Osteoporosis: Understanding, Preventing, and Treating Bone Loss—An Expert Interview with Prof. Moghaddam

Professor Arash Moghaddam-Alvandi, M.D., is an outstanding specialist in orthopedics and trauma surgery who brings his expertise to the Aschaffenburg Private Medical Center. His extensive clinical and scientific experience has made him a highly respected physician in the orthopedic and trauma surgery community. With additional specializations in specialized trauma surgery, specialized orthopedic surgery, and physical therapy, Prof. Dr. med. Arash Moghaddam-Alvandi has earned an excellent reputation.

His in-depth knowledge spans the diagnosis and treatment of various orthopedic conditions and injuries of the musculoskeletal system. As an expert in orthopedics, he effortlessly manages complex cases of degenerative conditions and the consequences of injuries, guiding his patients on their path to recovery and ensuring personalized care. Particularly noteworthy is his experience in performing surgeries on the hip, knee, and shoulder joints, as well as in hand and foot surgery. In these areas, he successfully treats a wide variety of conditions and injuries to alleviate pain and restore function. Through thorough diagnostics and personalized treatment, he slows the progression of the disease and reduces the risk of fractures.

In addition to surgical procedures, Prof. Dr. med. Arash Moghaddam-Alvandi is distinguished by his broad range of joint-preserving therapies. These include non-surgical approaches such as autologous blood therapy, platelet-rich plasma (PRP), hyaluronic acid, and physical therapy. These therapies aim to relieve pain, reduce inflammation, and improve joint mobility. In addition, he has long been particularly interested in the diagnosis and treatment of osteoporosis.

Prof. Dr. med. Arash Moghaddam-Alvandi creates a trusting atmosphere in which patients feel comfortable and well cared for, and he takes the time to answer all of their questions and address their concerns, provides comprehensive information about their condition and treatment, and—through his dedication, professional expertise, and patient-centered approach—helps numerous patients achieve a better quality of life. The editorial team of the Leading Medicine Guide spoke with Prof. Dr. med. Arash Moghaddam-Alvandi about osteoporosis, a condition that affects approximately 885,000 people in Germany each year.

Osteoporosis is a common chronic condition in which bone density and bone mass decrease beyond normal levels. In German, osteoporosis is therefore also known as “bone loss.” As a result, bone stability decreases, and the bones become porous and brittle. The risk of bone fractures increases. Women, in particular, are at higher risk for osteoporosis due to hormonal changes during menopause.

Various diagnostic procedures are used to identify osteoporosis. 

Dual-energy X-ray absorptiometry (DXA) is the most commonly used method for measuring bone density. Using a low dose of radiation, specialized X-ray images are taken of various body regions, typically the spine, hip, and wrist. Quantitative computed tomography (QCT) measures bone density using CT scans and is often used for the spine. It provides a more detailed analysis of bone structure. Ultrasound measurement determines the speed of sound through the bone, which can indicate bone density. 

“However, bone density measurement is only one component in identifying osteoporosis. Above all, the patient’s risk factors must also be analyzed, such as age, medications being taken, whether the patient smokes, and so on. This provides a fairly good risk assessment. Relying solely on bone density measurement can actually be detrimental, as it can give a false sense of security. There have been patients whose bone density results were normal, but who then presented with pain shortly afterward and were ultimately diagnosed with osteoporosis. “A comprehensive assessment is therefore very important,” explains Prof. Dr. Moghaddam at the beginning of our conversation, highlighting the false sense of security provided by a bone density test. “I’m also a trauma surgeon, and I’d like to emphasize that about one-third of bone fractures in older adults could generally be prevented through proper osteoporosis treatment. Fractures of the femoral neck, for example, can be life-threatening (especially in older people) or, depending on age, can also result in patients requiring long-term care. That’s why an osteoporosis screening is so important!” Prof. Dr. Moghaddam clarifies. 

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The World Health Organization (WHO) has recognized osteoporosis as one of the ten most serious global diseases. Approximately 200 million people worldwide—including 44 million in the U.S. and 7.6 million in Germany—suffer from this condition. A lifestyle characterized by a lack of physical activity and an unbalanced diet increases the risk of osteoporosis. Particularly in Western industrialized nations, where life expectancy is steadily rising, there is a significant number of patients who are not receiving appropriate treatment. The costs incurred in Germany due to osteoporosis and related fractures are steadily rising and are estimated at approximately 5 billion euros per year. It is therefore crucial to have a reliable and cost-effective tool for diagnosing osteoporosis. A study has shown that a simple medical questionnaire consisting of ten questions serves as a reliable test for quickly and effectively identifying a large number of patients with reduced bone density. Early detection of reduced bone density and the subsequent initiation of anti-osteoporotic therapy can reduce the risk of osteoporotic fractures, which are associated with high morbidity and mortality. This can lead to significant savings in healthcare costs for health insurance providers.

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Symptoms of Osteoporosis.

Osteoporosis is a progressive bone disease and often remains asymptomatic in its early stages. As the disease progresses, however, various signs may appear. “Back pain, especially in the lower back, could indicate vertebral fractures. Anyone experiencing this should take notice, especially if the pain is centered in the middle of the back,” Prof. Dr. Moghaddam emphasizes. The gradual loss of bone mass and vertebral fractures can gradually lead to a gradual decrease in height. A forward-leaning posture and reduced height are also possible consequences. The increased fragility of the bones makes people with osteoporosis more susceptible to fractures, especially in areas such as the hip, shoulder, wrist, and spine. The diagnosis is often not made until fractures occur, which underscores the importance of early detection and prevention. 

“The first step I take is to encourage the patient to be active. This means it is essential to motivate them to exercise. In addition, I prescribe vitamin D3 in combination with calcium,” explains Prof. Dr. Moghaddam. Both nutrients play a crucial role in bone metabolism. Calcium is an essential building block of the skeletal system and supports bone strength. Vitamin D3, in turn, is essential for calcium absorption in the intestines. Adequate vitamin D levels ensure that the body can efficiently absorb calcium from food. “The combination of vitamin D3 and calcium is particularly important for preventing bone loss in osteoporosis and promoting bone health. A deficiency in these nutrients can lead to a decrease in bone density, which increases the risk of fractures. Therefore, this combination is often recommended as a supportive measure in the treatment of osteoporosis as a basic medication, especially for individuals at higher risk of vitamin D deficiency or for older adults whose natural vitamin D synthesis may be reduced due to insufficient sun exposure,” explains Prof. Dr. Moghaddam.

Osteoporosis can be classified into different severity levels based on bone density and the associated risk of fracture. 

Classification is often based on T-scores, which represent the deviation of an individual’s bone density from the average of a young, healthy person.

• Normal: T-score above -1
• Osteopenia (reduced bone density): T-score between -1 and -2.5
• Osteoporosis: T-score of -2.5 or lower
• Severe osteoporosis: T-score of -2.5 or lower with a history of fractures

The frequency of bone density measurements to monitor the progression of osteoporosis depends on various factors, including the individual’s risk profile and existing risk factors. “I recommend that my patients come in for an osteoporosis checkup once a year if they have already suffered a fracture. If a person has not yet suffered a fracture, it is sufficient to have the checkup every two years,” advises Prof. Dr. Moghaddam. If there are additional health conditions that influence the risk of osteoporosis, this can affect the frequency of monitoring.

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New App Enables Rapid Osteoporosis Risk Assessment

An innovative osteoporosis risk calculator app is now available to predict the risk of fracture due to osteoporosis over a three-year period. The app is based on the osteoporosis guidelines published in September 2023 and uses various parameters, including age, gender, T-score from a hip DXA scan (Dual-Energy X-ray Absorptiometry, an imaging method for measuring bone density), as well as risk factors and comorbidities. The guideline recommends a short-term risk assessment, in contrast to the previous 10-year assessment. The app assists physicians and healthcare professionals in calculating fracture risk and provides clear recommendations for diagnosis and treatment. It complements the paper-based risk calculations in the guideline and does not use any personal data.

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There are various approaches to treating osteoporosis, including pharmacological and non-pharmacological options. 

Bisphosphonates, such as alendronate and risedronate, inhibit bone resorption and are taken orally. A potential drawback may be gastrointestinal side effects. “The drawback of bisphosphonates is that the consistency of the bone—which normally resembles that of a piece of wood—can become stone-like, with a marbled texture. The administration of bisphosphonates deeply interferes with the body’s biology. Therefore, this medication should not be administered indefinitely. It is necessary to take a six-month break after approximately two years. However, I expect these medications to improve over the next few years, allowing for more physiologically appropriate bone resorption,” notes Prof. Dr. Moghaddam.

Denosumab, on the other hand, is a monthly antibody that inhibits bone resorption. A potential drawback is the increased risk of infections and skin reactions. “With long-term use, this can lead to what is known as osteonecrosis of the jaw, a serious condition in which bone tissue in the jaw area dies. In that case, treatment must be discontinued immediately. A dentist should always be consulted before any treatment with denosumab. If dental treatment is scheduled during therapy with denosumab, the medication must also be paused,” advises Prof. Dr. Moghaddam, before turning to non-pharmacological treatment options: “Due to our modern lifestyles, we generally don’t get enough exercise, spend too little time outdoors in the fresh air, don’t get enough sun, and at the same time, we’re living longer and longer. I recommend that everyone spend at least 45 minutes outdoors doing something they actively enjoy. Eating a sufficient amount of calcium-rich foods also supports bone strength.”

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Bisphosphonates are medications used to treat bone diseases such as osteoporosis, bone metastases, and Paget’s disease. They inhibit bone resorption and can reduce the risk of fractures. The mechanism of action of bisphosphonates is based on their structural similarity to pyrophosphate, a natural substance in the body that is involved in bone formation and mineralization. Bisphosphonates selectively bind to hydroxyapatite crystals (mineral compounds) in the bone, particularly at sites where bone resorption is occurring. The drugs are taken up by osteoclasts, which are responsible for bone resorption, and inhibit these enzymes. However, bisphosphonates can also cause side effects in the jaw area. These side effects involve inflammation of the bone and surrounding soft tissues, which can progress to jawbone loss. Dentists refer to this as bisphosphonate-induced osteonecrosis of the jaw (BONJ for short). Monitoring and treating these side effects require careful attention. Dentists are generally responsible for monitoring patients undergoing bisphosphonate therapy. Regular dental checkups and thorough oral hygiene are crucial for detecting signs of BONJ early on.

Raloxifene belongs to the group of selective estrogen receptor modulators (proteins that respond to the effects of estrogen). It not only reduces bone resorption but also decreases calcium loss through the kidneys, leading to an increase in calcium levels in the body. Raloxifene can be used both to treat and prevent bone loss during menopause.

Teriparatide, which is similar to the body’s own parathyroid hormone, stimulates bone formation. It is administered as an injectable solution, particularly for the treatment of osteoporosis during menopause.

Denosumab is an antibody-based medication that specifically targets bone metabolism. It prevents the maturation of bone-resorbing cells (osteoclasts).

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Trust and a duty of care are Prof. Dr. Moghaddam’s top priorities.

“In my practice, I always take plenty of time for my patients and conduct a very thorough diagnosis. I rule out any potential pain the patient may be experiencing and encourage the patient to be active. Using imaging and functional testing, as well as robotics and AI (artificial intelligence), I can thoroughly analyze the patient and develop a personalized treatment plan,” says Prof. Dr. Moghaddam, describing his approach in his practice, and concludes our conversation with the following appeal: “If you’ve been suffering from back pain for an extended period, please always consider the possibility of osteoporosis and get checked! The earlier treatment can begin, the better!”

Dear Professor Dr. Moghaddam, thank you very much for these important insights on osteoporosis and your urgent advice!