Which risk factors for osteoporosis and osteoporotic fractures should be identified in the patient history?

Updated: Jan 20, 2021
  • Author: Rachel Elizabeth Whitaker Elam, MD, MSc; Chief Editor: Herbert S Diamond, MD  more...
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A thorough history should be obtained to screen for and identify the presence of known risk factors for osteoporosis and osteoporotic fracture. Specifically, the history should focus on the following [106, 107] :

  • Age (> 50 years), sex (female), and race (white or Asian) [106] ; the US Preventive Services Task Force (USPSTF) recommendations include screening for osteoporosis in women aged 65 years or older and in younger women with a fracture risk that is the same or greater than that of a 65-year-old white woman who has no additional risk factors [107]

  • Family history of osteoporosis, particularly maternal history of fractures

  • Reproductive factors, especially regarding early menopause and estrogen replacement therapy: postmenopausal women are at high risk, as are women who have undergone hysterectomy and oophorectomy

  • Hypogonadal states: men with hypogonadism secondary to any genetic or other conditions are at higher risk [106] ; the USPSTF notes that there is insufficient current evidence to assess the risk versus benefit of screening for osteoporosis in men [107]

  • Smoking: smokers are at higher risk

  • Alcohol consumption

  • Low levels of physical activity: immobility increases the risk [65] ; spinal cord injury and stroke cause physical impairment and are common causes of immobility

  • Strenuous exercise that results in amenorrhea (such as that which occurs in marathon runners)

  • Calcium and vitamin D intake

  • History of low-trauma "fragility" fracture in patients aged 40 years or older: a fragility fracture is defined as a fracture due to trauma that would not normally cause fracture (a force equal to or less than that resulting from a fall from standing height)

  • Signs of vertebral fracture (see below)

  • Coexisting medical conditions associated with bone loss: examples are hyperparathyroidism, hypogonadism, leukemia, rheumatoid arthritis, celiac disease, and Cushing syndrome [108]

  • Medications associated with bone loss: examples are glucocorticoids, cyclosporine, anticonvulsants, heparin, lithium, and tacrolimus [108]

  • Risk factors for falls in older patients: these include poor balance, orthostatic hypotension, weakness of the lower extremity muscles and deconditioning, use of medications with sedative effects, poor vision or hearing, and cognitive impairment

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