Guide osteoporosis

About Guide Q & A

Osteoporosis · What is that?

Osteoporosis is a bone disease that leads to a massively increased risk for fractures due to a loss of strength and stability of the bones. It is especially problematic that the persons affected are ususally not aware of this because a loss of bone density is not felt. Bone loss is a silent condition with no apparent symptoms for a long time. That is why osteoporosis is often only diagnosed after a fracture has occurred. An early visible sign might be a slight loss of height because the spine begins to collapse. Symptoms of advanced osteoporosis are:

Bone pain
Fractures (typically femoral head, wrist, vertebral bodies)
Prolonged fracture healing
Back pain and hyperkyphosis
Loss of height

Vicious circle osteoporosis

Most frequent are fractures of the femoral head close to the hip, of upper and lower arm, ribs and especially of the spine (fracture of vertebral bodies). Many patients with fractures that are a consequence of osteoporosis, i. e. of the femoral head or vertebral bodies, remain bedridden. The resulting lack of activity further weakens the bone system. Thus, chronic pain may develop which again worsens mobility restrictions that in turn now further an even faster bone resorption and thus a progression of osteoporosis.

In addition, the number and severity of these more or less spontaneous bone fractures (fragility fractures or minor fractures) significantly increases the risk of further bone fractures. One in five patients who suffer a hip fracture at an advanced age dies within the next year from the consequences.

Serious consequences of osteoporosis

Highly increased risk of fractures and bone fractures after minor causes · minor fractures
Care dependency, restrictions on movement and loss of independence
20% increase in mortality after a fracture of the femoral neck despite good accident surgery care
Only about half of the fracture patients regain their former mobility
Severe pain caused by broken bones

Osteoporosis · Causes

Bones have several functions. They serve as supporting tissue, which makes movement and walking upright possible in the first place. Secondly, they protect the organs from external mechanical influences. Despite their stability, however, all bones in the body are subject to constant change. They are permanently formed, modified and broken down in order to adapt to changing requirements. Old bone tissue is gradually replaced by new tissue. Fractures, in particular, require a high regenerative capacity of the bones, which necessitates these permanent remodelling and renewal processes.

Almost every bone in the body is completely regenerated within a period of about ten years. This process is called bone remodeling. The tissue of the bone consists of two substances: connective tissue, which guarantees the flexibility of the bone, and a mineral part, which brings the strength of the bone.

Bone resorption and bone formation are usually in balance (bone homeostasis) and is done through the interaction of several cell types. At the molecular level, bone remodeling is regulated primarily by the activity of the bone-forming osteoblasts and the bone-degrading osteoclasts. If the bone homeostasis is disturbed, osteoporosis or other bone diseases can be a consequence.

What happens within the bones in case of osteoporosis?

Osteoporosis translates as "porous bones". Bones become porous when the body loses too much bone substance and/or forms too little. If loss of bone tissue progresses faster than its formation, the bones lose density, they become weaker and break more easily. In medical terms, osteoporosis is described as a metabolic bone disease with a reduced bone density and it is distinguished between high-turnover-osteoporosis, i.e. increased bone breakdown causes the loss of bone substance, and low-turnover-osteoporosis, when the loss of bone substance is caused by a reduced bone metabolism.

The inside of the bone consists of cancellous bone. These are small beams of bone tissue, that make up the spongy interior of the bone (Spongiosa). Osteoporosis is the result of a regression of many of those beams, causing the cavities to become larger. Then the density of the bone is decreasing. Bones consist of the following basic tissue:

Basic bone substance consisting of organic and inorganic elements
Bone cells osteoblasts for bone formation, osteoclasts for bone resorption
Periosteum covers all human bones except at the joints
Bone marrow (medulla ossium) formation of blood cells and platelets

Osteoporosis · Stages

The bones reach their highest density value (PBM - Peak Bone Mass[1]) at about 30 years of age. From around the age of 35, however, a natural process of osseous degradation and ageing begins, so that bone density of both men and women decreases continuously. Only when bone substance degrades top fast above normal levels it is defined as osteoporosis or bone loss.

When is loss of bone density defined as osteoporosis?

The risk of fractures is important for the indication for diagnosis and therapy of osteoporosis. The basis of every diagnosis is first of all the patient's medical history (anamnesis). Notice should be paid to current complaints and pain as well as prevailing risk factors such as previous bone fractures, cases of osteoporosis within the family and other primary diseases such as hyperthyroidism (overactive thyroid gland) or the regular intake of medications that are known to further the development of osteoporosis. A main parameter to determine the risk of osteoporosis and to decide about starting treatment is the bone density. However, this should never be considered in isolation. If other factors are also taken into account, the risk of fractures of the individual patient can be estimated much better than with only a bone density measurement.

In bone density measurements, T-Score and Z-Score are determined (osteodensitometry). Together with the other risk factors, the results show whether osteoporosis is present or not. There are various densitometric measurement techniques. Standard is the dual X-ray absorptiometry (DEXA). The score results are specified in SD – standard deviations.

T-score · Z-score

The scores compare the bone mineral density of the patient with the Peak Bone Mass. A T-score between -1.0 to -2.5 indicates a preliminary stage of osteoporosis: osteopenia. Osteoporosis is indicated by a T-score of < -2.5 but without previous fractures. From the age of 70, the Z-score is used, which refers to healthy men or women of the same age.

Osteopenia · Reduced bone density · Early or preliminary stage of osteoporosis

The diagnosis osteopenia defines bone density lower than the age-specific norm value, a precursor of osteoporosis. However, patients suffering from osteopenia do not necessarily develop osteoporosis. The T-score for osteopenia is between -1.0 and -2.5.

Osteoporosis · Severe osteoporosis · Bone atrophy
A severe osteoporosis is indicated by bone fractures without a triggering event as an accident, fall or impact and a T-score of < -2.5. A socalled widow's hump, an increased curving of the spine, can also be a consequence of osteoporosis. Vertebrae that have become unstable break at little stress, the spine collapses and shortens.

Interpretation of measured values in osteodensitometry
In addition to bone density measurement, with the help of the World Health Organization (WHO) a model was developed to calculate the risk of osteoporosis. It estimates the risk of suffering a fracture of hip, vertebral body, radial bone or femoral neck within the next ten years. In addition to age, sex and the bone density with DXA, nine other risk factors are taken into account.

Basic diagnostics
If a person's age, sex, body weight and height are analysed and risk factors taken into account, an individual 10-year fracture risk can be determined. If it exceeds 20%, a thorough basic diagnosis is recommended. Measurement of the bone density is an additional but not the only factor that the decision is based on. The treatment of osteoporosis today is determined much more than before by individual circumstances and the total risk of fractures. The basic diagnostic consists of anamnesis, clinical examination, osteodensitometry and if necessary x-rays or other imaging and laboratory data.

Osteoporosis · Types or systematics of osteoporosis

Osteoporosis can be a primary diagnosis or can develop secondary, i.e. due to other factors. Primary osteoporosis is the term for osteoporosis that develops without any underlying disease. It is also known as idiopathic osteoporosis:

Postmenopausal osteoporosis
Type 1 osteoporosis, which about 30% of postmenopausal women develop
Juvenile osteoporosis
Reduction of bone density that occurs in childhood and adolescence
Senile osteoporosis
Type 2 osteoporosis developed by women and men in old age

Secondary osteoporosis is osteoporosis that is triggered by an underlying disease, such as disorders of the hormonal balance or the bone metabolism, tumor diseases, disturbed immune reactions. Therefore it is caused by another disease and/or its treatment:

Drug-induced osteoporosis
Possible side effect of long-term drug therapies
Immobilization osteoporosis
Possible consequence of a lack of stimulation of the bone metabolism due to chronic shortage of movement

Factors that may further osteoporosis are:

Endocrine causes · hormonal imbalances with consequences for the bone system
(Cushing's disease, hypogonadism, hyperthyroidism, hyperparathyroidism, acromegaly)
Metabolic causes · disorders of the bone metabolism
(homocystinuria, diabetes mellitus, malabsorption syndromes)
Medication causes · side effects on the osseous structures
(glucocorticoids – steroid-induced osteoporosis, thyroxine and triiodothyronine, tamoxifen, heparin, GnRH analogues, antiepileptics, cholestyramine, antiresorptive drugs, pioglitazone therapy for women with type 2 diabetes, malabsorption syndromes such as lactose intolerance and celiac disease)

Treatment options for osteoporosis

The goal of preventive and therapeutic therapies is the prevention of fractures and their consequences. Osteoporosis is currently still predominantly treated with drugs that are intended to slow down bone resorption or promote bone formation. Some medicines have to be taken or injected daily. These drugs often cause complaints in the gastrointestinal tract and can even have serious side effects such as osteonecrosis of the jaw due to bisphosphonates. Many patients abort the therapy prematurely because of complicated regulations for use and the very long therapy time of up to five years.

Antiresorptives are drugs which are intended to slow down bone degradation rates, such as bisphosphonates (alendronic acid, risedronic acid, ibandronic acid). They are administered as pills, injection or infusion. Depending on the indication, the active ingredients and dosages of bisphosphonates differ. In the treatment of osteoporosis, a fracture-preventive effect is well documented only for the postmenopausal type. According to a letter from the Drug Commission of the German Medical Association, another possible side effect of bisphosphonate treatment despite the well-known osteonecrosis of the jaw (ONJ) may be osteonecrosis of the external auditory canal (ONEAC). The most common side effects of bisphosphonates administered orally are gastrointestinal symptoms such as heartburn, abdominal pain, nausea, sickness or diarrhoea, seldom are esophageal ulcers or perforations and bleeding. Because of the direct irritating effect on the mucous membrane of the oesophagus, bisphosphonates should be swallowed in an upright position only and patients should not lie down again afterwards. Caution in the administration of all intravenous bisphosphonate applications is required if kidney functions are impaired.

Denosumsab (known as Prolia®) has to be injected under the skin every six months. The occurrence of patients suffering multiple fractures after aborting denosumab therapy has raised the question in medical circles if there is a counter-reaction (rebound effect). In 2016, the manufacturer informed physicians in Switzerland that in clinical trials the bone density of some patients had fallen below the initial scores before treatment after ending the therapy. This would mean that bone density would decrease below the original baseline and there might be an increased risk of fracture for the patients afterwards. The current available data is insufficient for evidence-based recommendations.

Osteoanabolics such as parathormones (teriparatide) are drugs that shall stimulate bone formation. In two two-year-long animal trials on carcinogenesis, rats developed osteosarcomas and other tumours of the bones, so the maximum duration of therapy is set to 24 months. Repetition is not recommended.

Nutritional supplements · Vitamin D · Calcium
In recent studies, the risk of osteoporotic bone fractures could not be reduced by the intake of calcium or vitamin D.

MBST in the treatment of osteoporosis

Molecular biophysical stimulation

MBST therapy takes a different approach and focuses directly on the bone metabolism – the cause of osteoporosis.

The metabolism is the basis of all vital processes in the body and requires a lot of energy. Energy that is also used in the bone for formation, protection and repair of tissue. If the bone cells lack energy, the body's own repair mechanisms can no longer be performed and bone loss starts. In order to ensure the structure and functioning of the bone, it is permanently renewed (bone remodeling). To keep the bone mass at a constant level, osteoclasts resorb bone tissue and osteoblasts form it. In case of misregulation, an increased bone resorption (high-turnover) or a reduced bone metabolism (low-turnover) can lead to a loss of bone substance[2].

This is where therapeutic magnetic resonance technology has its starting point. The MBST therapy system was developed to transfer engergy to bone tissue in a targeted way. The aim is to increase metabolism and retrigger repair mechanisms and regeneration processes. MBST therapy thus directly addresses one of the causes of osteoporosis.

MBST therapy is based on the physical principle of magnetic resonance, in which hydrogen nuclei first absorb energy and then partially release it into the surrounding tissue. Scientific data indicates that MBST magnetic resonance technology thus can stimulate various biophysical processes and trigger anti-inflammatory and pain-relieving effects. [3,4,5] Damaged cells shall be influenced in such a way that natural regenerative processes can be triggered. The treated tissue shall regain as much functionality as possible.

Other indications

In addition to osteoporosis and osteopenia, MBST therapy is also used for other bone metabolic disorders, such as aseptic osteonecrosis (including Osgood Schlatter disease) and bone oedema, or to accelerate the healing process in case of fractures. Please consult a doctor in an MBST treatment centre to find out if your complaints can be treated as well with MBST magnetic resonance therapy.