Active against osteoporosis

Osteoporosis: definition, synonyms, course

Definition: Osteoporosis is a generalized disease of the bone system, which is characterized by bone breakdown, the decrease in bone substance, deterioration of bone tissue and an increased risk of bone fractures. According to the WHO, osteoporosis is present if the bone density is at least 2.5 standard deviation below the mean value in healthy young adults. In Germany, around 6 million people over the age of 50 are affected, women significantly more often than men due to the hormonal situation in the menopause.
Synonyms: Osteoporosis, bone loss, bone decalcification, increased bone fragility, decrease in bone mass, decrease in bone density
Course: The WHO divides osteoporosis into 4 stages. In the first stage (Osteopenia) there is already a slight downward deviation in bone density without fractures. The 4th stage (advanced osteoporosis) is characterized by a severe loss of bone mineral content with multiple vertebral body fractures and fractures of the limb bones.
Increased risk for a primary osteoporosis exists above all for women from the age of 50 with the onset of menopause (estrogen deficiency) or for men from the age of 60 (testosterone deficiency), and generally with an increase in age (senile osteoporosis). Insufficient physical activity, especially at a young age, a diet low in calcium and vitamin D, prolonged use of cortisone, rheumatic diseases, nicotine and being underweight increase the risk of developing osteoporosis.
A secondary osteoporosis arises due to certain hormonal and / or metabolic disorders, immobilization, as well as increased, long-lasting cortisone intake.

Osteoporosis: diagnosis, symptoms, prevention, therapy

Diagnosis:

• Anamnesis: taking a history with a focus on the frequency of falls and fractures, genetic factors, prolonged use of cortisone, previous complaints, chronic back pain, was prevention carried out?

• Inquiring about current complaints: acute back pain or functional restrictions, spontaneous fractures?

• Physical examination

• Function test examples: getting up from a chair, time-up-and-go test, walking speed, balance test, one-legged stance, ICF (International Classification of Function)

• Bone density measurement

• laboratory

• roentgen

• Bone biopsy: removal and examination of bone tissue only in rare secondary forms

Symptoms:

• Free of symptoms at the beginning of the illness

• Acute or chronic back pain

• Reduction in body size, hunched back due to the formation of wedge-shaped vertebrae in the case of fractures in the thoracic spine, fir tree-like folds on the back

• spontaneous fractures, especially of the spine, hip joint fractures or extremities

• Deformation of vertebral bodies or limb bones

Read more on the topic: What kind of pain occurs with osteoporosis?

Prevention:

• Physical activity (starting in youth)

• Vitamin D and calcium as food supplements, sunlight, vitamin D and a diet rich in calcium (low in animal fats)

• Avoiding alcohol and nicotine

• Fall prevention as functional training and other preventive measures

• Wearing spine or hip protectors to reduce the increased risk of fractures

Therapy:

• Drug therapy depending on the stage, in particular biphosphonates and vitamin D, possibly estrogen / progestin

• Sport, increasing muscle strength and coordination, mobility and balance

• Calcium-rich and Vit.D-rich diet, alkaline diet

• Magnetic therapy, Bemertherapy and vibration training

Appointment with ?

I would be happy to advise you!

Who am I?
My name is dr. Nicolas Gumpert. I am a specialist in orthopedics and the founder of .
Various television programs and print media report regularly about my work. On HR television you can see me every 6 weeks live on "Hallo Hessen".
But now enough is indicated ;-)

In order to be able to treat successfully in orthopedics, a thorough examination, diagnosis and a medical history are required.
In our very economic world in particular, there is too little time to thoroughly grasp the complex diseases of orthopedics and thus initiate targeted treatment.
I don't want to join the ranks of "quick knife pullers".
The aim of any treatment is treatment without surgery.

Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

You will find me:

• Lumedis - orthopedic surgeons
  Kaiserstrasse 14
  60311 Frankfurt am Main

You can make an appointment here.
Unfortunately, it is currently only possible to make an appointment with private health insurers. I hope for your understanding!
For more information about myself, see Lumedis - Orthopedists.

Osteoporosis: bone remodeling

Our bone substance is not a rigid structure, but is adapted to the respective conditions and loads through constant reconstruction phases. Old bone substance is broken down and replaced by newly formed bone mass. Damage to the bone system caused by everyday stresses and movements is continuously repaired. After a broken bone (fracture), functional bone can be formed within a few weeks. These processes serve to maintain a stable, stable skeletal system. Within 7-10 years, the entire human bone mass is broken down and replaced by new bone substance. The individual bone density varies due to genetic requirements, diet, exposure to sunlight and continuous sufficient mechanical stress, e.g. through sport. There is usually a constant balance between bone loss and bone regeneration. The predominates in growth Bone building up to approx. 30 years of age, after a constant phase up to approx. 50 years of age, with increasing age and especially in women in the postmenopause, the Bone loss to.

The Stability of the bone mass will be decisive by sufficient dosed mechanical stress on the bone, especially in adolescence. Sufficient build-up of muscle mass results in a stable “peak bone mass”, which significantly delays and reduces bone loss in old age. Today, adolescents often no longer have sufficient mechanical stress due to sport or physical work due to long periods of sitting in school and at the PC.

A lack of mechanical stress on the bone skeleton leads to bone loss, which can be proven in studies on bedridden patients (approx. 4-5% bone loss per month) or in studies on astronauts after a long stay in weightlessness.

The process of efficient new bone formation takes an average of 3-4 months, which means that short-term sporting activity without continuity has little positive effects on new bone formation.

Osteoporosis: Effects of Exercise Training

Exercise training and adequate physical activity are important therapeutic building blocks as well as in the Prevention, as well as the Treatment of osteoporosis.

Training goals:

• Health Promotion and Prevention

• Increase in bone formation, inhibition of bone loss that has already taken place and stability (especially of the spine)

• Increasing muscle mass, building strength

• Improving mobility, balance, coordination and reaction

• Posture improvement

• Increase in cardiopulmonary endurance

• Pain relief

• Reduction of fear of falling, fall and fracture prophylaxis

• General improvement in vitality

Osteoporosis: training goals, principles, training content

Training goals:

• Health Promotion and Prevention

• Increase in bone formation, inhibition of bone loss that has already taken place and stability (especially of the spine)

• Increasing muscle mass, building strength

• Improving mobility, balance, coordination and reaction

• Posture improvement

• Increase in cardiopulmonary (heart, lungs) endurance

• Pain relief

• Reduction of fear of falling, fall and fracture prophylaxis

• General improvement in vitality

Training and execution principles:

• As a preventive measure, training should definitely begin in adolescence

• Positive effects on bone mass can also be achieved when training begins in old age

• Let older patients (especially those with a high risk of falling) train under continuous supervision as part of functional training, rehabilitation sports or in the gym. In individual therapy under the supervision of the physiotherapist.

• The training stimulus must be above the daily physical demands (slow, progressive increase in load taking into account the individual performance level until high stimulus intensity is reached)

• continuous training adjustment, (otherwise there is a risk that a constant bone density plateau will appear after approx. 1 lahr)

• Minimum requirement: 2-3 training units / week

• The structure of the training and its intensity depend on the individual performance (survey of the initial values), age and cardiopulmonary (heart / lungs) resilience, consider the individual risk of falling when choosing the exercises

• Apart from the feeling of muscular effort, training must be pain-free; slight sore muscles are tolerable / desirable

• Keep breathing or exhaling to exert yourself as you practice

• In addition to the specific exercises, daily brisk walking of around 30 minutes, hiking, climbing stairs

• The training must be continued continuously; interruptions lead to the loss of the effects on the bone bank that have already been worked out

Training content:

• Collection of baseline values

• Information (oral and written)

• Strength-based dynamic training forms for all large muscle groups, especially trunk muscles, hip and arm muscles) characterized by high muscular activity, axial load (upright against gravity), flexibility, jumping units (only for younger test subjects without risk of fractures)

• Speed, reaction, balance and coordination for fall prevention (plus living space renovation)
• Endurance training in the mix of high and low impact training

• Body awareness exercises and posture training

• Vibration training

• Whole-body electro-myostimulation

• Relaxation and stretching units to reduce pain

• For older patients, choose exercises that are close to everyday life and that are gentle on the joints, no jump loads, intensive training controls and support

• Basically avoid high-risk sports with an increased risk of fractures

• Variable mixed programs to avoid a lack of motivation and stagnant performance development

Osteoporosis: High and Low Impact

Impact is not to be equated with Intensity. Impact refers to the forcethat the body has to expend in order to be able to perform a certain exercise and to which the exercise took place Joint loading.

intensity is characterized by the level of difficulty and the exhaustion after training.

High Impact Training: High impact or high intensity training can be used in both strength and endurance areas.

in the Strength training that stands out HIT through short and hard training units with longer regeneration time. The growth stimulus for the musculature is set by high stress intensity up to muscular exhaustion, whereby the overall extent of stress is relatively low. It is trained with high weight, short holding times and few repetitions (e.g. 6-8 seconds holding time with 6-10 repetitions and 2 series, the last repetition is characterized by a drop in performance and momentary muscle failure, as the energy generated by the oxygen supply is no longer sufficient . (anaerobic area).

In order to individually determine the limit of the aerobic, anaerobic threshold, performance diagnostics and performance monitoring are necessary at regular intervals during continuous training in order to be able to adapt the training stimulus accordingly by changing the training program.

High impact training in the Endurance range is characterized by short, intensive exertion beyond the aerobic threshold (energy generation for the muscles through conversion of carbohydrates by means of lactic acid fermentation without oxygen, volume increase of the muscle fibers). The energy yield is much lower with anaerobic training, a faster drop in performance with prolonged exercise is the result. The HIT in the endurance area not only increases the ability to sprint, but also significantly improves endurance performance. Typical sports are jogging, short sprint intervals with high loads, and jumping. You train with approx. 75-80% of the maximum heart rate.

Low Impact Training: gentler training with less stress on the joints. This works with low training loads such as with slow continuous running. Low impact training can be aerobic as well (Carbohydrates are converted into energy by means of oxygen) and can also be carried out with high intensity in the anaerobic area. Hiking, Nordic walking, swimming and light cardio training on the cross trainer are typical low-impact sports, as one foot is always on the ground during training. Increases in training intensity e.g. When walking, you can use inclines on the route, additional weights, and intervals with higher speeds. The low impact endurance training trains with approx. 65-70% of the maximum heart rate.

Osteoporosis: guideline

The guideline published in 2008 provides the basis for osteoporosis therapy from a physiotherapeutic point of view. Guidelines summarize the current research and consensus results on a clinical picture. The results summarized in the guideline can be directly implemented in practice and serve as an orientation for the Movement and physiotherapy. The guideline on osteoporosis deliberately distinguishes between physical therapy and Exercise therapy distinguished. In the primary preventive Physical therapy largely overlaps with sports therapy, while in the Secondary and Tertiary prevention especially the Individual physiotherapeutic therapy of the elderly patient with osteoporosis is in the foreground. These patients have often already suffered fractures and may suffer from the consequences of the fracture (pain, loss of mobility, loss of independence).

Primary prevention:

Target group: people who have not yet had osteoporosis. The PPV is aimed at healthy people who are willing to avoid risky behavior and maintain their health through prevention through healthy diet and exercise. PPV is to be striven for, better prevention than cure.

Measures in the JPA:

• Sports training from an early age, for life

• Exercising in old age still has positive effects on the bone bank

• Exercise therapy in the group

Secondary prevention:

Target group: Informed, health-conscious patients who are in the first or second stage of osteoporosis and who are ready to take their own preventive measures and implement decisive rules of conduct. Prevention of the progression (progression) of osteoporosis through targeted Osteoporosis Treatment and Activity.

Measures in the SP:

• Strength training

• Fall prevention

• Posture training, flexibility, everyday routines

• Pain reduction

• Exercise therapy in the group

Tertiary prevention:

Target group: informed patients who maintain the "disease state" (2nd and 3rd stage of osteoporosis) and want to prevent its aggravation through targeted osteoporosis treatment and rehabilitation. Avoidance of complications and secondary diseases, e.g. by Fractures.

Measures in the TP:

• Individual physiotherapeutic treatment for strengthening and core stability, posture training and mobility

• Physiotherapeutic treatment after fractures, for pain and restricted mobility (caution with manual therapy, increased risk of fractures)

• Fall prevention with targeted strength training

Osteoporosis: exercise examples

There is no such thing as "ONE" osteoporosis program!

Although it can be safely proven that sport has a positive effect on the development of bone mass and on the fear of falling and the incidence of falls, there are no uniformly defined training and exercise programs for which the optimal effectiveness can be proven. This is particularly due to the different target groups and the variety of training goals.

The most common mistake is subliminal training as well as in the strength and endurance areas. In the best case scenario, subliminal training has a sustaining effect on bone density, as well as on the risk of fractures and cardiovascular endurance.

Less than 10% of women do a sufficiently dosed training 2-3 / week.

Target group: women and men, average age approx. 50 years, no fractures so far, average level of training:

Equipment: 0.5 - 2 kg dumbbell, 0.5 - 2 kg weight cuffs, airpad

Training goals: Strengthening the back and neck muscles in the direction of straightening (risk of developing a hunched back due to wedge-shaped vertebral collapse), the abdominal muscles to stabilize the spine, the leg muscles to relieve the back

Load: In the training recommendations I only list general values, as the individual training plan is based on personal performance. In training theory, one is increasingly no longer based on fixed load values, but on the individual feeling of exertion. If the trainee reaches his / her individual performance limit feeling (I can no longer!) With increasing number of repetitions, 2-3 repetitions of the exercise are added to it.

• 60 - 70% of the maximum strength, weight load can be built up by your own body weight or equipment

• Holding time per exercise: approx. 10 sec.

• 40-60 sec. Break between the exercise series

• 3-4 series of 6-10 repetitions per exercise

The exercises can be done with or without weight load!

You will find detailed balance exercises under the topic drgumpert, fall prophylaxis

The stretching program can be found in detail under the topic dr-gumpert stretching and fascia

Starting position: prone position, possibly a pillow under the stomach or, in the case of severe complaints in the lumbar spine, place the upper body on a Pezzi ball or a fitness snail, the arms are stretched out next to the head, dumbbells or cuffs in the hands, cuffs on the feet, Legs slightly open

Execution of the exercise: the lower abdominal and pelvic floor muscles are tensed, both arms are raised, the shoulder blades are pulled together towards the back and down in the direction of the trouser pockets, the arms are raised and lowered a little bit in a short, fast rhythm

Starting position: prone position, possibly a pillow under the stomach, the right / left arm is stretched up and slightly apart, the thumbs point towards the ceiling, both legs are stretched out and slightly apart, dumbbells or weight cuffs in the hands, weight cuffs on the feet

Execution of the exercise: the arm and leg are lifted and lowered slightly diagonally in a short, fast rhythm from the floor towards the ceiling (small movement, not too high, as otherwise the lumbar spine is too stressed), changing sides

Starting position: kneel in front of a fitness snail or a padded stool, rest your upper body up to your hips on the snail or stool, your head is relaxed, your hands are folded behind your head

Exercise execution a: lift the upper body towards the ceiling and put it down again

Exercise execution b: while lifting the upper body, perform a lateral turn towards the ceiling (right / left elbows towards the ceiling), then lower again

Starting position: Forearm support, the elbows are under the shoulder joints, the forearms are parallel with the palms on the floor, the knees are straight, the feet are up

Exercise execution a: Hold the position for approx. 30 seconds, the body is stretched out parallel to the floor, the stomach and gluteal muscles are tense

Exercise execution b: alternately lift one leg straight from the forearm support

Exercise execution c: from the forearm support, lower the upper body between the shoulders towards the mat and raise it again

Starting position: Quadruped, the knees are under the hip joints, the hands under the shoulder joints, the back is straight and stretched parallel to the floor by tensing the lower abdominal and pelvic floor muscles, weight cuffs on the hands and feet

Exercise execution: diagonally stretch one arm and one leg, then bring elbows and knees together under the body and stretch them out again

Starting position: four-footed position, the knee joints are under the hip joints, the hands under the shoulder joints, the back is straight and parallel to the floor, weight cuffs on the hands and feet

Exercise execution: one arm is combined laterally for inhalation and the upper body is opened towards the ceiling, with the exhalation the arm is passed under the support arm, the upper body and the head (thoracic and cervical spine) bend

Starting position: Lie on your back, your legs are close to your buttocks, your arms are stretched out sideways next to your body on the mat

Exercise execution a: With the pelvic floor (sphincter muscles inward, pull up) and lower abdominal tension (pull the navel towards the spine), the spine is rolled up until the back is in the shoulder bridge. Then roll your back slowly and in a controlled manner.

Exercise version b: in the shoulder bridge, alternately lift the feet a little above the mat

Exercise version c: alternately stretch one leg in the shoulder bridge so that the knee joints are at the same level

The exercises can be done with or without weight load

Starting position: supine position, the legs are in the "table position" (lower legs are in a raised position parallel to the mat), the soles of the feet are touching, the knees are open, the arms are in the U-bracket next to the head on the mat

Execution of the exercise: the elbows remain on the floor, the lumbar spine stays in contact with the mat, the weight of the legs is shifted to the right / left towards the mat, start with a small movement, increase in a controlled manner

Exercise execution: Elbows and knees are crossed and brought together over the navel,

at the same time, the free leg extends over the mat

Starting position: supine position, the left leg is pulled towards the stomach, the right leg stretches out onto the mat, the right hand is on the knee joint of the left leg, the left hand behind the head, then change sides

Execution of the exercise: the right hand and the left knee press against each other, the left leg presses on the mat, the left elbow remains open, then change sides, the head can also be raised

Starting position: Lateral position on the left, the legs are bent backwards at a right angle, the left forearm rests on it, the right arm is stretched out on the body

Exercise execution a: the pelvis is raised and lowered again

Exercise version b: the pelvis is raised, the right arm is passed under the support arm and then lifted up towards the ceiling, the upper body turns open

Exercise version c: the pelvis is raised, the right arm stretches towards the ceiling, the right leg stretches out, then the elbows and knees are brought together over the raised pelvis and stretched out again

Starting position: Stand with legs apart, the tips of the feet point slightly outwards, the arms are stretched out next to the body with the palms facing towards the floor

Exercise execution a: Squats with the upper body leaning forward and stretched (by bending the hip joints), movement is initiated by moving the buttocks backwards, thereby relieving the knee joints

Exercise execution b: from the bent position, perform short, quick up and down movements with your arms

Starting position: Stand with legs apart, the tips of the feet point slightly outwards, the arms hang in front of the body, a weight is in front of the feet (e.g. a filled laundry basket or water box)

Exercise execution: the knees bend over the toes, the buttocks are pushed back and down, the stretched back moves forward, then the weight is lifted by stretching the legs and straightening the back