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Osteoporosis (physiological or pathological) is to be expected in about 7 million citizens of the Federal Republic. Fracture-promoting osseous atrophy, vertebral deformities limiting movement for maintenance of stability and skeletal pains due to muscular weakness and change of posture are the symptoms which frequently lead to disability. When osteoporosis turns to a disease in this way, then sodium fluoride therapy is recommended for reossification and restabilization of the bones. Prophylactically, for reduction of osteoporosis over the age of 40, light gymnastics, regular swimming and the avoidance of noxae which decrease the blood flow are to be advised.

In a prospective study 26 patients with primary or steroid-induced osteoporosis were treated for 15 months with a combined fluoride and calcium preparation. X-ray pictures showed no further aggravation or improvement in 70% of the cases. Bone mineral measurements of the axial skeleton showed no further bone loss in 38% and an increase in bone mineral mass in 54%. Improvement of subjective symptoms was observed in 92%. Recalcification began as expected after nine to twelve months of treatment.

Neither the bone-matrix theory of osteoporosis established by Albright in the 1940's nor the lack-of-calcium theory of the 1960's especially represented by Nordin, due to experimental tests and clinical results could be maintained. Here a new theory of osteoporosis is introduced, explaining osteoporosis not to be primarily a disfunction of calcium- or bone metabolism, but as a part-symptom of disfunction of the whole sustentaculum -bones, marrow, nucleus pulposus and musculation. Osteoporosis is predisposed by amyothenia respectively in activity and is initiated by reduced blood circulation of the sustentaculum. Certain relevant conclusions for prophylaxis and therapy of osteoporosis can be deduced without neglecting already the presently only effective therapy using sodium fluoride.

Osteoporosis as a disease is more than a mere development of porosity of the bone. Between the axial skeleton and the musculature of the trunk there are mutaual relationships affecting circulation, metabolism and function which become active in the genesis and development of an osteoporosis. For this reason, therapy must not only be directed towards reossification of the bony skeleton, but also to the elimination of muscular insufficiency and improvement of the functional capacity of the musculature of the trunk.

Based on the author's new haemodynamic biostatic theory of osteoporosis the typical symptoms of osteoporosis are demonstrated by X-ray, revised, interpreted and completed. Atrophy of trabeculae related to osteoporosis, consequences for vertebrae bodies and vertebrae column are chronologically explained. Introduction and distribution of force are discussed and the special importance of muscular system and discs to maintain supporting capacity is emphasized.

Every form of osteoporosis--except the physiological involution osteoporosis--requires treatment. Osteoporosis is no disease by itself but a result or a concomitant phenomenon of various diseases. Therefore the primary disease has to be treated also. Only for the so-called idiopathic osteoporosis hitherto no cause is known. Today sodium fluoride is the only substance with an influence upon the bone which may induce re-ossification and re-stabilization. In the described series of investigations this compound, with which treatment by gradual dosage is possible, has proved its effectiveness. Osteoporosis is more than bone porosity, therefore additionally afflicted organic or functional system like the muscular apparatus, bone marrow, or the intraosseous blood supply, must be treated too. Psychological guidance of the patient is necessary as he must be motivated for activity.

Dennert and Münzenberg recommend comparative examination of x-rays of the spine and coxal end of the femur both for the differentiation of physiological bone atrophy and pathological osteoporosis and for the gradual evaluation of osteoporosis. The systematic bone deterioration in the proximal section of the femur in physiological osteoporosis is absent in the pathological forms of osteoporosis where only the skleletal trunk is usually involved. Since quantitative examination procedures for the exact differenciation of osteoporosis are generally not available for the practice, the comparative examination represents an essential help for diagnosis and the gradual evaluation of osteoporosis. To support the interpretation of the findings from this procedure which is well suited for the practice, the chronological and local process of physiological and pathological osteoporoses (obtained by quantitative radiological measurements) are compared.

A new theory of the etiology of osteoporosis--inaugurated by the author and developed in cooperation with Fricke--is step by step elaborated and explained. Alteration of the bone marrow is observed simultaneonly with osteoporosis--caused by reduced blood flow in bone and bone marrow, and promoted by reduced muscle work, i.c. inactivity, influencing blood circulation in bone and bone marrow. Alteration of statics and vertebral bodies resulting from bone atrophy and reduced muscular force are newly interpreted by a new theory capabilities of radiological osteoporosis-diagnostis are preceding.

According to a theory of the authors both senile osteoporosis and pathologic osteoporoses (rheumatic, in diabetes, bronchial asthma, pulmonary emphysema, portal hypertension and Cushing's disease) are due to disturbances of the circulation of the blood in bone. Every type of stasis in the sinusoids, be it due to reduced arterial supply or venous stasis or to a reduction of extravascular fluid-pressure will provoke an increase in osteoclastic activity and thus osteoporosis.