Bone disease - Reduction of bone mass: Osteoporosis is the result of an imbalance between bone formation and bone resorption. Its causes are multifactorial, ranging from nutritional deficiencies, lack of exercise, and genetic predisposition to hormonal imbalances. Osteoporosis is characterized by low or decreasing bone mass and deterioration of bone tissue structure (bone minerals and matrix). The reduction in bone substance is not always immediately apparent. If unrecognized and untreated, advanced stages can lead to not only fractures but also changes and deformities in the spine, which can sometimes result in neurological disorders. Timely prevention or early treatment is crucial for the prognosis.

Osteoporosis: Risk and Prevalence 

In old age, the risk of bone loss increases significantly. Today, it is estimated that there are about 6 to 7.5 million patients with this bone disease in Germany. This results in follow-up costs of approximately one billion marks per year. Annually, around 65,000 hip fractures are expected. For women over 50 years of age, the likelihood of experiencing a hip fracture at some point is approximately 15%. Of women over 60 years old, 18% have already experienced at least one vertebral fracture, with a rising trend. One in four women over 65 years of age can expect osteoporosis-related vertebral fractures. Men are also increasingly affected in old age.

Prevention of osteoporosis is based on four pillars.

  • risk aversion
  • adequate supply of calcium
  • muscle and body training
  • use of medication:
    Commencement with low skeletal starting mass or bone density loss of over 3.5% per ye

Even in children, premature bone loss can be prevented. This is achieved with calcium supplementation tailored to their age, which should be maintained throughout life. Regular muscle and body training, contributing to the formation, strengthening, and maintenance of muscle and bone tissue, is also beneficial. The goal of medication treatment is to halt bone mass loss. An increase in maximum bone mass by just 4 to 5% already reduces fracture risk by 40 to 50%. In recent years, fluoride and estrogen have primarily emerged as medications. Both are not without controversy in their effectiveness and may have undesirable side effects. The pros and cons are not to be discussed here, but these medications must be carefully monitored in terms of dosage, duration of therapy, and side effects. So far, there is no standardized treatment regimen for osteoporosis. Treatment varies among countries; for example, some completely avoid the use of fluorides. Generally, there is a lack of alternative therapies from the perspective of experts.

Two approaches are often overlooked in the bone disease osteoporosis: supporting bone metabolism with complex nutrients and influencing hormone levels with spleen peptides.

Calcium supply: Often insufficient
Calcium plays essential roles in bone formation, maintenance, and healing. Sufficient intake from early childhood is crucial but often not achieved by many age groups. According to new recommendations from a consensus conference in the USA, adults over 25 years of age should consume 1,000 mg of calcium per day. Since losses can occur during the body's utilization process, it is better to aim for 1,200 mg per day. It is not necessary to meet the target every day; rather, the weekly balance should be adequate. However, the actual calcium intake is usually much lower. Women of all age groups fall short of the daily requirement, with half of them critically below the norm. Those aged 15 to 35 consume only about 70% of the daily recommended calcium intake, with 10% of women ingesting only 400 mg per day. Children and adolescents also often fail to meet the desired requirement. Older men and women typically consume less calcium than younger individuals, significantly below the recommendations. Women over 60 years of age, for example, only consume about 400 mg of calcium per day. Adequate intake is typically achieved only by men aged 35 to 65 years.

Calcium supply
Milk and dairy products, vegetables, and fortified beverages. The cause of inadequate supply is often an inappropriate selection of foods. Calcium is mainly obtained from milk and dairy products.
For example, drinking milk is often unappealing to many children and adolescents, while older individuals may reject milk due to its relatively high cholesterol and fat content. Butter contains only a small amount of calcium. When it comes to cheese, attention must be paid to those coagulated with rennet, as they contain calcium. However, most cheeses available in stores are coagulated with rennet. Those who do not enjoy milk or dairy products can turn to other calcium-rich foods. These include, for example, oil sardines, broccoli, or garden cress. Drinking calcium-enriched fruit juices or mineral and medicinal waters, as well as calcium-rich drinking water, is also recommended in such cases.

Guideline for provision:

Five-point rule
Each point provides:

  • 1 glas of milk
  • 1 cheese sandwhich
  • 1 cup of joghurt
  • 1 portion of curd cheese

At least 5 points must be achieved per week! There isn't such a simple rule for other foods. With them, one should pay attention to the amounts of calcium contained and possibly supplement with additional calcium.

Way out of undersupply: Calcium supplements
Experiences show that achieving sufficient calcium intake through daily diet is difficult for many people. Therefore, supplementing with calcium supplements, combined with other substances that stabilize bone tissue, is advisable for certain groups or times (e.g., during pregnancy). The evidence of a connection between bone mass and daily calcium intake is clear. However, not only the quantity but also the type of calcium intake is crucial for its utilization in the body. Calcium citrate has higher bioavailability, is well tolerated, and is more soluble in water than salts of other acids.

Calcium metabolism and homeostasis :
In order for calcium to fulfill its functions effectively in the body, several other substances are necessary. Calcium metabolism and homeostasis are governed by a complicated regulatory system. Particularly involved in this process are parathyroid hormone, calcitonin, and vitamin D. Calcium is absorbed through the intestinal wall, and its availability depends on nutritional factors. Absorption, for example, is inhibited by vitamin D deficiency and a low-protein diet. However, it also improves with vitamin D and optimal protein supply, especially with lysine as well as lactose and citric acid. When it comes to osteoporosis, attention is often focused only on these relationships, possibly also on adequate supply of vitamins C and B6.

Typical for bone metabolism, as for all bodily functions, is an active interplay of many nutrients. These include, for example, boron, zinc, copper, manganese, folic acid, and pantothenic acid. This is far too often overlooked in the prevention and treatment of osteoporosis.

For the prevention and treatment of osteoporosis: Combined vitamins and minerals
Meaningful combinations of important nutrients for bone formation allow for better utilization of calcium while simultaneously reducing the required amounts of vitamin D. Bone matrix and mineralization improve, and key parameters of bone metabolism are favorably influenced. This also applies to processes involved in bone and wound healing after surgeries, fractures, and other injuries. Additionally, other properties of vitamins have positive effects, such as on cellular immune competence. Of course, osteoporosis cannot be treated solely with nutrient supplements, but they provide a good foundation for therapy. This may allow for lower dosages of other interventions.

Documentation of mineral nutrient supply
For determining mineral nutrient supply, hair mineral analysis (which is technically reliable) has proven effective. This method allows for the determination of the most important minerals, trace elements, and heavy metals in tissues. Disturbances in mineral balance can be detected before clinical symptoms occur. Blood levels of calcium, magnesium, and zinc, for example, may be only moderately indicative due to homeostatic mechanisms, diurnal variations, nutritional influences, and stress. For instance, even in severe osteoporosis cases, normal blood calcium levels may be found, while tissue examinations already indicate the imbalance. Additionally, exposure to heavy metals (such as lead, cadmium, mercury, etc.) is often detectable only late through blood analysis. These pollutants are deposited in fat tissues, bones, and hair within a few days and can only be detected there.

Bone mass loss: Normal or pathological?
After the age of 35, humans begin to lose bone mass. The normal rate of loss is approximately 2 to 3% per year, in extreme cases up to 10%. Generally, women have lower bone mass, and the loss starts earlier and is more pronounced. Therefore, women have a much higher risk of osteoporosis. For them, bone loss increases at the onset of premenopause and synchronously with the decline in ovarian function. In the first five years after menopause, women lose about 15% of their bone mass. After approximately four to six years, the rate of loss decreases, remaining relatively constant thereafter.

Bone mass: dependent on sex hormones
The structure of bone mass is influenced by hormones in addition to nutrition and age. Until puberty, bone is an "asexual" organ; afterward, it is influenced by sex hormones. If they are insufficiently present, the bone mass becomes inferior. Recognizing the deficiency of sex hormones early in younger individuals can improve bone mass formation through supplementation. Generally, the critical period for this is before the age of 20. If the deficiency is recognized later and only then supplemented, reaching normal values ​​is usually not achieved. In women, estrogen and progesterone levels are crucial. For example, if estrogen levels are insufficient after the removal of ovaries or after menopause, bone mass is more rapidly depleted. In men, testosterone deficiency contributes to bone loss. Androgen levels decrease in older age, and then men also more frequently suffer from osteoporosis.

Critical period for bone loss in women: Menopause
During menopause, serum estradiol levels decrease, leading to an increase in gonadotropins LH and FSH. These hormones bind more to receptors on ovarian target cells, reducing estradiol synthesis. Estrogen therapy is recommended for the treatment of osteoporosis to stabilize its effects on bone formation. However, it is only beneficial if there is an actual risk of osteoporosis (e.g., due to ovarian removal or early onset of menopause). The supplementation must be continued until the natural slowing of bone loss occurs, typically around age 65. Many women find it difficult to adhere to this regimen. Estrogen therapy is contraindicated, especially in women with breast, uterine, or ovarian cancer. Some predispositions also argue against the use of estrogens, such as existing liver, gallbladder, and heart diseases. Isoflavones, phytoestrogens from soy, may offer an alternative.

Supplementation or alternative to hormone therapy: Spleen peptides (Splenin)
Spleen peptides stimulate, among other things, the ovary and can delay or reduce the development of osteoporosis in the pre- and postmenopausal period. They stimulate estrogen production in the follicle, but only as long as follicular structures are present in the ovary. Splenin shares similarities with gonadotropins and can displace them from receptor binding. Upon recognition as "free," the receptor reactivates cell enzymes, increasing estrogen production and lowering gonadotropin levels. Spleen peptides can significantly alleviate typical menopausal symptoms. For example, the increase in estradiol production reduces hot flashes, angina pectoris, and depressive moods. Until the onset of endocrine menopause (about three to four years after the last menstrual period), stimulable follicular structures are usually present in the ovary, which can be stimulated by spleen peptides. The rise in estradiol also prevents osteoporosis. Maintaining estradiol levels for three to five years beyond clinical menopause can protect patients from significant bone mass loss during this period and extend bone health by years. Like estrogens, spleen peptides must be used long-term. Regular administration may potentially avoid or delay estrogen therapy or at least reduce its dosage.

For further questions regarding therapy, we are of course available to you gladly and in detail.

Copyright: Arbeitskreis Immuntherapie e.V., Dr. med. Günter Neumeyer