Who Is at Risk for Osteoporosis?

It is important to know the common risk factors for osteoporosis in order to be able to take preventive measures to delay or avoid low bone density later in life.

Risk Factors for Osteoporosis

Several key risk factors for developing osteoporosis include:

• Advanced age. The process of bone growth (called bone remodeling) naturally slows down as a person ages, creating a higher risk for osteoporotic fractures after age 65.
• Sex. In general, women are at a higher risk than men due to naturally thinner bones and lower bone mass.¹Osteoporosis Overview. The National Institutes of Health Osteoporosis and Related Bone Diseases - National Resource Center. https://www.bones.nih.gov/health-info/bone/osteoporosis/overview. Updated October 2018. Accessed April 2019.
• Family and personal history of fractures. A personal history of broken bones or fragility fractures in adulthood (past age 45) can indicate an increased risk of osteoporosis. Additionally, if a parent (especially the mother) has had osteoporosis or fragility fractures in adulthood, the risk of osteoporosis may be greater.
• Genetic predisposition to low bone density. Peak bone mass is reached between ages 18 and 25, and is mostly determined by genetic factors.²Cosman F, de Beur SJ, LeBoff MS. Clinician’s Guide to Prevention and Treatment of Osteoporosis. Osteoporos Int. 2014;25(10):2359–2381. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4176573/. doi:10.1007/s00198-014-2794-2. In particular, the body’s reception of vitamin D is largely controlled by genetic factors. If vitamin D reception is weaker, the bone growth process may also be weaker and a person may be more at risk for developing osteoporosis.
• Menopause. As the body’s sex hormones change during menopause, lower levels of estrogen affect the bone remodeling process and accelerates the rate of bone loss, causing decreased bone strength and a higher risk of fracture.
• Menstrual history in females. Light menstruation throughout life and/or early menopause can create a somewhat higher risk for osteoporosis.
• Low testosterone in males. Low testosterone levels in men can affect bone growth and lead to osteoporosis.
• Race. Caucasian and Asian women have higher rates of osteoporosis.¹Osteoporosis Overview. The National Institutes of Health Osteoporosis and Related Bone Diseases - National Resource Center. https://www.bones.nih.gov/health-info/bone/osteoporosis/overview. Updated October 2018. Accessed April 2019. While women of other races are less at risk, screening is still advised if they are over 65 or have any additional risk factors.

These risk factors are not controllable aspects of one’s health. Those with known risk factors are advised to talk with their doctor about earlier screening and diagnostic tests.

Lifestyle Factors that Increase Risk for Osteoporosis

There are a few risk factors for osteoporosis that are able to be managed or controlled, including:

• Eating habits. A balanced diet with sufficient vitamin D and calcium is important for healthy bone growth. A diet with low vitamin D or calcium intake can impact bone
• Exercise. A major risk factor for osteoporosis is a sedentary lifestyle, so maintaining a regular exercise routine throughout life is important for keeping the bones healthy. In particular, weight-bearing exercise can lead to adaptations in bone growth that increase density and bone strength.²Cosman F, de Beur SJ, LeBoff MS. Clinician’s Guide to Prevention and Treatment of Osteoporosis. Osteoporos Int. 2014;25(10):2359–2381. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4176573/. doi:10.1007/s00198-014-2794-2.
• Excessive alcohol use. Alcohol use in excess throughout life can interfere with the bone remodeling process and lead to weaker bones over time.¹Osteoporosis Overview. The National Institutes of Health Osteoporosis and Related Bone Diseases - National Resource Center. https://www.bones.nih.gov/health-info/bone/osteoporosis/overview. Updated October 2018. Accessed April 2019.
• Nicotine intake. Nicotine is a toxin that inhibits the bone growth process. Additionally, women who smoke have lower levels of estrogen than non-smokers,¹Osteoporosis Overview. The National Institutes of Health Osteoporosis and Related Bone Diseases - National Resource Center. https://www.bones.nih.gov/health-info/bone/osteoporosis/overview. Updated October 2018. Accessed April 2019. which can further inhibit bone growth. Any cigarette smoking, especially prolonged use, can raise the risk for osteoporosis.¹Osteoporosis Overview. The National Institutes of Health Osteoporosis and Related Bone Diseases - National Resource Center. https://www.bones.nih.gov/health-info/bone/osteoporosis/overview. Updated October 2018. Accessed April 2019.

A doctor can recommend strategies to help establish healthy eating and exercise habits that reduce the overall risk for osteoporosis later in life. Establishing healthy lifestyle habits early is especially important if a person already has known risk factors.

Preventing Complications of Osteoporosis

Primary osteoporosis can be significantly influenced by several preventative measures. Many of these measures include daily habits and lifestyle factors that help maintain healthy bones throughout life, before most people are within the standard age range for developing osteoporosis. Examples include regular exercise and a balanced diet rich in nutrients.

In order to minimize the risk of secondary osteoporosis (caused by a separate health condition), it is important to manage the underlying condition carefully. A team of doctors and care specialists may be beneficial for providing comprehensive care that considers long-term effects of high-risk conditions and medications.