Risk factors for osteoporosis

The risks of osteoporosis and fragility fractures include the following:

• personal history of fracture (1)
  • women with a history of fragility fractures are at an increased risk of further fractures ( independent of BMD)
  • people who have already had fracture include - those with loss of height or kyphosis which may indicate vertebral fractures (2)
  • people over the age of 50 with a history of fragility fractures should be offered DXA scanning to evaluate the need for anti-osteoporosis therapy (5)
    
    
• family history of osteoporosis
  • may be related to the genetic profile
  • should include maternal, paternal and sister history
  • family history should also include kyphosis and low trauma fractures after age of 50 years (not only the diagnosis of osteoporosis) (2)
  • people with a parental history of osteoporosis, particularly those over the age of 50, should be considered for fracture-risk assessment (5)
    
    
• female sex
  • women are at a greater risk of osteoporosis
  • however, secondary causes of osteoporosis are more common in men (2)
  • women over the age of 50 with a history of previously untreated early menopause should be considered for fracture-risk assessment, particularly in the presence of other risk factors (5)
    
    
• advanced age
  • as BMD decreases with age the risk of osteoporosis increases
    
    
• Caucasian or Asian race
  
  • compared to blacks, the risk of sustaining a fragility fracture is twice more in Caucasians (1)
  • caucasian men and women are at increased risk of fragility fractures at all sites compared with other ethnic groups. Black Caribbean women are at the lowest risk of any
    osteoporotic fracture (5)
    
    
• current smoker
  • smokers are considered at a greater risk of getting osteoporosis than non smokers
  • smokers over the age of 50 should be considered for fracture-risk assessment, particularly in the presence of other risk factors (5)
  • smokers should be advised to stop smoking to reduce their risk of fragility fracture (5)
    
    
• low body weight or low body mask index (BMI)
  • weight <127 lb [57.6 kg] in women and <154 lb [69.9 kg] in men
  • BMI <20 in women and <25 in men (3)
  • women and men with low BMD on DXA scanning should undergo further fracture-risk assessment to evaluate the need for anti-osteoporosis therapy (5)
    
    
• excessive consumption of alcohol, caffeine
  • alcohol
    • people over the age of 50 who consume more than 3.5 units of alcohol per day should be considered for fracture-risk assessment
    • people who consume more than 3.5 units of alcohol per day should be advised to reduce their alcohol intake to nationally recommended levels (<14 units per week)
      
      
• lack of physical activity and immobility
  
  
• history of falls (1)
  
  
• low calcium and vitamin-D intake
  
  
• use of certain medications
  • androgen deprivation therapy
  • anticonvulsants
  • glucocorticoids
  • high dose thyroxine (4)
    
    
• presence of certain medical conditions
  • untreated hypogonadism in men and women e.g. - premature menopause, bilateral oophorectomy or orchidectomy
  • inflammatory bowel disease
  • thyroid disorders

Reference:

• 1. Sweet MG et al. Diagnosis and treatment of osteoporosis. Am Fam Physician. 2009;79(3):193-200
• 2. Scottish Intercollegiate Guidelines Network (SIGN) 2003. Management of osteoporosis
• 3. Dell RM et al. Osteoporosis disease management: What every orthopaedic surgeon should know. J Bone Joint Surg Am. 2009;91 Suppl 6:79-86
• 4. International Osteoporosis Foundation and National Osteoporosis Foundation 2011. Osteoporosis: burden, health care provision and opportunities in the EU. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA)
• 5. SIGN (June 2020). Management of osteoporosis and the prevention of fragility fractures