X
More than 60,000 patients use Brite
4.6 stars
Your health finally understandable with Brite
Enter email and you're done. No subscription, no credit card.
Search, tap and you're done. Over 3,400 medicines.
Check, remind, get an overview.
Sarah K., 34
I finally understand my therapy. The app reminds me, answers my questions — and I don't feel alone with it anymore.
At a glance
Enter your osteoporosis medication in brite, get reminded of the correct dosing ritual, and keep track of calcium, vitamin D and follow-up appointments. Free of charge.
Never stop osteoporosis medication on your own or shorten the dosing ritual — if you have questions about tolerability or a treatment break, always speak to your treating practice.
In osteoporosis (colloquially bone loss) the skeleton loses bone mass and internal structure. Bone is not a dead scaffold but living tissue that is broken down and rebuilt throughout life. In osteoporosis this balance falls out of rhythm: more bone is broken down than is newly formed. The fine trabeculae inside the bone become thinner, lose their cross-connections and break more easily — the bone becomes porous and less able to bear load.
The insidious part: this remodelling does not hurt and goes on unnoticed for years. Many people only learn of their osteoporosis once a bone has already broken — often after a harmless incident that would never have damaged a healthy bone. This is why osteoporosis is also called a "silent" disease. Typical break sites are the vertebral bodies, the femoral neck (the classic hip fracture) and the wrist.
Why does this matter so much? A broken bone in older age is no trifle. A fracture of the femoral neck in particular often brings an operation, a longer hospital stay and a loss of independence in its wake. Vertebral fractures in turn lead to chronic back pain, to a rounded back and to affected people losing several centimetres of height over the years. The goal of every osteoporosis treatment is therefore clear: prevent broken bones before they happen.
The central examination in osteoporosis is the bone density measurement, technically called DXA (short for "dual-energy X-ray absorptiometry"). This is a short, painless X-ray procedure with a very low radiation dose. It is usually measured at the lumbar spine and the femoral neck — the sites where fractures have the most serious consequences.
The result is given as a T-score. It sounds complicated but is easy to understand: the T-score compares your bone density with that of a healthy young adult. A T-score of 0 means your bone density corresponds exactly to this healthy average. The further the value slips into the minus, the lower the bone density. The World Health Organization has defined fixed thresholds:
| T-score | Category | Meaning |
|---|---|---|
| down to −1.0 | Normal | Bone density in the healthy range |
| −1.0 to −2.5 | Osteopenia | Precursor stage — reduced density, not yet osteoporosis |
| −2.5 and lower | Osteoporosis | Markedly increased fracture risk |
| −2.5 and lower plus a broken bone | Established osteoporosis | Osteoporosis with a fracture that has already occurred |
Important: the T-score is only one building block. Whether and how treatment is given is not decided by the practice on the T-score alone, but on the overall risk of a broken bone in the coming years. This risk takes in age, sex, fractures already suffered, long-term cortisone use, falls and other factors. This is why a person with a T-score of −2.3 may well need treatment, while for another with the same value only the baseline measures are recommended at first.
The most important point first: osteoporosis itself causes no complaints. The bone becomes more porous, but you cannot feel it. Pain only arises through the consequences — that is, through broken bones and their effects. This is why the disease is often overlooked until the first fracture happens.
Signs that can point to already advanced osteoporosis with vertebral fractures are:
A vertebral body fracture can show as sudden, severe back pain — but sometimes also creeping and almost unnoticed. Not every back pain is due to osteoporosis; the most common cause remains muscles and intervertebral discs, for example with a herniated disc. New, severe back pain in older age should, however, be medically assessed.
Bone mass reaches its peak around the age of 30 and slowly declines after that — this is normal. This loss becomes osteoporosis when it proceeds too quickly or too strongly. Two large groups are distinguished.
Primary osteoporosis is the most common form. This includes above all postmenopausal osteoporosis in women: after the menopause the oestrogen level falls, and oestrogen is an important protection for bone. When it drops away, breakdown speeds up markedly. The second form is age-related osteoporosis, which affects men and women alike and in which the general ageing process is to the fore.
Secondary osteoporosis arises as a consequence of other diseases or medication. The most important risk factors at a glance:
A secondary cause is thought of particularly when osteoporosis occurs unusually early, is very pronounced, or occurs in a man. Then a targeted assessment is worthwhile, because if the underlying cause is treated, bone metabolism often improves too.
At the start is the conversation and the assessment of risk factors. Anyone over 50 who has already suffered a broken bone without an appropriate fall, takes cortisone long-term or brings along several risk factors should have a bone density measurement. The diagnosis rests on several building blocks:
From all these building blocks the practice derives whether baseline therapy alone is enough or whether a specific bone medication is additionally needed. The measurement is repeated over time — usually after a few years — to check the success of treatment. How often depends on the initial findings and on the treatment.
Every osteoporosis treatment rests on a foundation — and that is an adequate supply of calcium and vitamin D. Calcium is the most important building material of bone, and vitamin D is needed so that the body can absorb this calcium from the gut in the first place and build it into the bone. Without this foundation no specific osteoporosis medication can develop its full effect.¹
Most calcium should come from the diet: dairy products, green vegetables such as broccoli and kale, nuts and calcium-rich mineral water are good sources. The aim is an intake of about 1,000 milligrams per day. Anyone who achieves this through diet needs no tablets — an unnecessarily high additional intake brings no benefit. The body forms vitamin D with the help of sunlight in the skin; in older age, with little time spent outdoors or in the dark months, this is often not enough, so vitamin D is supplemented.
If the foundation is not enough or the fracture risk is markedly increased, a specific osteoporosis medication is added. The most commonly used group are the bisphosphonates. They slow the cells that break bone down, and so give the upper hand back to bone formation. The best-known representative to take by mouth is Alendronic acid, which is usually taken once a week as a tablet.¹,²
With bisphosphonate tablets the correct way of taking them is absolutely decisive. The active substance is in fact only very poorly absorbed from the gut, and the tablet can irritate the oesophagus if it stays lying there. Both problems are solved by the same dosing ritual — follow it step by step:
Bisphosphonates are also available as an infusion, given only once a year at the practice — an alternative for people who find the weekly ritual difficult or who have gastrointestinal problems. Alongside these, further active substances are available, such as an antibody injected every six months or — with very high risk — building-up medication that actively forms new bone. Which preparation fits is decided by the practice based on T-score, risk and tolerability.
brite reminds you on the right day of the week of the empty-stomach dosing ritual and documents calcium, vitamin D and follow-up appointments without any gaps.
A question that occupies many affected people and is rarely answered clearly: Do I have to take the bisphosphonate forever? The answer is a clear no — with bisphosphonates there is the concept of the treatment break, known in the jargon as a "drug holiday".
The background is a special feature of this group of substances: bisphosphonates are deposited in the bones and go on working there for a while after they have been stopped. Unlike, say, a blood-pressure medication whose effect ends when it is stopped, with a bisphosphonate a reservoir remains in the bone. It is precisely this that allows the intake to be paused after some time without the protection being lost immediately.
As a rule, a treatment break is considered when the bisphosphonate has been taken as a tablet for about five years (or as an infusion for about three years) and the fracture risk has improved in the meantime. The reasoning behind it: with very long, uninterrupted use, unusual side effects can occur in rare cases. A break lowers this small risk, while the bone still benefits from the deposited substance reservoir.
Whether and when a break makes sense depends on the individual risk — with a very high fracture risk or after fractures already suffered, treatment is often continued without a break. Important to know: the concept of the treatment break applies specifically to bisphosphonates. With the antibody injected every six months the opposite is the case — here it precisely must not simply be paused, because the fracture risk rises quickly after stopping and a follow-on therapy is needed. The decision is always made by the treating practice.
Record in brite since when you have been taking your medication and when the next bone density measurement is due — the best basis for the conversation about a possible treatment break.
A porous bone breaks — but it usually only breaks when a fall is added. This is why fall prevention is just as important a part of the treatment as any tablet. Anyone who avoids falls prevents fractures right at the source. A few habits make the difference:
In everyday life the following also applies: keep moving. Stopping moving out of fear of fractures is the wrong path — taking it easy weakens muscles and bones further. Adapted, regular activity is the better protection. And: take your medication reliably and keep to the dosing ritual, because a therapy taken irregularly cannot reach its goal.
Osteoporosis is not treated in weeks but over years — with a special dosing ritual, several preparations and regular check-ups. The therapy only works if it runs reliably and correctly. That is exactly where brite supports you.
