pathology: osteoporosis

yogabook / pathologie / osteoporosis

osteoporosis

Definition of

Systemic skeletal disease, all bones affected; as the vertebrae are under the most stress, the qualitative deficiency of bone mass is felt there first and most. Localization in the spongiosa rather than in the compacta (bone cortex). Osteoporosis is therefore excessive loss of bone mass, the most common bone disease in old age. 80% of osteoporosis affects postmenopausal women. 30% of postmenopausal women develop clinically relevant osteoporosis. This is exclusively a disease of the white race, cause unknown, possibly genetic defect

Cause

Primary osteoporosis (approx. 95%)

  1. Type 1: postmenopausal
  2. Type 2: senile
  3. Dent-Friedman syndrome (idiopathic juvenile osteoporosis, usually heals spontaneously)

secondary osteoporosis (only 5%):

  1. endocrine due to
  2. medicinal
  3. for diseases
  4. Vitamin B12 deficiency
  5. Folic acid deficiency
  6. Underweight

Predisposing

– Behavior

  1. Smoking
  2. Predominantly sedentary work
  3. Low sun exposure
  4. Meat-rich, vegetable/low-fat diet

– Other factors

  1. female
  2. breastfed several children
  3. Oestrogen levels too low

Diagnosis

  1. X-ray, especially X-ray absorptiometry (DXA), is still the best method for 10-year fracture prediction with 35% accuracy
  2. Increased beam transparency of the vertebrae (become darker in the XRay)
  3. Rarification of the spongiosa
  4. Laboratory: – (Ca, AP, phosphate normal, as gradual process), possibly hydroxyproline excretion in urine

Symptoms

  1. Pain in the area of the spine
  2. paravertebral myogelosis
  3. Highlight: in months to years: significant decrease in height -> apparent excess length of the arms, possibly the lower ribs dip into the pelvis, hence small frog belly,
  4. Widow’s hump (excessive kyphosis) due to the resulting wedge vertebrae
  5. Highlight (radiographic): Fish vertebrae, top and base plates of the vertebrae collapse gradually or suddenly, possibly touching vertebrae, very painful
  6. Highlight (radiographic): Wedge vertebra, the vertebra is smaller ventrally than dorsally -> hyperkyphosis
  7. Late: Spontaneous fractures

Therapy

  1. balanced diet
  2. Movement
  3. Special osteoporosis gymnastics
  4. Estrogen patches in the menopause are quite controversial because of the side effects and should not be used for longer than 3-5 days, otherwise the protective effect is reversed Ca and vitamin D administration
  5. Vitamit-D3 and calcium supplements, increase the dietary intake to 800-1200 mg/d. Calcium carbonate often causes bloating, diarrhea, constipation and discomfort; in this case it is better to use calcium lactate, calcium gluconate and calcium hydrogen phosphate
  6. Osteoclast inhibitors (bisphosphnpnates), have a delayed and prolonged effect
  7. Osteoclast-inhibiting antibodies (RANKL antibodies, „denosumab“)
  8. biologically produced PTH (parathyroid hormone) for osteoblast stimulation
  9. synthetically produced raloxifene during the menopause (oestrogen receptor modulator, reduces bone resorption and renal calcium losses, leads to a positive calcium balance)

Asana practice

In the area of exercise therapy, the most important pillar is to implement a regulated level of comprehensive exercise that eliminates the risk of fracture, especially if the osteoporosis is more advanced. Exercise should include all major bones, both those of the extremities and the spine, and should be as vigorous as possible. It has long been known that strength training is the best prevention against osteoporosis in the area of proactive behavior. This is of course particularly important for those at risk. Endurance sports and flexibility training, as valuable as they are in general, are of secondary importance for the prevention of osteoporosis.

For asanas, therefore, gentle stretches are not suitable postures in this sense, but postures are required in which muscles have to work with sufficient contraction force, such as in the lower extremities in standing postures with bent legs:

With regard to the spine
are suitable for

to name just a few. As far as the upper extremities are concerned, postures with strong use of the arm flexors and extensors are suitable. The former include forward bends in which the arms pull the pelvis further into hip flexion, while the latter include all postures in which bent arms are used to hold or move against gravity, such as the bar or some dips. In heavy standing postures, the work of the gluteal and dorsal hip muscles (pelvitrochanteric muscles) is likely to supply the bony structures of the pelvis, as well as the scapula and clavicle in postures that are intensive for the upper extremity.

When considering which exercises are effective and efficient, it is easy to think of training with external weights, and not without reason. They are easily scalable due to the weights and sometimes other parameters such as the extension of the arms during side raises or front raises, i.e. the lever arm, and quite a few of them can be performed at home with just a small investment, such as bicep curls, overhead tricep strengthening, squats, deadlifts, rowing, pull-ups, front raises and side raises. There is no need to worry about possible loss of flexibility, as most of these exercises offer the possibility of working with a large range of motion, and there are corresponding asanas for all possible flexibility-reducing effects of the exercises to compensate for these effects.