Osteoporosis is one of the most common and yet greatly underestimated diseases of old age. It develops insidiously and goes unnoticed for a long time – until a fracture occurs. Osteoporosis-related fractures – especially femoral neck and vertebral body fractures – are associated with impaired quality of life and increased mortality and determine the high level of suffering of those affected. But it doesn’t have to be that way!

With modern diagnostic methods such as DXA bone density measurement, we can identify your risk at an early stage and then initiate targeted preventive measures. At the Z.O.R. – the Center for Orthopedics & Regenerative Medicine in Münster, orthopedist and osteologist Dr. Ulrich Frohberger relies on this precise, low-radiation technology to optimally protect your bone health as well. Find out in this article why early examination is so important and what advantages DXA technology offers.

Overview:

What is osteoporosis and why measure bone density?

Osteoporosis is a systemic disease characterized by a decrease in bone strength and structure. It often results in painful and serious fractures of vertebral bodies and femoral neck bones, significantly reducing quality of life and life expectancy. The causes can be genetic predispositions. However, in most cases, avoidable systemic metabolic disorders, eating habits and other lifestyle factors lead to osteoporosis. Particularly in regenerative medicine, immunological laboratory and stool examinations and, not least, genetic tests are becoming increasingly important for determining individual risk. It is becoming more and more common to initiate a causal therapy.

In Germany, an estimated 6 to 8 million people are affected by osteoporosis – women aged 50 and over and men aged 55 and over are the main focus. However, it is difficult to say exactly because the disease often goes undetected (Bone Evaluation Study 2013). Risk factors such as age, gender, numerous medications and pre-existing conditions also increase the risk of fractures, which is why we at Z.O.R – a center of excellence for osteoporosis – consider early bone density measurement to be essential and highly recommend it to our patients.

Bone density measurement – early diagnosis with DXA technology

Modern diagnostic techniques, in particular DXA technology, provide precise insights into bone health. Accurate diagnostics are a necessary prerequisite for preventive measures and individual therapy proposals, as we initiate them for you as an orthopaedic in Münster. With innovative approaches and a personal consultation approach, Dr. Frohberger offers DXA bone density measurement to provide his patients with the best possible support and to help them overcome their fear of possible fractures.

What does a DXA bone density measurement cost for patients with statutory health insurance?

DXA Münster Dr. Frohberger

Was ist eigentlich die Knochendichte?

Dichte ist ein physikalischer Begriff und beschreibt, wie viel Masse eines Materials in einem bestimmten Volumen vorhanden ist. Die Knochendichte gibt an, wie viel mineralische Substanz sich in einer bestimmten Knochenmenge befindet. Analog zur Dichte von Wasser oder Metall lässt sich die Knochendichte als Masse pro Volumen definieren. Doch während eine höhere Dichte oft mit Stabilität gleichgesetzt wird, ist dies beim Knochen nur ein Teil der Wahrheit. Denn nicht nur die Menge an Knochensubstanz ist entscheidend, sondern auch deren Struktur.

Auf die Knochenstruktur kommt es an!

Während Wasser eine homogene Struktur besitzt, ist Knochen ein hochkomplexes, dreidimensionales Gewebe aus fein vernetzten Knochenbälkchen und Hohlräumen. Die Stabilität des Knochens hängt nicht nur von der reinen Masse ab, sondern auch davon, wie diese Struktur aufgebaut ist. Ein dichter, aber unregelmäßig angeordneter Knochen kann weniger stabil sein als ein feingliedrig strukturierter Knochen mit gleichmäßig verteilten Knochenelementen. Daher definiert sich Osteoporose nicht nur über eine verringerte Knochendichte, sondern auch über eine gestörte Mikroarchitektur des Knochens. Studien zeigen, dass insbesondere diese strukturellen Veränderungen zu einer erhöhten Brüchigkeit des Knochens führen.

Die Rolle der Knochendichtemessung

Die DXA – Knochendichtemessung dient der Überprüfung, ob eine niedrige Knochendichte vorliegt und damit die Kriterien einer Osteoporose und der belegten Wirksamkeit einer spezifischen medikamentösen Therapie erfüllt werden. Weiter dient sie der Erfassung des Ausmaßes der Knochendichteerniedrigung. Dies ist wiederum wichtig für die Abschätzung des individuellen absoluten Frakturrisikos und der damit verbundenen Empfehlungen der therapeutischen Maßnahmen.

The new version of the guidelines from 2023 recommends using the minimal TOTAL HIP T-score for both hips in addition to the lumbar spine to determine the therapy threshold. For the lumbar spine, the mean T-score of those vertebrae from L1-L4 is determined using quantitative digital radiography DXA, for which a prognostically evaluable measurement is possible. At least two vertebrae must be evaluable.
Evaluation is impeded, for example, by spondylophytes, vertebral fractures, degenerative changes > of grade 2 according to Kellgren, significant scoliosis and torsion scoliosis.

When is basic diagnostics necessary?

Basic diagnostics should be recommended as a case-finding strategy for postmenopausal women and men aged 50 and over with a risk constellation for fractures considered relevant by a physician. Taking into account the absolute risk of fracture.

For all fractures occurring after the age of 50, especially if there is evidence of a fragility fracture. This also applies to postmenopausal women and men under the age of 50 and when planning treatment with glucocorticoids with a prednisolone equivalent of over 7.5 mg/day for > 3 months.

It should be offered to everyone turning 70.

Depending on the individual risk factor profile, this may also apply to women and men under the age of 50 if there are immediate therapeutic or diagnostic consequences and if the risk is current or has been present for less than 1-2 years.

A basic osteoporosis diagnosis includes several examinations, depending on the initial examination findings. A specific diagnosis is made if there are indications of secondary osteoporosis, a nutritional anamnesis, examination of the overall function of the musculoskeletal system including muscular function, indication of gait instability, dysfunction, etc.

To clarify an increased risk of falling, assess muscle strength and coordination, especially after previous falls, in patients aged 70 and over or with indications of impairment, carry out “geriatric assessment examinations” (Timed Up-and Go-, Chair-Rising-Test, etc.).

IHHT Individual mitochondrial medicine

Excellent diagnostics in the Z.O.R.

In order to detect osteoporosis at an early stage or to determine a possible risk, we offer a much more comprehensive, additional diagnostic examination at the Z.O.R. Münster. This includes:

  • Manual full body examination
  • Risk of falling analysis “osteological fall assessment”
  • 3D gait analysis and muscle strength measurement
  • X-rays of the spine and hip joints (if necessary)
  • Laboratory tests in serum, whole blood, stool, and, if necessary, saliva and urine

DXA bone density measurement: modern, low-radiation procedure

One of the most precise methods for diagnosing osteoporosis is the DXA bone density measurement (dual-energy X-ray absorptiometry). This low-radiation X-ray procedure precisely measures the density of the bones and allows a differentiated determination of the severity of osteoporosis. This not only allows an early detection of a loss of substance, but also the success of an already initiated therapy to be monitored.

The examination using DXA technology is characterized by its low-radiation application, which makes the procedure suitable for older people and patients with risk factors. Patients benefit from the early identification of low bone density, so that preventive steps can be taken.

Ein weiterer Vorteil ist die individuelle Anpassung der Therapie. Anhand der Messergebnisse, die als T-Score dargestellt werden, und zusätzlicher Risikofaktoren kann das Risiko zukünftiger Frakturen unter Berücksichtigung der aktuellen Leitlinien des deutschen osteologischen Dachverbands DVO sehr genau abgeschätzt werden. Dies ermöglicht eine gezielte Planung spezifischer diagnostischer und therapeutischer Ansätze, die auch verschiedene medikamentöse Therapien zur Hemmung des Knochenabbaus oder zur Förderung der Knochenbildung sowie Änderungen des Lebensstils und der Ernährung umfassen können.

 

Die Untersuchung der Knochendichtemessung gestaltet sich als ein unkomplizierter und für unsere Patienten angenehmer Prozess, der innerhalb weniger Minuten abgeschlossen ist. In der entspannten Atmosphäre des Z.O.R beraten wir Sie umfassend, sodass sie sich während der gesamten Untersuchung gut aufgehoben fühlen. In Ergänzung zur eigentlichen Messung führen wir zudem eine ausführliche Anamnese sowie entsprechende Laborauswertungen durch, um Ihre individuellen Risikofaktoren und Vorerkrankungen zu berücksichtigen.

Unsere persönliche Betreuung sorgt dafür, dass der gesamte Ablauf für Sie komfortabel verläuft und wir die Messergebnisse ausführlich mit Ihnen besprechen.

Osteoporosis is not inevitable.

If detected early, there is a lot we can do about it.

After your examination, the results of the bone density measurement, including a T-score, will be displayed. This value tells us the extent to which you have a reduction in mineral salt content and is an important factor in assessing your risk of fracture.

Depending on the test results, we will recommend holistic, integrative therapeutic approaches. These may include medication, lifestyle changes such as targeted physical activity, and dietary adjustments.

Regular monitoring of the abnormal values in the Z.O.R ensures the success of the measures taken and enables us and you to make adjustments during the course of treatment.

Preventing osteoporosis with functional medicine

At the Z.O.R., we don’t just focus on treating illnesses. We much prefer to prevent you from becoming ill in the first place. That’s why an early bone density measurement can identify risks at a very early stage, which we want to minimize together with you. The integrative, functional medicine practiced by Dr. Frohberger knows many ways to influence your risk of developing osteoporosis. Functional medicine does not consider osteoporosis as an isolated disease of the bones, but as a systemic problem influenced by various factors.

We focus on the underlying causes and individual risk factors, rather than just treating the symptoms.

Osteoporosis prevention from the Z.O.R. perspective

A nutrient-rich, anti-inflammatory alkaline diet plays a central role. This should be rich in micronutrients that are essential for bone health, in particular:

  • Vitamin D3 and K2 to improve calcium absorption and utilization
  • Magnesium for bone metabolism
  • Omega-3 fatty acids for the reduction of chronic inflammation
  • Antioxidants from vegetables and berries protect bone cells
  • High-protein food to support muscle strength and bone substance

The absorption of calcium and other essential nutrients depends largely on an intact intestinal flora and an uninflamed intestinal mucosa. Dysbiosis (imbalance of intestinal bacteria) and leaky gut syndrome – with the consequence of reduced absorption capacity for minerals and phytochemicals – as well as a cause of polyarthritic symptoms, can lead to poor nutrient utilization and thus increase the risk of osteoporosis.

Hormones such as estrogen, testosterone, cortisol and thyroid hormones play a crucial role in bone health. At Z.O.R, we use natural methods of hormone regulation, such as diet adjustments, stress management and targeted supplementation of bioidentical hormones.

Long-term stress leads to increased cortisol levels, which promote bone loss. Techniques such as meditation, breathing exercises and sleep optimization, as well as intermittent hypoxia/hyperoxy therapy (IHHT) to improve oxygen transport and, in particular, intracellular mitochondrial metabolism, possibly supplemented by an infusion treatment (10x) with mitotrope substances, help to reduce the vegetative and biochemical stress level.

Physiotherapeutic manual therapy to mobilise blocked vertebral joints and stretch shortened muscle groups, combined with targeted physiotherapy exercises under the direction of experienced sports physiotherapist Anna Wienen, create the conditions for improved trainability of the entire muscular system.

Strength training in the Z.O.R under the direction of Marlon Frohberger can promote new bone formation by improving muscular performance and directly influencing the bone system.

Likewise, balance training and training on the SinfomedVibe vibration plate reduces the risk of falls.

We consider exposure to heavy metals (e.g. mercury, lead, cadmium and many others) to be a possible risk factor for osteoporosis. A targeted examination of saliva for toxic metals, e.g. from dental implants, and of whole blood for nutrition-related exposure, e.g. to saltwater fish, provides important information in this regard. Targeted detoxification measures and the reduction of environmental toxins help to counteract this.

In addition to the DXA bone density measurement, comprehensive laboratory analyses in serum and in particular in whole blood and stool provide us with valuable insights into possible metabolic disorders that affect bone metabolism.

At Z.O.R, we view osteoporosis as a multifaceted disease that cannot be prevented by calcium supplementation alone. Instead, a systematic, personalized approach is needed that combines nutrition, gut health, hormones, stress management, and exercise.

FAQ

The cost of a DXA bone density measurement is usually between €50 and €100, depending on the scope of the examination. Private health insurance companies usually cover the costs in full, while statutory health insurance companies only cover the costs under certain conditions and to a very limited extent.

 

The measurement is particularly recommended for women over 50 and men over 55, as the risk of osteoporosis increases significantly in these age groups. In addition, people with known risk factors such as a family history of osteoporosis, long-term cortisone therapy or certain chronic illnesses such as rheumatism, diabetes, or disorders of the digestive system should consider an early examination.

The examination is painless and takes only a few minutes. You will lie partially undressed on an examination table while the DXA X-ray machine measures your bone density at specific points on the body – usually the hip and the lumbar spine – using a low dose of radiation.

The radiation exposure of the DXA bone density measurement is extremely low – far lower than with a conventional X-ray. It therefore does not pose a health risk even for sensitive patient groups.

The DXA bone density measurement is considered the gold standard in osteoporosis diagnostics. The measured values are precise and enable an accurate assessment of the individual’s risk of fracture and a follow-up.

Protect your bone health before it’s too late – have your bone density measured professionally at the Z.O.R. Münster and get clear recommendations for prevention and treatment!