Micronutrient therapy
| Abstract | |
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Osteoporosis is a disease of the bones, which by definition is characterised by reduced bone density and loss of proteoglycans, collagen and minerals, which in turn increase the risk of bone fractures. The preliminary stage of osteoporosis is called osteopenia. Because of its often asymptomatic course, osteoporosis often goes undetected at first until it eventually leads to fractures in the pelvis, hip, spine and wrist. For this reason, osteoporosis is also associated with a significantly increased morbidity and mortality among the elderly. It is mainly women after menopause who are affected by this disease of the bones due to hormonal changes. Osteoporosis is also favoured by, among other things, bedriddenness and directly by the permanent intake of gluococorticoids. Osteoporosis is diagnosed by means of bone density measurement, which belongs to the procedures of osteodensitometry. The so-called T-score is used to distinguish between osteopenia (T-score between -1.0 and -2.5 standard deviations below the norm) and osteoporosis (T-score less than 2.5 standard deviations below the norm). Various micronutrients are used for prophylaxis and also as therapy, as well as physical exercise, which supports the build-up of bone mass by stimulating the formation of new bone. |
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| Classification and causes |
| Primary osteoporosis |
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Osteoporosis can be divided into primary and secondary osteoporosis. Primary osteoporosis (the majority of osteoporoses) is an age-related form that is also associated with a lack of sex hormones and can be divided into postmenopausal osteoporosis and senile osteoporosis. In addition, „Idiophatic juvenile osteoporosis“ is also one of the subtypes of primary osteoporosis. In women, it is mainly the decline in oestrogen production during the menopause that has a significant influence on the increase in bone loss. In men, the inactivation of testosterone and oestrogen by sex hormone-binding globulin contributes to the decline in bone mineral density with age. |
| Secondary osteoporosis |
| In secondary osteoporosis, the cause lies in various diseases related to an imbalance of calcium, vitamin D and sex hormones, and/or various medications, most notably long-term therapies with glucocorticoids. For example, Cushing's syndrome accelerates bone loss due to excessive production of glucocorticoids, but inflammatory diseases such as rheumatoid arthritis, which requires long-term therapy with glucocorticoids, are also associated with secondary osteoporosis. In this context, studies have found that after starting therapy with glucocordicoids, bone mineral density already decreases rapidly within three to six months. In addition, excessive alcohol consumption, as well as Cushing's syndrome, hypogonadism, hyperparathyroidism, malabsorption of calcium, deficiency of vitamin D, hyperthyroidism and hypocalciuric hypercalcaemia are also associated with secondary osteoporosis.
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| Symptoms | |||||||||||
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From around 30 years of age, humans begin to steadily lose bone mass, which is sometimes dependent on genetics, but also on lifestyle factors such as exercise and diet, and is additionally influenced by diseases and medication. To enable bones to remain strong, they are continuously resorbed in the body by osteoclasts and replaced by new bone formed by osteoblasts. Osteoporosis occurs when there is an imbalance between resorption and formation and more is resorbed than formed. Hormones also have a significant influence in regulating bone function, as both oestrogen and testosterone inhibit bone resorption. In addition, the protein RANKL (acronym for: Receptor Activator of NF-κB Ligand) also plays an essential role in the development of osteoporosis by activating osteoclasts and thus bone resorption. At the beginning, osteoporosis is often manifested by back pain, later also by reduced height, the formation of a rounded back and fractures without an identifiable cause |
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| Diagnostics | |||||||||||
| In the diagnosis of osteoporosis, the measurement of bone density (osteodensitometry) by means of DXA (abbreviation for Dual Energy X-Ray Absorptiometry), as well as diagnostic criteria based on the T-score, is considered the gold standard. According to this, a strongly negative T-score correlates with a high fracture risk and results in osteoporosis from a value of - 2.5 and lower (see figure 1).
Bone density can additionally be determined using quantitative computed tomography (QCT), which is expressed in the physical density (kg/m3) of each volume element (voxel). Furthermore, FRAX ®, the fracture risk calculator, can also be included in the diagnosis of osteoporosis. This is an online diagnostic tool developed by the University of Sheffield in the UK. To determine the 10-year fracture risk by country, FRAX ® takes into account risk factors such as age, sex, body mass index (BMI), previous fractures, parental hip fracture, smoking, glucocorticoid use, presence of secondary osteoporosis and/or rheumatoid arthritis and alcohol consumption. FRAX ® also has limitations, including not including a history of falls as a risk factor, using only the parent's hip fracture, and undifferentiated consideration of previous fractures. Furthermore, various laboratory tests with different parameters can also be taken into account in the diagnosis of osteoporosis (see "Laboratory tests"). |
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| Therapy and relevant micronutrients | |||||||||||
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Calcium and phosphorus are components and building elements of the hydroxyapatite of bone and thus play an essential role in building the supporting apparatus. High levels of silicon are found in connective tissue where, as a component of mucopolysaccharides in epithelia and connective tissue, it is responsible for cross-linking and also plays a role in maintaining bone density. Vitamin D promotes the absorption of calcium from the intestine and increases its storage in the bones. Vitamin K activates various proteins of bone metabolism such as osteocalcin and matrix GLA protein via carboxylation. The trace element boron is also involved in the regulation of hormone, bone and mineral metabolism. The trace elements zinc, copper and manganese are essential cofactors of enzyme systems for the synthesis of various bone matrix proteins. It is known that magnesium deficiency increases the activity of osteoclasts (cells that break down bone). In addition, magnesium is involved in the conversion of vitamin D into the bone-active active form calcitriol. A strong acid load can have a negative effect on the bone structure, because on the one hand calcium is released directly from the bone matrix and on the other hand the osteoclasts are stimulated. Calcium and magnesium have an alkaline effect and have a stabilising effect on the acid-base balance. If the body's own oestrogen level decreases sharply in the postmenopause, isoflavonoids from soy or red clover can counteract the risk of osteoporosis as a weak oestrogen substitute (phytoestrogens) (menopausal osteoporosis). |
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