ENOsteoporosis treatment in Germany is built around the risk of the next fracture, not a single number on a scan. Often it starts with a fall: an elderly mother slips in the kitchen and breaks her wrist. Or someone loses a couple of centimetres in height and develops back pain. Osteoporosis does not hurt for a long time; the first sign is often a fracture.
This page explains how osteoporosis is treated in Europe and in Germany, from tests and medicines to fracture surgery and travel.
What osteoporosis is and who is at risk
Osteoporosis is a disease in which bone loses its density and inner lattice and becomes fragile; it mostly affects women after the menopause and older people. Such bone breaks under minor strain, such as a fall from standing height, typically in the spine, hip, wrist or shoulder.
Other risk factors are a hip fracture in a parent, long-term corticosteroids such as prednisolone, rheumatoid arthritis, an overactive thyroid or parathyroid gland, low body weight, smoking and repeated falls. Men get osteoporosis too, though less often than women.
Tests: bone density scan, blood tests and risk assessment
The work-up combines a DXA bone density scan, blood tests and a fracture risk calculation. DXA is a painless, very low-dose X-ray of the lower spine and hip. Its T-score compares your bone density with that of healthy young adults of the same sex; by the WHO definition, a T-score of −2.5 or lower means osteoporosis.
Blood tests look for causes of bone loss and for look-alike diseases: calcium, phosphate, kidney and liver function, thyroid hormone and inflammation, plus parathyroid hormone, vitamin D or, in men, testosterone when indicated (see hormone tests). Back pain or lost height calls for a spine X-ray or MRI to find silent vertebral fractures.
In its 2023 guideline, the DVO, the umbrella body of German-speaking osteology societies, bases the decision on medicines on the three-year risk of hip and vertebral fractures, calculated from bone density, age, sex and risk factors. The current text is the DVO osteoporosis guideline in the AWMF register.
How osteoporosis is treated in Europe: from calcium to bone-building medicines
How osteoporosis is treated in Europe rests on shared foundations: the European Medicines Agency authorises the medicines for the whole EU, and European guidance from specialist societies sets out assessment and treatment. In Germany, the DVO guideline now measures risk over three years instead of ten. The basis for everyone is exercise for strength and balance with a physiotherapist (see physiotherapy in Germany), a home without tripping hazards, calcium from food, vitamin D if needed, and no smoking.
The first group of medicines slows bone breakdown: bisphosphonates, as tablets or infusions, and denosumab, injected under the skin every six months. Denosumab must not be stopped without switching to another medicine: afterwards bone breakdown rebounds, the density gained is lost quickly and the risk of vertebral fractures, sometimes several at once, rises. So after denosumab the doctor usually prescribes a bisphosphonate.
At very high risk, for example after recent vertebral fractures, treatment often starts with bone-building teriparatide or romosozumab. Each has limits: a teriparatide course is limited in time, and in the EU romosozumab is approved only for women after the menopause with severe osteoporosis and must not be given to anyone who has had a heart attack or stroke. Afterwards, a medicine that preserves the gain follows. Medicines lower the risk of new fractures but do not rule it out.
Osteoporotic fractures: what surgeons do
Surgeons usually treat a vertebral fracture without an operation and operate on a hip fracture as early as possible. A vertebral fracture gets pain relief, a brace if needed and early mobilisation; if pain persists, kyphoplasty may follow: a balloon is passed through a needle into the vertebra, inflated, and the space filled with bone cement. Hip surgery in Germany takes place, as a rule, within 24 hours of admission, using screws, a nail or a joint replacement.
Older patients can be treated in orthogeriatric trauma centres (Alterstraumatologie), where trauma surgeons and geriatricians work together and also treat the osteoporosis after surgery, as the risk of another fracture is especially high right after one. Prof. Ulrich Spiegl, chief of trauma surgery and orthopaedics at München Klinik Harlaching, works in geriatric trauma and spine surgery and is deputy head of the working group on osteoporotic vertebral fractures in the spine section of the German Society for Orthopaedics and Trauma Surgery (DGOU). Dr Matthias Hesse is chief of trauma surgery and orthopaedics at DRK Kliniken Berlin Köpenick, where he co-leads the joint replacement centre and the geriatric trauma centre.
Frequently asked questions
Can osteoporosis be cured?
Osteoporosis is a chronic condition: it usually does not go away completely, but it can be kept under control. Medicines lower the risk of fractures, and bone-building ones raise bone density markedly. Treatment lasts for years; the doctor checks tolerance and new fractures, repeats scans if needed and decides whether to continue, switch or pause.
Can osteoporosis medicines harm the jaw?
Jaw problems are possible but rare. Bisphosphonates, denosumab and romosozumab can cause osteonecrosis of the jaw, damage to the jaw bone that may show as pain, mouth sores or loose teeth. The German guideline therefore advises a dental check when treatment starts and regular check-ups afterwards, without delaying the osteoporosis treatment.
How is osteoporosis treated in men?
Mostly with the same medicines as in women: zoledronic acid, a bisphosphonate, as well as denosumab and teriparatide are approved in the EU for men at increased risk of fracture. The exception is romosozumab, approved only for women after the menopause. Doctors also look for a cause of bone loss, such as low testosterone or long-term corticosteroids.
Who treats osteoporosis and how AlenMed arranges it
In Germany, osteoporosis is treated by endocrinologists, orthopaedic surgeons and rheumatologists trained in osteology, and AlenMed arranges tests and treatment with them. Complex cases, such as osteoporosis in young people or with hormonal disease, go to endocrinology departments (see endocrinology in Germany); fractures and operations belong to orthopaedics and trauma surgery.
AlenMed collects your scans and test results, has them translated and sends them to an osteologist or a geriatric trauma centre. We obtain the hospital’s estimate, arrange the visa invitation and provide an interpreter. The work-up can fit into a short trip, with treatment continuing at home on a written plan. AlenMed’s office is in Munich; partner hospitals are across Germany.
This material is for information only and is not an offer. The treatment plan is decided by a doctor at an in-person consultation.
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