What are the risk factors for osteoporosis?

From the Guidelines

Risk factors for osteoporosis include increasing age, female sex, post-menopause, hypogonadism, low body weight, and history of parental hip fracture, among others, as identified in the 2017 American College of Physicians clinical practice guideline update 1. These risk factors can be broadly categorized into:

• Demographic factors: increasing age, female sex, post-menopause, and ethnic background (white persons are at higher risk than black persons) 1
• Medical history: history of parental hip fracture, previous clinical or morphometric vertebral fracture, previous fracture due to minimal trauma, rheumatoid arthritis, and long-term use of certain medications such as glucocorticoids and anticoagulants 1
• Lifestyle factors: current smoking, alcohol intake (3 or more drinks daily), low bone mineral density (BMD), vitamin D deficiency, low calcium intake, hyperkyphosis, falling, and immobilization 1 It is essential to consider these risk factors when assessing an individual's risk of developing osteoporosis, as they can significantly impact bone health and increase the likelihood of fractures. Some of the key risk factors, such as low BMD, can be diagnosed using dual-energy x-ray absorptiometry (DXA), which is the current gold standard test for diagnosing osteoporosis in people without an osteoporotic fracture 1. Additionally, risk scores that combine clinical risk factors with BMD testing results, such as FRAX, can be used to predict fracture risk among people with low bone density 1.

From the FDA Drug Label

Osteoporosis occurs in both males and females but is most common among women following the menopause, when bone turnover increases and the rate of bone resorption exceeds that of bone formation. From age 50 to age 90, the risk of hip fracture in white women increases 50-fold and the risk of vertebral fracture 15-to 30-fold. It is estimated that approximately 40% of 50-year-old women will sustain one or more osteoporosis-related fractures of the spine, hip, or wrist during their remaining lifetimes

The main risk factors for osteoporosis are:

• Age: increasing risk from age 50 to 90
• Gender: more common in women, especially after menopause
• Bone turnover: increased bone turnover and rate of bone resorption exceeding bone formation 2

From the Research

Risk Factors for Osteoporosis

• Family history is a significant risk factor for osteoporosis, with a positive family history being independently associated with osteoporosis 3
• Low calcium intake is a risk factor for osteoporosis, and adequate calcium intake is important for maintaining bone health 4, 5
• Sedentary lifestyle and lack of mobility are risk factors for osteoporosis, and regular exercise and physical activity can help maintain bone strength 4, 5
• Vitamin D deficiency is a risk factor for osteoporosis, and adequate vitamin D intake is important for maintaining bone health 5
• Smoking and alcohol consumption are risk factors for osteoporosis, and cessation of these habits can help reduce the risk of osteoporosis 4, 5
• Low body weight and excessive weight loss are risk factors for osteoporosis, and maintaining a healthy weight can help reduce the risk of osteoporosis 4
• Early menopause and exercise-induced amenorrhea are risk factors for osteoporosis in women, and hormone replacement therapy and other treatments may be necessary to reduce the risk of osteoporosis 4
• High intakes of protein, caffeine, and phosphorus are potential risk factors for osteoporosis, although the evidence is not yet clear 4, 5
• Genetic factors can also contribute to the risk of osteoporosis, with several genes identified as contributing to the regulation of bone mass and osteoporosis-related phenotypes 6
• Use of glucocorticoids can also increase the risk of osteoporosis, with about 30-50% of chronic glucocorticoid users developing secondary osteoporosis 7

Modifiable Risk Factors

• Maintaining a healthy diet with adequate calcium and vitamin D intake
• Engaging in regular exercise and physical activity
• Avoiding smoking and excessive alcohol consumption
• Maintaining a healthy weight
• Getting enough sleep and managing stress
• Avoiding excessive caffeine and phosphorus intake

Non-Modifiable Risk Factors

• Family history of osteoporosis
• Genetic factors
• Age and sex (with older women being at higher risk)
• Menopause and hormone changes
• Use of glucocorticoids and other medications that can increase the risk of osteoporosis