Glossary
Starting with A for "ACE inhibitor" and continuing through to Y for "Yolk Sac Tumour", we give you succinct explanations for scientific and medical terms in clear and simple words.
- OsteoporosisDefinition
Disease of the skeletal system, with loss or reduction in bone substance and structure and increased susceptibility to bone fracture.
Causes
The causes of primary osteoporosis (osteoporosis without underlying disease) remain largely unexplained. They could include a lack of the hormone oestrogen in women, particularly after the menopause, and lack of exercise. Secondary osteoporosis (osteoporosis as a secondary disease) can arise from the following underlying diseases: metabolic diseases (e.g. diabetes mellitus), hereditary cartilage diseases, complex bone diseases (e.g. renal osteopathy and intestinal osteopathy) and cancer (particularly of the bone marrow). Secondary osteoporosis can also be due to drugs (e.g. glucocorticoids) or lack of exercise (e.g. bed rest, paralysis of one side of the body).
Symptoms
1. In the state preceding osteoporosis, neither bone fractures nor deformations of the spine occur. A clear reduction in bone mass is nevertheless evident, in comparison with the normal values for the same age and sex.
2. Marked osteoporosis is characterised by at least one fracture from a slight injury or no injury at all, perhaps accompanied by additional fractures. In severe cases there is shortening of the trunk, humpback, transverse skin folds in the region of the flanks and a syndrome of chronic pain, particularly in the area of the trunk. The four clinical stages are based on the mineral content of the bones and the radiological findings in the spine (cf. radiology). The so-called T-score is important here. This describes the deviation of the bone density from the mean value for healthy young adults, relative to the standard deviation (SD).
Stage 0: state preceding osteoporosis (decrease in bone mineral content, T-score -1 to -2.5 SD), no bone fractures;
Stage I: Osteoporosis without bone fractures (bone mineral content decreased, T-score less than -2.5 SD), no bone fractures;
Stage II: manifest osteoporosis with bone fractures (bone mineral content decreased, 1-3 fractures to the vertebral bodies without the application of external force);
Stage III: advanced osteoporosis (bone mineral content decreased, numerous fractures to the vertebral bodies, often additional bone fractures).
Diagnosis
Reduction in the bone mass, as found in the measurement of bone density (osteodensitometry), fractures in the base and end-plate of the vertebral bodies, wedge-shaped deformity to the vertebra, cod-fish vertebra, possible histological study of a bone sample from the iliac crest. Laboratory measurements with blood serum (calcium, phosphorus, alkaline phosphatase) are normal.
Therapy
Occasion for Treatment
1. Osteoporosis without bone fractures should be treated not later than Stage I, or when the bone density has decreased by more than 2.5 standard deviations from the mean bone density for a young adult; 2. Treatment is indicated for marked osteoporosis with fractures to the vertebral bodies.
Drug Treatment
Primary osteoporosis and postmenopausal osteoporosis in women:
Stage 0
Basic program (reduction of risk factors, calcium rich nutrition, more exercise, gymnastics, additional calcium), hormone replacement treatment with a combination of oestrogens and gestagens. If there is no menstrual cycle, the treatment can be started at any time. Hormone replacement therapy may be supplemented with calcium and also with vitamin D3 (cf. calciferols) for older women, or with a fixed combination of calcium and vitamin D.
Stage I
Basic program (see above), fluoride, in addition to hormone replacement and additional calcium; alternatively bisphosphonates.
Stage II
Basic program (see above), analgesics (analgesics); if the osteoporosis is inactive or the bone metabolic rate is low, the bone-forming cells (osteoblasts) can be stimulated with fluorides, such as sodium fluoride. In an acute phase, with, for example, new bone fractures or a high rate of bone metabolism, treatment is with calcium, hormones (oestrogens plus gestagens, calcitonin), the metabolic products of vitamin D (e.g. alphacalcidol) or bisphosphonates.
Stage III
Treatment as in Stage II. Depending on age and general state of health, possibly only symptomatic treatment (analgesics); possibly anabolic steroids; calcium and vitamin D if there is a high risk of femoral fracture.
Operative Treatment
Operative treatment of bone fractures, e.g. artificial hip joint for fracture of the femoral neck.
Other Measures
1. Stabilising physiotherapy: strengthening of the musculature of the stomach and back, equilibrium training in combination with isometric motion exercises; 2. respiratory therapy for the frequent restriction to breathing; 3. practice in pressing and pulling, to stimulate the regeneration of bone substance; 4. thermotherapy with fango packs or short wave radiation and baths (melissa or valerian), to improve perfusion and to reduce the perception of pain; 5. regular and moderate periods in the sun or artificial light baths (see light therapy); 6. ergotherapy; 7. calcium-rich nutrition (milk products); avoidance of alcohol and nicotine.
Comments
1. Long-term bed rest is in general not necessary after osteoporotic fracture to the vertebral body. 2. Inadequate dosage with analgesics increases physical inactivity and the loss of bone substance (inactivity osteoporosis). 3. It has not been scientifically proved that magnetic field therapy is useful in osteoporosis. 4. The treatment of the underlying disease is part of the treatment of secondary osteoporosis.
Prevention
Risk factors should be reduced as far as possible. Preventive measures include calcium-rich nutrition (milk products), additional calcium intake, increase in physical activity with, for example, gymnastics. Alcohol and nicotine should be avoided. Moderate exposure to the sun is reasonable.
Glossary entries: Roche and Walter de Gruyter, Berlin