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Osteoporosis - the underrated widespread disease

Dr. Jutta Semler
Photo: djd

Expert Interview

The WUNDERWEIB expert for osteoporosis: Dr. med. Jutta Semler

Dr. Jutta Semler is Medical Director of the IWHC Center for Prevention and Health Promotion of the Department of Metabolic Diseases with focus on Osteology at the Immanuel Hospital in Berlin-Wannsee.

In the large WUNDERWEIB interview, the expert explains the typical features of osteoporosis, talks about the current situation with regard to diagnosis and therapy in Germany and talks about the reason why the number of people with osteoporosis is increasing.

It also provides helpful tips for preventing osteoporosis and how to identify your personal risk and first alarm signals.

Osteoporosis is considered an underrated widespread disease. What does that mean?

Dr. Semler : A widespread disease is a disease affecting millions of people. So far, experts have assumed that about four to six million Germans suffer from osteoporosis. But only recently has the BoneEVA study shown that we have to expect just under eight million sufferers.

What are the typical features of the disease?

Dr. Semler : At first, the affected person does not notice, because the disease is largely silent. The rate at which the disease progresses is also very different. First signs may be a hunchback and a significant decrease in height of more than 4 cm. With a broken bone can then also pain occur. However, only 4.3 percent of the nearly eight million sufferers have osteoporotic fractures such as vertebral body or femoral neck fractures. So that it does not break at all, a targeted control in risk groups such as people over 70, extremely slim women after menopause, cortisone patients and smokers is essential.

Sometimes it is said that osteoporosis can be deadly - how is that understood?

Dr. Semler : A hunchback, for example, affects the lungs. It becomes very small and is badly ventilated, not least because of the pain in breathing, so that pneumonia easily sets in which patients can die. A femoral neck fracture that causes a long bed rest can lead to fat embolism or fatal thrombosis. The long storage in bed also leads to bedsores (bedsores), which can lead to blood poisoning or pneumonia.

What is the current situation with regard to diagnosis and therapy in Germany?

Dr. Semler : As the BoneEVA study shows, only 22 percent of sufferers in Germany receive osteoporosis therapy at all. The gold standard of a contemporary treatment is in combination with vitamin D and calcium given bisphosphonates, which receive only ten percent of the patients. What is frightening, however, is that over 90 percent of patients are prescribed pure pain therapy, leaving the underlying disease untreated. The treatment with morphine pain is very expensive and also comes with side effects. A modern osteoporosis therapy, however, makes these pain therapeutics after a short time often superfluous.

Why is it that the number of osteoporosis patients is increasing, and who is affected?

Dr. Semler : Whether the number of those affected actually increases is questionable. All that is certain is that the attention that the disease causes increases. Basically, however, the demographic development speaks for an increase. The number of those affected is expected to almost double by 2050. Women affected by menopause, the elderly, extremely slim women, patients with hyperthyroidism or chronic bowel inflammation as well as those receiving cortisone treatment as well as diabetics and smokers are particularly affected.

How do you recognize your personal risk and first alarm signals?

Dr. Semler : One should first consider whether one belongs to the already named risk groups. Also, the question of whether father or mother have suffered a femoral neck fracture in the past, provides information about their own risk. With advancing age one should pay attention to whether one loses serious in body size.

How to prevent?

Dr. Semler : is a bone healthy lifestyle displayed. In addition to abstaining from cigarettes and excessive alcohol consumption, this includes sufficient intake of calcium with food. As calcium suppliers, not only milk and dairy products should be consumed, but a colorful diet rich in vegetables and fruits as well as calcium-rich mineral water. Highly recommended is a Mediterranean diet with lots of fish. Equally important is a regular physical exercise that trains coordination and balance and builds muscle. Depending on your constitution, Thai Chi, Nordic Walking and dancing can be suitable sports that you can start at any age.

When do you have to be active against bone loss?

Dr. Semler : As soon as you realize that you belong to a risk group - ultimately, for life. The bone density can in fact decrease in women suddenly in pregnancy. Men who have consumed a lot of alcohol at a young age also carry a certain risk of illness. Targeted control is essential in all risk cases. With modern osteoporosis therapeutics such as bisphosphonates, fractures can be effectively prevented. This also makes sense in terms of cost: a reasonable Osteo-therapy costs about 650 euros a year - a thigh neck about 10, 000 euros.

What does a modern, scientifically proven continuous treatment look like?

Dr. Semler : It should be a tailor-made therapy that exploits all the possibilities of a scientifically proven medication with modern bisphosphonates or other medications, and includes a basic therapy of vitamin D, calcium and exercise. The fixed combination Fosavance, which already contains the necessary weekly dose of vitamin D, is helpful.

What role does calcium play in therapy, and why is it important to take vitamin D in particular?

Dr. Semler : Calcium is an indispensable bone component. But only vitamin D makes it possible that calcium can be incorporated into the bones. In addition, the vitamin helps to prevent falls, and strengthens muscle strength. Normally, vitamin D is formed when exposed to sunlight (UV light) in the skin. However, as you grow older, your ability to synthesize vitamin D decreases, so vitamin D supplementation in your osteoporotic patients requires medication.