Osteoporosis is an underestimated common disease: According to the World Health Organization (WHO), osteoporosis is one of the ten most important serious diseases worldwide; In Germany alone, up to eight million people are affected. Above all, osteoporosis is a woman's job: 80 percent of women suffer from the systemic disease of the skeletal system, which causes unbearable pain, around 400,000 fractures annually, mostly fractures of the femoral neck and vertebral body, and therapy costs of around nine billion euros in the health system.
"Nevertheless, osteoporosis has not yet reached the consciousness of most people. Education and public awareness are required, because excessive bone loss is not a fate, but an illness that we can successfully prevent in crucial phases of life, ”says gynecologist Dr. Jürgen Klinghammer, CEO of the medical organization GenoGyn.
Prevention of osteoporosis at a gynecologist? “This may sound unusual at first, but it makes medical sense, because orthopedists generally see the patient at the earliest when symptoms or even when fractures have occurred. The gynecologist, on the other hand, accompanies the crucial stages of life for the primary prevention of osteoporosis, ”says Dr. Klinghammer. This is how the bone density is built up to around 30 years of age. After a balance between bone build-up and breakdown, the steady decrease in skeletal mass predominates from the age of 40. Anyone who has reached a maximum starting position can better cope with the partially unavoidable mining in later life.
This is exactly where primary prevention comes into play - even during pregnancy and lactation. "Via fetal programming, a calcium deficiency in the expectant mother also affects the fetus, because the organism of the unborn child needs sufficient calcium and vitamin D to build up its skeleton," says the Cologne-based gynecologist. Especially for pregnant vegans who are vegan while breastfeeding, reduced calcium intake is problematic for the child's bone growth.
In puberty, bone health is often endangered by eating disorders, severe under- and overweight, but also extreme competitive sports. In this age group, calcium robbers such as fast food or phosphate-rich soft drinks should also be provided.
After the menopause, every third woman suffers from osteoporosis; after the 70s, every second woman is affected. The main cause is the drop in estrogen levels. GenoGyn gynecologists therefore advise risk screening from the age of 40 with a detailed medical history, a blood test and the so-called DXA bone density measurement as the gold standard of diagnosis. "This enables us to identify our patients who already have osteopenia before the menopause, i.e. a bone density that is below average, and to provide them with appropriate interdisciplinary therapy," says the GenoGyn CEO. Today, less than a quarter of all osteoporosis diseases are recognized early and treated appropriately.
Hormone deficiency is the most common cause of osteoporosis, but other diseases or their treatment with certain medications can also cause so-called secondary osteoporosis. These include chronic bowel diseases such as ulcerative colitis and Crohn's disease, anorexia, thyroid dysfunction, rheumatic inflammatory diseases, which are often treated with cortisone, which leads to a decrease in bone density. Antidepressants, antiepileptics, cytostatics and aromatase inhibitors from tumor therapy as well as immunosuppressants, which are used after organ transplants, for example, have a bone-damaging effect.
Known risk factors for osteoporosis include age, gender, predisposition (genetics) and an unhealthy lifestyle with improper nutrition (under and overweight), lack of exercise and alcohol and nicotine consumption.
Prevention and personalized therapy for osteoporosis always include a high-bone diet with sufficient calcium, vitamin D and regular exercise with strength and endurance training. If the disease has already progressed, so-called bisphosphonates are predominantly prescribed for drug treatment today.
"Lifelong prevention is more important than ever," warns GenoGyn board member Dr. Jürgen Klinghammer. "Due to the demographic development, experts, especially in rich industrial nations, are expecting a further growing number of osteoporosis patients and by 2025 annual therapy costs in Germany of around eleven billion euros. We need a social hearing for effective primary prevention of osteoporosis, as it can and above all be performed by the gynecologist, because our patients represent the largest risk group, which occurs in our practices on a regular basis in almost every age. ”Osteoporosis is therefore also a standard topic on GenoGyn prevention training for gynecologists.