
[mt_tab title = "Definition"]
[mt_lineheader size = “4 ″] Osteoporosis [/ mt_lineheader]
Osteoporosis is a disease of the entire skeleton that is associated with a loss of bone substance and an increased risk of breakage.
But: Not every bone metabolism disorder associated with decreased bone density is treated with exercise, calcium, vitamin D and various osteoporosis medications. In principle, treatment may only take place after the so-called basic laboratory diagnostics to rule out other causes of reduced bone density.
Therefore: The diagnosis of osteoporosis is not only made by a measuring device with a computer on it, but by an osteologically trained doctor who is well versed in differential diagnostics. Operating a bone density meter is not enough to treat osteoporosis patients.
Therefore: The diagnosis of osteoporosis does not only require a measuring device with a computer, but an osteologically trained doctor who is well versed in differential diagnostics. Operating a bone density meter is not enough to treat osteoporosis patients.
Our download area contains a summary of some of our osteoporosis lectures.
[mt_tab title = "(FAQ) (frequently asked questions)"]
[mt_lineheader size = “4 ″] Frequently asked questions about osteoporosis diagnosis and therapy (FAQ) [/ mt_lineheader]
[mt_toggle title = “What is osteoporosis?“] According to the guidelines of the relevant specialist societies, osteoporosis is a skeletal disease characterized by reduced bone density with an increased risk of fracture. In contrast to earlier specifications, this definition is based purely on metrological conditions and the risk of fractures. The disadvantage here is that the diagnosis of this disease and the various causes (so-called differential diagnoses) are often no longer taken into account. Knowing the causes ultimately determines the special forms of therapy that affect bone metabolism. [/ Mt_toggle]
[mt_toggle title = “How are osteoporosis patients treated?“] That simply cannot be answered, since every person with osteoporosis has an individual disease. It is very important that osteoporosis treatment can only be started after what is known as differential diagnosis, i.e. the search for the cause has been carried out. Otherwise it is possible that any diseases affecting the bones, which have nothing to do with osteoporosis in the narrower sense, are overlooked and the patient can be seriously harmed. [/ Mt_toggle]
[mt_toggle title = “What do bisphosphonates do?“] So-called bisphosphonates are drugs that are mainly used when the bone is too broken down by osteoporosis. This degradation activity is slowed down. Long-term use of such drugs is only useful under the supervision of an experienced doctor. [/ Mt_toggle]
[mt_toggle title = "How is osteoporosis detected?"] Ideally with a standardized procedure such as the DXA method (also: "DEXA" method). This is an X-ray procedure with two point-shaped beams of different energy. The radiation exposure of this measurement is around the 300th of a conventional X-ray image and is therefore negligible. [/ Mt_toggle]
[mt_toggle title = “Is osteoporosis hereditary?“] There seem to be hereditary factors that favor the development of osteoporosis. But that does not mean that you can do without appropriate diagnostics or preventive measures for individual patients with suspected osteoporosis. [/ Mt_toggle]
[mt_toggle title = “How is calcium best supplied to the body?“] Calcium intake through food (dairy products, calcium-containing mineral water) has the best absorption properties and the fewest side effects. It is important to ensure that the vitamin D (promotes calcium absorption from the intestine) is available in sufficient quantities. [/ Mt_toggle]
[mt_toggle title = “Do men also get osteoporosis?“] However, especially with poor nutrition, under the influence of alcohol, lack of exercise or low testosterone (influenced by being overweight), osteoporosis can be demonstrated in many men, which requires treatment. [/ mt_toggle]
[mt_tab title = "Bone density measurement"]
[mt_lineheader size = “4 ″] Bone density measurement [/ mt_lineheader]
[mt_one_half] In our practice, bone density is measured using the globally recognized standard of DXA method (also DEXA), in which two punctiform X-rays scan certain skeletal regions and use this to calculate the so-called apatite content. These measurements are secured by standard values in the spine area and on the femoral neck and are currently considered to be the most suitable method, especially for progress assessments. The device must be calibrated daily to ensure the reproducibility of the measurement results. Only measurements with this method are permitted when it comes to determining the so-called T-values, i.e. the deviation from the normal range with the risk of breakage determined. [/ mt_one_half] [mt_one_half_last] [/ mt_one_half_last] The computed tomographic measurement methods (often misleadingly referred to as "CTXA") have the problem, apart from a significantly higher radiation exposure, that the resulting T values are not validated with regard to the risk of breakage. Many devices are also equipped with an outdated evaluation method, which often measures values that are significantly too low. This method can be recognized by the fact that no value is given for the outer shell bone (compacta) in the CT findings. Again: It is by no means sufficient to diagnose osteoporosis simply to measure the bone density with any method!
Our download area contains a summary of some of our osteoporosis lectures.
[mt_tab title = "General Therapy"]
[mt_lineheader size = "4"] Basic therapy movement [/ mt_lineheader]
[mt_four_fifth]Anyone who has osteoporosis should never think that all that remains is the TV armchair:
On the contrary, one of the most important measures in the treatment of osteoporosis is exercise. The tension and pressure of the muscles and tendons on the bone stimulate the cells within the bone to incorporate calcium in the right places.
For this reason, osteoporosis gymnastics groups have formed at many sports clubs, associations, health insurance companies and adult education centers, which also help the untrained to find forms of movement with which they can keep their bones fit.
[mt_lineheader size = “4 ″] Calcium and Vitamin D [/ mt_lineheader]
Calcium is the fifth most abundant element in the earth's crust, it cannot be produced by the body itself, nor can it be supplied in the form of highly diluted substances. Humans and their skeleton have a calcium requirement of around 1000 to 1500 mg per day, depending on the individual calcium loss and breakdown. In order to be able to absorb this calcium with food, the intestine needs vitamin D (about 1000 - 2000 so-called international units per day).
Download a lecture by Dr. Beyer on osteoporosis and nutrition ...
The need for calcium can usually be met through diet (see below), vitamin D (which is formed in the skin, for example, through exposure to the sun) is quite often too low. Vitamin D (as so-called vitamin D3) is available in stores quite cheaply, but should only be taken after consulting an osteologically experienced doctor.
A study published in the British Medical Journal in 2008 (PDF 170 KB) showed that calcium intake in the form of so-called dietary supplements leads to a slightly higher risk of vascular diseases in older women. This supports our recommendation for calcium intake through mineral water (more ...) and dairy products, which we have given for many years ("... more calcium through diet - fewer heart attacks ...").
Link to our calcium tables: 500 mg is not everywhere that it says 500 mg! You can now download the updated tables as a PDF file:
Mineral water table
Link to Gerolsteiner's mineral calculator
[mt_lineheader size = “4 ″] Avoid broken bones (fall prevention) [/ mt_lineheader]
The following measures are suitable for the prophylaxis of bone fractures:
- Maintain coordination and muscle strength through regular exercise and plenty of exercise
- Dispose of carpet edges, sharp-edged furniture corners and other traps in the apartment
- If necessary, use of a hip protector (protective shells around the thigh / hip region to avoid fractures in the thigh neck, has proven to be a highly effective measure)
Our download area contains the summary of one of our osteoporosis lectures
[mt_tab title = "Medicines"]
[mt_lineheader size = “4 ″] Special drug therapy [/ mt_lineheader]
After the general measures have been exhausted and, in principle, only after the so-called basic laboratory diagnostics to rule out other causes of reduced bone density, various drugs are available that influence the bone metabolism.
You should know the following: Bones do not consist of dead substance, a complete reconstruction of the skeleton takes place within approx. 3-5 years in order to ensure stability and elasticity in the long term. There are different cell systems that are responsible for either breaking down or building bones, depending on the requirements of different loads. Therefore, a reduction in bone mass can be caused either by excessive breakdown (“high turnover”, “almost looser”) or by too slow a build-up (“low turnover”). In addition, there are changes between these states at the cellular level.
With knowledge of these mechanisms, osteoporosis drugs can be roughly divided into two groups:
(inhibit bone loss)
(stimulate bone formation)
(no longer in use today)
(no longer in use today)
(no longer in use)
(Once a week or as an infusion)
(daily as a subcutaneous injection)
(on the market since mid-2010)
(shortly before admission)
In this list, among other things, the RANK ligand inhibitors (Denosumab, Prolia (R)) which use a different approach than the bisphosphonates to very largely reduce the number of functional osteoclasts. In recent years, side effects caused by the reduction in bone cell activities, especially with bisphosphonates and denosumab, have been discussed again and again, although these mostly occur in indications that require a much higher dose of these drugs. A statement from the umbrella association of German-speaking osteological umbrella associations (DVO) and an S3 guideline from the Dental Scientific Societies (AWMF).
The latest development consists in the sclerostin antagonists ("Romosozumab "), with which, especially in comparison to the bisphosphonates given in tablet form, significant reductions in the number of bone fractures can be achieved in high-risk patients. The approval was delayed by the occurrence of complications in the approval studies in the cardiovascular area. However, approval in Germany can be expected within the first half of 2019.
We will monitor these developments carefully and will certainly not be among the first to “jump” on the new drug train. Even if the manufacturers are busy advertising in the practices and osteoporosis self-help groups, drugs that intervene so clearly in the bone metabolism do not have to have a positive effect on every patient. Osteoporosis patients, in whom the bone metabolism is already greatly increased, continue to benefit, in our opinion, more from anti-resorptive, i.e. osteoclast-inhibiting forms of therapy.
The differentiated use of these sometimes highly effective drugs requires the doctor to have precise knowledge of their mechanism of action, possible risks and side effects and the interaction with food and other drugs. In addition, the success of the therapy benefits if as much information as possible about the current activity of the building cells (so-called osteoblasts) and their counterparts (osteoclasts) is available.
[mt_tab title = "Vitamin D hormone"]
[mt_lineheader size = “4 ″] Vitamin D [/ mt_lineheader]
Vitamin D has long been used in connection with the treatment of osteoporosis. What is this substance all about?
Vitamin D is a hormone that is initially formed in the skin as a preliminary stage through exposure to sunlight. The actually effective form of vitamin D, "1,25 (OH) 2 vitamin D3", is produced in the kidneys with the help of the parathyroid hormone (parathyroid hormone or PTH). Vitamin D stimulates the absorption of calcium from the intestines. The regulatory mechanism works in such a way that if there is a lack of calcium in the blood, more parathyroid hormone is released, which in turn favors the formation of the effective vitamin D from the preliminary stage.
In addition, some special features:
- A large proportion of the population has low vitamin D levels (despite the fact that the skin is often sufficiently exposed to the sun), especially the elderly.
- Vitamin D also influences the activity of the cells working in the bones (osteoblasts and osteoclasts).
- A severe vitamin D deficiency leads to a special form of bone loss, osteomalacia.
- Low vitamin D levels encourage overproduction by the parathyroid glands, which then induce increased calcium mobilization from the skeleton.
- The administration of vitamin D is part of the basic therapy for osteoporosis, but should be discussed with the attending physician.
- As a fat-soluble substance, vitamin D is best taken with meals.
- With low vitamin D levels, the glucose or sugar metabolism seems to be negatively influenced (for a so far unexplained cause)
- Vitamin D receptors are found in many cells of the human body; not all related functions have yet been fully explained (muscle coordination, susceptibility to infection, immune system, tumorigenesis?).
[mt_highlight] IMPORTANT: [/ mt_highlight] Vitamin D is not a dietary supplement or even an anti-aging agent, but a hormone that is important for the bones and belongs to the therapeutic repertoire of the experienced osteologist.
[mt_tab title = "Bone Metabolism"]
[mt_lineheader size = “4 ″] bone metabolism [/ mt_lineheader]
Our skeleton is made of a material that ingeniously combines high strength and elasticity with a low weight. These properties, which previously could not be maintained for such a long time in any artificial building material, can only be achieved through the ability to permanently add and dismantle. When it comes to bones, what is known as "bone remodeling" is involved, which can best be translated as "new bone formation". The constant renovation means that our skeleton is completely renewed every five to ten years. But humans also have to do something for this: We not only need the appropriate building materials such as calcium and vitamin D, but also compressive and tensile forces on the bones, i.e. sufficient physical activity.
How are these renovation processes controlled in detail?
In the bones there are cells that bring about the breakdown (osteoclasts) and cells that are responsible for the regeneration (osteoblasts). The graphic on the right shows in a simplified way that the osteoclasts first start clearing away bone material from the trabeculae (right side). They have a brush border at the end of the bone. They are followed by the osteoblasts (left in the picture) with cultivation activity. Such a process takes about three months from the beginning of the breakdown to the complete rebuilding of functional bone. Various drugs intervene in this system.
In recent years there has been a better understanding of how cell activities are controlled: the osteoblasts both produce an activator for the osteoclasts (RANK ligand) as well as a protective factor of the bone, the Osteoprotegerin, which intercepts (binds) the activator and puts it inoperative. RANK ligand converts the osteoclast precursors into functional osteoclasts, which are only able to break down bone in this way.
External factors can influence the ratio of RANK ligand and osteoprotegerin:
Estrogens, calcium and exercise, among many other factors, favor the protective osteoprotegerin. Cortisone, parathyroid hormone and inflammatory changes (e.g. rheumatism), on the other hand, lead to increased RANK ligand.
Conversely, osteoclast activity releases a tissue factor (TGF-ß), which in turn stimulates the osteoblasts to work extra.
These lists and explanations are greatly simplified, but give an impression of the complexity of the regulation.
[mt_tab title = "Calcium tablets"]
[mt_lineheader size = “4 ″] Calcium… [/ mt_lineheader]
... is not only the fifth most common element in the earth's crust, but also an important part of our skeletal system. It has to be supplied to humans from outside with the help of vitamin D. This supply cannot be replaced by the body's own synthesis or calcium in high-percentage dilution series (such as in homeopathic medicines). You can find a summary of a lecture by Dr. Download Mathias Beyer. We also provide lists of the contents of mineral water, food and medication at this point.
When calcium is consumed in medicinal form, it should be noted that some studies have shown risks of developing kidney stones and vascular damage compared to intake through food (1997, 2008).
Mineral water table
[mt_tab title = "Men"]
[mt_lineheader size = “4 ″] Osteoporosis in men [/ mt_lineheader]
Not only women but men can also suffer from osteoporosis:
In the past, osteoporosis was primarily seen as a disease of women. that is different now. Possible causes of male forms of osteoporosis are:
Of course, it should also be noted here that the measurement of a low bone density alone must not lead to a diagnosis of osteoporosis. It requires a doctor trained in osteological differential diagnosis to find out what are known as secondary osteoporoses, possibly also rare malignant diseases, among others. Particularly noteworthy is the so-called Klinefelter syndrome, a male chromosomal disorder which, if left untreated, leads to the typical signs of testosterone deficiency and almost always to osteoporosis.
[mt_lineheader size = “4 ″] Therapy? [/ mt_lineheader]
It is not always easy to find a sensible therapy after the disease is diagnosed in men. So-called secondary causes must be eliminated, the supply of calcium and vitamin D must be ensured (if there are no medical reasons against it). Most of the drugs that have a highly effective effect on bone metabolism are now also approved for men in Germany (including strontium ranelate since September 2012). Lecture by Dr. Beyer on this subject as a download ...
[mt_tab title = "Klinefelter Syndrome"]
[mt_lineheader size = “4 ″] Klinefelter syndrome and osteoporosis: [/ mt_lineheader]
A special form of (congenital) testosterone deficiency is a chromosome change that does not have the normal set of 46 chromosomes, but rather a form with 47 chromosomes with an excess X chromosome ("XXY"). Every 500th man in Germany has the excess X chromosome. Of the approximately 80,000 boys and men affected by this, only around 10% have been recognized and diagnosed so far. The testosterone deficiency often only becomes noticeable after puberty and, if left untreated, leads to a loss of performance, erectile dysfunction, lack of libido, osteoporosis, etc. The diagnosis of Klinefelter's syndrome does not mean that the person affected is less "male" because of it or that life expectancy would be lower as a result. The lack of testosterone can now be compensated for without any problems, but the disruption of testicular function with small testicles and impaired sperm production cannot be repaired.
Until about 10 years ago, after the diagnosis was made, it had to be assumed that the Klinefelter patients necessarily suffered from non-treatable childlessness. This prognosis could be changed, at least in many cases, by modern methods of sperm collection and subsequent artificial fertilization of a female egg.
There is a great deal of misinformation about Klinefelter syndrome, not only among the general public, but also among doctors. Detailed information there is, for example, the German Klinefelter Syndrome Association, which is particularly committed to educating patients and doctors. In some cities in the Federal Republic of Germany there are now self-help groups whose members are on hand to offer advice and assistance. There is a lot of information for those affected, but also for parents and (very important!) For parents-to-be of a boy with Klinefelter syndrome. Such activities are particularly worthy of support because of the often existing uncertainty of patients and doctors about the Klinefelter problem.
[mt_tab title = "DVO guidelines"]
[mt_lineheader size = “4 ″] Guidelines as the gold standard for dealing with osteoporosis patients? [/ mt_lineheader]
After years of discussion on the question of how to treat osteoporosis, the umbrella organization of the German-speaking scientific osteological societies (DVO) came into being at the turn of the millennium. The goals were and are among others (quote from the DVO website):
- research into calcium and bone metabolism as well as bone and joint diseases
- the optimization of the prevention, diagnosis and therapy of osteological diseases in German-speaking countries on the basis of science-based medicine
- advanced and advanced training as well as comprehensive quality assurance in osteology
The DVO board of directors and the scientific advisory board have made the effort since 2005 to sift through the currently relevant literature on osteoporosis and then to issue guidelines for diagnosis and therapy. Anyone who has dealt with science and research in this way can judge the effort put into such a project. Already in 2006 there were guidelines in a detailed long version, a clearer short version and a “pocket version” with key words. The recently published version from 2014 is also available as a long and short version. The 2009 guidelines were also developed as a 2009 patient version.
At the time, we published a comment on the 2006 version, which in our opinion offers some pitfalls in the area of the therapeutic indication for osteoporosis.
In addition, a structured training program was created which, in conjunction with extensive previous experience in the field of osteological diagnostics and therapy, leads to an additional designation recognized by the state medical associations ("Osteologist DVO"). This additional qualification was acquired by the doctors in the practice for endocrinology in 2005 and is maintained (“recertified”) through continuous training and further education, in part also in events organized by ourselves as lecturers.
Nevertheless, it is important for us that we not only serve as implementers or vicarious agents for the guidelines of the DVO, but that we continue to think about the risk of fractures and of course also the risk of therapeutic measures for each patient individually. Guidelines never take the circumstances of individual patients to heart, but can always only concern themselves with statistically verifiable advantages of diagnostics and / or therapy. We, on the other hand, are not dealing with statistics, but with the sick person.
[mt_tab title = "Training CD"]
[mt_lineheader size = “4 ″] Osteoporosis and training [/ mt_lineheader]
The Osteoporosis training CD for the training of resident doctors and pharmacists working in clinics was created in a joint project of the State Medical Association and the State Chamber of Pharmacists of Bavaria with the participation of Prof. E. Heinen, Nuremberg, Prof. Dr. Franz Jakob, Würzburg and others
Here are some excerpts that are supplemented by cinematic animations on the CD:
[mt_tab title = "Miscellaneous"]
Our calcium tables: 500 mg are not always included where it says 500 mg!
Osteoporosis advanced training CD from the Bavarian Medical Association with the collaboration of Endocrinology practice.
You can now use this CD in our practice in the waiting room; we have installed a PC terminal for this purpose, which also contains our website.
9-year study from the Endocrinology practice, Nuremberg as a PDF file (presented at the 44th Symposium of the German Society for Endocrinology from May 5th - 12th, 2000)
DVO guidelines for the prophylaxis, diagnosis and therapy of osteoporosis have existed since 2006, each in a short version and a detailed long version.
Keyword: "Hip protector" as a PDF file for download.
Original paper on the hip protector from the New England Journal of Medicine (October 2000) as a summary
The links to other websites listed here do not reflect our opinion on the subject under all circumstances!
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