What is it?

Osteoporosis is the medical name for porous bone (os = bone). The bone structure is then damaged to such an extent that the risk of bone fractures is high. An earlier stage is osteopenia. It manifests as weaker bone mass and altered bone structure.

Many do not know that bone tissue is very dynamic and active tissue. There is a daily interaction of calcium of 500 mg in storage or breakdown and weekly we recycle about 6% of our bone mass. Spongy bone tissue is totally replaced every 3 years and compact bone tissue is totally replaced every 10 years.

The balance between bone building (osteoblasts) and bone breakdown (osteoclasts), also known as bone homeostasis, is achieved by adequate intake of vitamin C, vitamin D, vitamin A, calcium, phosphorus, magnesium and manganese as well as adequate intake of protein. These must then be proteins that the individual can properly digest. In addition to proper nutrition, exercise and sunlight are essential for healthy strong bones. 

Movement creates a pulling motion on the muscles of the bones and combined with gravity, this causes activation of the osteoblasts. Sunlight activates hormones in your skin that enable the body to convert vitamin D.

Calcium plays a major role in bone remodeling, but it is also required for a whole range of physiological reactions in the body: impulse conduction, muscle contractions, blood clotting, secretion by glands and nerve cells, and cell division. An adult body contains about 1200 - 1400 g of calcium, of which more than 99% is stored in the skeleton. Approximately 1.5 g of calcium is found in blood and the calcium concentration is between 9 and 11 mg/dl of blood.

Proper balance between bone formation and bone breakdown occurs through the process of bone remodeling, which is under the control of 2 systems:

  • hormonal system responsible for keeping the calcium concentration in the blood constant;
  • mechanical forces and gravity acting on the skeleton. Stretching and compression generate electrical signals that stimulate osteoblasts.


Underlying the hormonal system is the activity of 2 hormones: parathormone (PTH), a hormone produced by the parathyroid glands, and calcitonin produced by the parafollicular cells of the thyroid gland. Therefore, a properly functioning thyroid and parathyroid glands are essential for calcium balance.

PTH is secreted when blood calcium concentration drops and stimulates bone resorption by the osteoclasts thus allowing bone structure to be broken down if needed. When the blood calcium concentration rises too much, calcitonin is secreted, inhibiting bone resorption and stimulating the osteoblasts, allowing excess calcium to be absorbed into the bones.

In addition to the hormones PTH and calcitonin, there also seems to be a role for leptin, a hormone that regulates the "feeling of hunger" and energy balance in conjunction with ghrelin.

Healthy bone tissue has a dense matrix structure. When there is osteopenia or osteoporosis, "holes" fall into the matrix to a greater or lesser extent. The different stages of degradation of the bone matrix are shown in the figure to the right. 


How osteoporosis is diagnosed

There are 4 steps to diagnose osteoporosis:

  • Measurement of bone density, DEXA scan;
  • VFA, checking for vertebral fractures;
  • Laboratory tests;
  • Fall risk analysis.
  • DEXA scan, or bone density measurement, is available in almost every hospital and some diagnostic centers. This involves measuring the amount of minerals in the bone of the hip and vertebrae using a type of X-ray machine, but with low radiation. The examination takes about 10 minutes.


Bone density is expressed by the T-score. The lower the bone density the greater the risk of bone fracture:

T-score between +1 and -1: there is no problem.

 T-score between -1 and -2.5: osteopenia (reduced bone mass)

 T-score -2.5 or lower: osteoporosis

  • VFA, checking for vertebral fractures

A modern DEXA scanner can usually also take a VFA image. That is a (low power) X-ray image of all the vertebrae. This allows one to determine if there is damage to one or more vertebrae. If a recent X-ray of the entire spine is already available, this can be used if necessary. But there is a strong preference for a VFA image with the DEXA scanner because it gives a much lower radiation exposure.

  • Laboratory tests

The doctor will also request a number of blood tests such as vitamin D, calcium, TSH, FT4, parathormone, albumin, creatinine, BSEm, alkaline phosphatase. With that, they look for any underlying causes for osteoporosis. This is not only to determine vitamin D and calcium, but with the set of blood tests, other common causes can be identified, which may be part cause of low bone mass.

  • Fall risk analysis

The combination of physical examination, laboratory tests and a series of personal questions comes together in a fall risk analysis. Using a short questionnaire, the doctor or nurse will identify your personal fall risk. Points of interest include:

Heredity, your genetic profile

Surely the most important risk factor is heredity. You have inherited it from your parents and grandparents, so there is little you can do about it. Pay attention. It also affects your family. If you have osteoporosis yourself, your children/grandchildren also have an increased risk;

Low weight

Partly hereditary, but also due to your lifestyle (see below). A low BMI ( Body Mass Index) is an important risk factor, but also a signal for possible other underlying conditions;

Lifestyle

Your bones actively form during childhood and the rest of your life under the influence of exercise and diet. Thus, little exercise and little varied/unhealthy diet will cause your bones to be/be weaker. Activities of Daily Living (ADL) in work and private life also play a major role;

Other diseases

There is a long list of diseases that have the side effect of causing additional bone loss such as joint diseases (rheumatoid arthritis), as well as those that increase fall risk such as balance disorders, impaired vision, CVA, etc.;

Medication

We know that some medications for entirely different conditions can also cause additional bone loss or fall risk, such as psychopharmaceuticals. Also an additional risk, some of which can be anticipated;

Age

It is a natural process that your bones will weaken ever so slightly after age 35. Because of this, age is also a risk factor. This does not exclude the possibility that you can have osteoporosis at a young(er) age as well!

A previous bone fracture

The risk of another fracture doubles after a previous one, especially above age 50.

Hence, this should also be the starting point for further investigation ( DEXA etc..);

Vertebral fracture/vertebral collapse

That too is a bone fracture and therefore an increased risk of a subsequent fracture. Vertebral fractures often go unnoticed because there is not always pain. But then loss of length of about 4cm or more!

In general, vitamin D deficiency (due to disease, diet, skin color and/or lifestyle) warrants further treatment. Further imaging studies may also be needed to assess skeletal status. 


Regular treatment of osteoporosis and osteopenia

  • Deployment of bisphosphonates for up to 5 years. These are drugs that inhibit bone breakdown. This drug does have the potential to cause a substantial number of side effects such as nausea, diarrhea, abdominal discomfort, bone and muscle pain;
  • Deploy calcium with vitamin D. Vitamin D allows for better absorption of calcium from the gastrointestinal system into the bones;
  • More exercise with emphasis on gentle, even loading (if possible);
  • Adaptation of diet with calcium-rich foods (if needed);
  • Lifestyle modification such as smoking cessation and alcohol restriction (if needed);
  • Fall risk reduction involving home and work situations;
  • Moderate exposure to sunlight;
  • Possible pain management;
  • Psychological support (including sexuality) regarding osteoporosis.

Treatment of osteoporosis and osteopenia by BeterKliniek

  • Regular treatment broadly followed;
  • More emphasis on individual nutritional status. Many people do not tolerate well certain protein structures such as those present in dairy, soy, gluten and spinach. It is advisable to consider in advance the individual's digestive capabilities and enzyme status necessary for digestion;
  • Supplement any deficiencies. Think magnesium, vitamin D, calcium but most importantly amino acids in the right proportions; 
  • Research hormones. Improve hormone levels;
  • Deploying Pulsed Electromagnetic Field Therapy (PEMF). This device emits electromagnetic pulses to the body in the form of a pulsing electromagnetic field. Metabolism at the cellular level improves greatly by amplifying the electrical voltage, causing detoxification and greatly increasing the interaction with nutrients and wastes. For further explanation of PEMF, please click HERE

Above all, it is the use of PEMF that will make the difference! The pathologies of osteoporosis and osteopenia will improve significantly for the long(er) term, in a non-invasive natural way. 


Treatment BeterKlinic

BeterKliniek is the clinic for Integrative Medicine that bridges regular and non-regular medicine.

An van Veen (physician) and Michael van Gils (therapist) look for the cause of a condition or disease. That is where the treatment starts otherwise, as people often say, it is 'carrying water to the sea'. We call this cause medicine. Sometimes it is also desirable to treat the symptoms (at the same time). We call this symptom medicine.

Chronic disorders often have their cause in epi- genetics. You can schedule a free informative telephone consultation (phone number 040-7117337 until 1 p.m.) at BeterKliniek to discuss your symptoms so that we can provide you with further advice.