Osteoporosis is a systemic skeletal disease, characterised by the reduction of bone mass and the impairment of the skeletal architecture as a whole.
The definition of the disease is essentially based on anatomopathological criteria, which attribute to the skeleton particular characteristics of fragility, such as making bone prone to fracture even after minor trauma.
Skeletal fragility can be diagnosed, thanks to current sensitometric methods, even in the absence of symptoms, therefore also in the absence of fractures.
Being a condition that heightens the risk of fracture, but that does not make itself necessary for the definition of the disease, osteoporosis can evolve in a completely asymptomatic way for a long time, in some cases even for a lifetime.
An increasing social phenomenon
Osteoporosis – explains Roberto Pessariello, professor of Radiology, head of the Department of Radiological Sciences, Sapienza University of Rome – is a phenomenon linked to an ageing population.This is why it is expected that osteoporosis patients with fractures will increase in the coming years.
Since ageing – adds Prof. Giovanni Luisetto of the Department of Medical and Surgical Sciences, Endocrinology Unit, University of Padua – is one of the main causes of bone density reduction, the countries with the highest elderly populations are those that are more affected by the social impact of the disease.
The most typical fractures following osteoporosis are those in the femur, vertebrae and wrist.
Involutive osteoporosis, that typical of the elderly, affects at least 40% of women after the menopause and concerns up to 90% of the over 90s.
Since osteoporosis is a disease that affects the entire skeleton, the discovery of low bone density in any area is a predictor of the risk of fracture.In other words, when the bone mass is too low to sustain minimal mechanical stresses, a situation of greater fragility of the skeleton is revealed.
Low skeletal mineral density is directly related to the risk of fractures of the vertebrae, wrist and hip and is the major risk factor for fractures in these areas.
Early menopause is also commonly associated with an increased risk of fracture. But this – explains Prof. Luisetto – is not so much because bone loss is faster, but rather because women have lower bone mass for a longer period of time.
Finally, having suffered a fracture, also traumatic, before the menopause, the risk of traumatic fracture after menopause increases.
It affects the quality of life
With osteoporosis, the skeletal segments become more and more fragile and can fracture following modest trauma.In other words, the quality of life is seriously affected if fracturing of one or more skeletal segments occurs, as their support function is also lost.
In the elderly, in particular, osteoporosis is subtle because it often remains dormant for a long time. When symptoms occur, they usually consist of bone pain, deformity of the spine (more or less linked to the decrease in height) and, in severe cases, fractures.
Often, vertebral pain may be confused with arthrosis, since this condition also afflicts the elderly. However, vertebral fractures mainly have a detrimental impact on the elderly’s quality of life. Such fractures lead to a variation in the position of the ribs, which incline forward together with the whole rib cage, which in turn is lowered. This situation can even result in severe pain.
Moreover, the curvature of the rib cage forward also has consequences on the function of the internal organs, especially on the respiratory system, because the movement of the diaphragm is partly hampered.
The areas most affected by vertebral fractures are the last dorsal and medial dorsal vertebrae.
It should be added that even the kyphotic posture, combined with the often more uncertain gait of the elderly and the decrease of sense of balance, can result in dangerous falls, which in turn can lead to fractures of the limbs, shoulder, elbow or, in even more severe cases, of the proximal femur, i.e. the hip. The latter is the most serious risk for the elderly, since it is an injury that requires surgery.
Although hospitalisation is relatively short, the rehabilitation phase is much longer, even if it is generally successful even in older patients, who usually regain good autonomy.
However, there are also more serious cases, in which the elderly person can no longer regain full autonomy and has to use walking aids.
Finally, in extreme cases the patient has to use a wheelchair to get around and needs continuous help at home or to be admitted to a nursing home or sheltered housing.
Osteoporosis and PEMF therapy
PEMF therapy is particularly indicated for the treatment of hard tissues and in delayed bone union, as in the case of osteoporosis, fractures, etc.
It is a form of therapy that uses pulsed low frequency and high intensity magnetic fields, referred to as PEMF (Pulsed ElectroMagnetic Fields).
Intensity usually not higher than 100 Gauss and reduced frequencies (not greater than 100 Hz) form the basis of PEMF therapy today, a traditional, non-invasive method, and, as already mentioned, particularly indicated for the stimulation of the regeneration of fractures and to slow the process of decreased bone density triggered by osteoporosis.
PEMF therapy can be applied either in a targeted way, concentrating the application on particular parts of the body, or in a total way, with the entire body being subjected to the beneficial action of pulsed magnetic fields.
The first method is applied in case of localised conditions, due to trauma, overload or degeneration, and in the case stimulating fracture healing. In particular, when the spine is involved (or a section of) there are specific devices that support the spine and consolidate portions of bone.
Total PEMF therapy, on the other hand, is used to stimulate the rebalancing of the entire metabolism and can help slow down the loss of bone mineral substance due to osteoporosis.
PEMF therapy, through the pulsed magnetic fields generated, interacts with the cellular structures, favouring the recovery of the physiological conditions of equilibrium.
It acts on cell membranes favouring the ion exchange between the two sides of the membrane. This leads to the restoration of the correct transmembrane potential that is essential to ensure the supply of nutrients within the cell.
Furthermore, in the case of nerve cells, there is a faster recovery of the membrane potential able to increase the pain threshold, thus inducing an analgesic effect.
The same action at an intracellular membrane level leads to the restoration of the optimal production of ATP, the molecule that provides energy to all the cellular structures of the body.
In terms of the body’s organs and structures, these effects translate into analgesia, a reduction of inflammation and a stimulation of the reabsorption of oedemas.
In addition, pulsed magnetic fields have a particular effect of stimulating the migration of calcium ions into the bone tissue, which is able to induce the consolidation of bone mass and promote fracture healing.
"Total body" therapy
As previously mentioned, osteoporosis is a systemic condition, i.e. it involves our body’s entire skeletal system.
As a result, treatment is necessary that allows you to act simultaneously on all areas affected by the disease without forcing the patient to undergo long and uncomfortable therapy sessions where they have to wear multiple applicators at the same time.
For treatments defined as “total body”, particular applicators such as the one in the photo come in handy.
The therapy takes place using a mattress containing different solenoids inside, able to emit the magnetic field across a very large surface.
One of the main advantages is that overnight sleep therapy is possible as this mattress provides a comfortable flat surface to lie on.
It is also suitable for daytime therapy in immobilised patients or for particularly active people (e.g. housewives, professionals, self-employed workers, etc.) who struggle to carry out long therapy sessions during the day and, therefore, prefer night therapy.
Treatment using PEMF therapy requires 90-120 days and applications of at least 4-8 hours a day, even divided into several applications, or performed during the night. The intensity can be adjusted within a range between 50 and 100 Gauss. Treatment can also be performed 2 times during the year.
Sources and Bibliography
- Adely, W.R. Whispering between cells: electromagnetic fields and regulatory mechanisms in tissue.Frontier Perspect, 3, 21-25, 1993
- Alpen, E.L. Magnetic field exposure guideline. In: Magnetic field effect in Biological systems.,cap.3, New York- London, T.S. Tenforde Ed., Plenum Press, 1979.
- Astumian, R. e Weaver, J.C. The response of living cells to very weak electric fields: the thermal noise limit. Science 247: 459-462, 1990.
- Baker, R.R.; Kennaugh, J.H.; Mather, J.G. Magnetic bones in Human sinuses, 301, 78-80. Nature, 1983.
- Barnothy, M.F. Biological Effects of Magnetic Fields. New York, Plenum Press, 1964.
- Basset, C.A.L.; Pawluk, R.J.; Pilla, A.A. A non operative salvage of surgically resistant pseudoarthrosis and non-union by pulsing electromagnetic fields,124, 128-143. Clin. Orthop. Rel. Res., 1977.
- Basset, C.A.L.; Pawluk, R.J. Acceleration of fracture repair by electromagnetic fields. A surgically non invasive method. Ann. New York Acad. Sci., 238, 2442-261, 1974.
- Basset, C.A.L.; Pawluk, R.J.; Pilla, A.A. Augmentation of bone repair by inductively coupled electromagnetic fields.Science 1974; 184:575-577.
- Betti, E.; Marchetti, S.; Cadossi, R.; Faldini, A. Effect of electromagnetic field stimulation on fractures of the femoral neck. A prospective randomized double-blind study. In Second World Congress for Electricity and Magnetism and in Biology and Medicine. Bologna June 8-13, 1997.
- Bistolfi, F. Campi Magnetici e Cancro. Torino, Ed. Minerva medica, 1985.
- Bistolfi, F. Campi Magnetici in Medicina. Torino, Ed. Minerva Medica, 1983.
- Bistolfi, F. Radiazioni Non Ionizzanti, Ordine, Disordine e Biostrutture. Torino, Ed. Minerva Medica, 1989.
- Bollet, A.J.; Trock, D.H.; Markoll, R. The effect of PEMF in the treatment of ostheoarthritis of the knee and cervical spine. Journal of rheumatology, 21-1903-1911, 1994.
- Brechna, H. Medical applications and biological effects of magnetic fields. Roma, 5th Intern. Magnetic Confer., 351-366, 1955.
- Chiabrera, A.; Nicolini, C.; Schwann, H.P. Interactions between magnetic fields and cells. Londra, Plenum press, 1985.
- Dal Conte, G.; Rivoltini, P. La Magnetoterapia. In: Elettroterapia, basi fisiologiche ed applicazioni cliniche, 143-152. Milano, Ghedini Editore, 1991.
- Del Giudice, E.; Doglia, S.; Milani, M.; Vitiello, G. Structures, correlations and electromagnetic interactions in living mater: Theory and applications. In: Biological Coherence and Response to External Stimuli, 49-64. Berlin-Heidelberg, H. Frohlich, ed., 1988.
- Fukada E.; Yasuda I. Piezoelectric effects in collagen. Jap. J. Appl. Phys., 3, 117-121, 1964.
- Gerardi, Gabriele; De Ninno, Antonella; Prosdocimi, Marco; Ferrari, Vanni; Barbaro, Filippo; Mazzariol, Sandro; Bernardini, Daniele; Talpo, Getullio. Effects of electromagnetic fields of low frequency and low intensity on rat metabolism, BioMagnetic Research and Technology 2008, doi:10.1186/1477-044X-6-3
- Giammarile, P. Magnetoterapia. Roma, Enrico Montagnoli E., 1987.
- Gigli Berzolari, A. Introduzione all’elettromagnetismo. Pavia, Ed. La Gogliardica Pavese, 1978.
- Goodman, E.M.; Greenebaum, B.; Marron, M.T. Effect of electromagnetic fields on molecules and cells. Int. rev. Cytol., vol.158:279-338, 1995.
- Guenel, P.; Lellouch, J. Effects of very-low-frequency electromagnetic fields on health: analysis of epidemiological literature. Paris Cedex 13, Les editions INSERM, vol.101, 1992. Opera citata qui, un interessante articolo sulla magnetoterapia in generale
- Hinsenkamp, M. Influence of physical factors on osseous consolidation. Bull Mem Acad R Med Belg, 151(12);517-26, 1996.
- Hinsenkamp, M.; Burny, F.; Donkerwolcke, M.; Coussaert, E. Electromagnetic stimulation of fresh fractures treated with Hoffmann external fixation. Orthopedics, 7: 3 411-416, 1984. Opera citata qui, un articolo completo sull’uso della magnetoterapia per la ricostruzione delle ossa e dei tessuti connettivi.
- Liboff, A.R.; Williams, T.; Strong, D.M.; Wistar, R. Time-varying magnetic fields: effect on DNA synthesis. 223:818-820, Science 1984.
- Mammi, G.I.; Rocchi, R.; Cadossi, R.; Traina, G.C. Effect of PEMF on the healing of human tibial osteotomies: a double blind study. Clin. Orthop. Rel. Res., 288: 246-253, 1993.
- Marchetti, N. Magnetoterapia in ortopedia. Indicazioni e risultati. Bologna, Aulo Gaggi Ed., 1988.
- Massidda, Piergiorgio e Bradimarte, Bruno. Principi e fondamenti di Magnetoterapia e Laserterapia, Iatreia 2003.
- Milazzo, G. Proceedings of the First International Meeting of the A.B.A.E.M. on Biological Effects and Therapeutic Applications of Electromagnetic Fields. Venezia, Bioelectrochemistry and Bioenergetics, Vol. 14, 23-25 febbraio 1985.
- Missoli, F. Trattato di Medicina Fisica e Riabilitazione, Vol. 2 1276-1291, UTET 2000.
- Polk, C. e Postov E. CRC handbook of biological effects of electromagnetic fields. Boca Raton,FL, CRC Press, Inc., 1986.
- Presman, A.S. Electromagnetic fields and life. New York-London, Plenum Press, 1970.
- Presti, D. e Pettinger, D.J. Ferromagnetic coupling to muscle receptors as a basis for geomagnetic field sensitivy in animals. Nature, 285, 99-101, 1980.
- Wood, A.W. Possible health effects of 50/60 Hz electric and magnetic fields:review of proposed mechanism. Australas Phys. Eng.Sci.Med., vol.16:1-21, 1993.
- Ortopedici e Sanitari, n° 8 novembre 2010, edito da Tecniche Nuove. Articolo a cura di Nicoletta Modenesi.