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Multimodal osteoporosis treatment “Osteoporosis is complex but manageable“

Issue 01/2017

As an osteologist and pain therapist , Dr. Peter Schorr from the Vitarium Health Center in Dillingen/Saar knows a great deal about how the disease emerges and progresses. Schorr believes that a flexible straightening orthosis offers a very good option for treating stable vertebral fractures.

Bauerfeind life: You work in a facility that focuses on osteoporosis. How does that benefit patients?
Dr. Schorr: All physicians in our orthopedic group practice have been certified by the Dachverband Osteologie (Umbrella Association for Osteology – DVO) since 2004. This certification in bone metabolism disorders has to be renewed every five years, which means that patients are always treated by physicians who possess the latest knowledge in the field.

What type of patients seek you out?
Dr. Schorr: Most of our patients are women who come to us after menopause. However, we also have male patients. The knowledge all of these patients possess is varied. Some are well informed and just want to find out how high their risk is, while others already display symptoms. Many are completely surprised when they find out that their diffuse symptoms are being caused by osteoporosis.

Are more and more people learning about the disorder?
Dr. Schorr: Things have gotten better. There are a lot of informative reports in the media. However, even we doctors didn’t really become aware of osteoporosis until the 1980s. The disorder is tricky. For example, a patient can sit down abruptly and suffer a fracture of the vertebral body without having previously experienced a level of trauma one would consider necessary for this. It’s hard to predict something like that. Osteoporosis creeps up on people. The fractures in the initial stages are often compression fractures with diverse symptoms ranging from absolutely no discomfort to severe pain.

How do you treat osteoporosis at your center?
Dr. Schorr: First we need to determine if we’re dealing with primary hormone-related osteoporosis or secondary osteoporosis that results from risk factors. It’s therefore very important to draw up a detailed medical history in each case. We also measure bone density in the spinal and hip areas using the DXA method. Diagnoses and treatment decisions are carried out on the basis of the DVO guidelines: Depending on the results of the examination of the patient , we select the right medication to prevent further bone atrophy and prescribe vitamin D and/or calcium supplements. We often need to relieve pain as well , and as a pain therapist I can initiate a multimodal treatment. However, it takes more than painkillers and physiotherapy to alleviate pain. I also need to relieve pressure on skeletal sections of the spine subject to inappropriate mechanical stress – and I do this with orthoses.

Dr. Schorr likes the new Spinova Osteo because it straightens up the thoracic spine while also preventing hyperlordosis and allowing for movement.
Dr. Schorr likes the new Spinova Osteo because it straightens up the thoracic spine while also preventing hyperlordosis and allowing for movement.

How do orthoses support your multimodal treatment concept?
Dr. Schorr: Orthoses are designed to straighten the upper body and relieve pressure on sections of the ventral vertebral body. They can reduce the pain caused by static inappropriate mechanical stress and help prevent further fractures. It’s important to be able to adapt orthoses to individual body shapes. The idea is to achieve as much support as necessary with the least possible restriction, as patients will only wear an orthosis that they feel comfortable in. This is actually where the problem lies, as some orthoses work well when patients are standing but cause pressure or slide upwards toward the head when they sit down.

What’s your opinion of the new Spinova Osteo?
Dr. Schorr: There aren’t all that many orthoses that meet the requirements I’ve mentioned. The Spinova Osteo is a straightening orthosis that also works well when patients are seated. Its central axis ends in a form-fitting manner at the upper spine; it doesn’t slide up. It’s unobtrusive under clothing, provides for a secure enclosure of the pelvic area, and displays good stability in the back region. It straightens up the thoracic spine, but its structural design prevents hyperlordosis. The orthosis provides support toward the back and also allows for movement , which is extremely important.

Movement rather than stabilization?
Dr. Schorr: Both! Naturally, external stabilization is important in the case of fresh stable vertebral fractures, as such stabilization relieves pressure on the affected areas of the vertebral body and also alleviates pain. In this sense, stabilization makes it possible to reduce the use of painkillers, which is an important aspect with regard to older patients who may already be taking multiple medications or have problems with side effects and interactions. This in turn improves quality of life and makes things safer for patients – in the sense of preventing falls as well. At the same time, use of the right orthosis increases mobility, which is something we also want to see after a vertebral fracture because it’s important that patients begin to trust their bodies again and start moving. Orthoses with activating functions for back extensor muscles and trunk muscles can promote such trust and movement.

Is it just the muscles that benefit from the movement , or do the bones benefit as well?
Dr. Schorr: Movement and pressure and the associated muscle pull a have a positive effect on bone metabolism. The tension of the muscles exerts mechanical pressure on the bones. The piezoelectric properties of bones convert this mechanical force into electrical potential that impacts bone cell metabolism. This metabolism is out of balance in osteoporosis patients. Here, osteoclasts, which are cells that break down bone, are present in greater numbers than the osteoblasts that build up bone. However, when pressure is exerted on bones, the tables are turned: Growth of osteoblasts is stimulated and bone material becomes more solid again. In other words, the type of movement that the right orthosis enables can, in combination with other treatment steps, improve bone density in osteoporosis patients. This means that it’s important to choose an orthosis that’s conducive to the multimodal treatment.

Is osteoporosis curable?
Dr. Schorr: Let me put it this way: Osteoporosis is a complex condition that must be treated – but it can also be managed if you start treating it early and properly.

Images: Detlef Majer