Osteoporosis Low Mineral Smoking

Osteoporosis
Definition: go beyond the normal level of bone fragility caused by a reduction in bone mass and destruction of the bone structure. This can break the so damaged bone at the slightest stress or simple falls.
Frequency: According to WHO, one of the 10 most common diseases. It suffer now about 40% of women and 13% of men over 50 years of osteoporosis-related bone fracture. As life expectancy increases, more and more, the incidence of osteoporosis-related fractures in the future will continue to increase significantly.
Formation: The bone is living tissue and is in a constant steady state (continuous assembly and disassembly process). this balance is disturbed, the degraded bone can not be completely replaced. This is lost bone mass.
Causes: Chronic hereditary. Diseases such as for example Overactive parathyroid gland, diabetes mellitus, type 1, chronic hyperthyroidism. inflammatory bowel disease and rheumatoid diseases, cortisone, kidney damage, underweight (body mass index under 20, see DXA whole-body BMD), calcium and vitamin D deficiency (see Ernähungstherapie), smoking, alcoholism, lack of sex hormones, physical activity (see DAVID therapy), gravity (see vibration therapy)
Prevention: adequate supply of calcium (1000-1500 mg / day) and vitamin D (daily outdoor exercise, Vit D-containing foods), avoidance of smoking and lower weight, regular physical activity, hormone therapy in menopause.

High levels of risk factors that can be seen in combination with a bone density test is particularly hazardous even in bone-healthy lifestyle:
- Body size decrease> 4cm
- Suddenly and lasting for weeks and frequently recurring back pain
- Bone fracture in lower violence after 50th Age
- Falls in the last year without any external forces (> 2x in 6 months)
- Body Mass Index (BMI) <20 - Unintentional weight loss in recent years,> 10%

Diagnosis:

Doctor-patient interview (family history, pain, fractures, risk factors)
Clinical examination (height, weight, hunched back, muscle tension Hart, disabilities, fall hazard)
WS-X: in V.a. Vertebral fractures, if size decrease> 4cm, back pain
Bone density measurement:
As the gold standard DXA measurements at the lumbar spine and / or hip is recommended. Thus, the bone mineral content by X-ray technology at a very low radiation dose is determined.
Ultrasound measurements of bone collect certain aspects of bone quality, namely, the physical strength, which determine the bone mass independently of the breaking strength of the bone.
We use in our practice, both a whole-body DXA equipment from the Lunar Company (GE) and a Sahara ultrasound device made by Hologic.
Is not a DXA scan in patients with hip replacements and severe degenerative changes in the Lendnwirbelsäule feasible, we direct the patient to a Qantitativen computed tomography (QCT) on.
Tests to bone metabolism can be seen with increased bone fracture risk, in addition to exclude secondary osteoporosis (see chronic diseases among causes of the above)

- Normal bone

- Osteopenia (bone poverty, precursor)

- Osteoporosis (bone loss)

Therapy:
Is described according to the guidelines osteopenia or osteoporosis, consequently it significantly increased bone fracture risk and should therefore consider the above mentioned preventive measures are observed.
A single treatment with calcium and vitamin D is sufficient in most cases for the treatment of osteoporosis is not present. In addition other drugs to prevent fractures are required.
Osteoporosis Treatment is a long-term therapy, which should normally be made over several years.
According to the latest findings are wissenschtlichen bisphosphonates and SERMs (selective estrogen receptor modulators) in the best proven their effectiveness and therefore in the osteological treatment of first choice. Both groups of compounds inhibit the bone resorbing cells (osteoclasts) and thus bone resorption.

- Bisphosphonates:
e.g. Alendronate (Fosamax) and risedronate (Actonel)
For both preparations is shown that they can reduce vertebral and hip fractures and other bone fractures in women after the menopause. Both products are available as tablets in a daily and a once weekly dosage form. In men with osteoporosis is alendronate (Fosamax) are admitted.
When taking medication, note the following: alendronate actonel and should be at least 30 minutes before breakfast with 200 ml of tap water taken in the upright posture. Then you should not lie down again and make any other beverage, food or drugs. Side effects of bisphosphonates can be gastrointestinal intolerance and esophageal inflammation (with correct medication, but very rarely).
- SERMs (selective estrogen receptor modulators)
e.g. Raloxifene (Evista)