Risk Factors for Osteoporosis: A Review

Janet R. Guthrie, MSc, Dip Ed, PhD,Lorraine Dennerstein, AO, MBBS, PhD, FRANZP, DPM and John D. Wark, MBBS, PhD, FRACP

In This Article

Abstract and Introduction

Skeletal fragility and falls are the 2 most potent factors leading to osteoporotic fractures. The aim of this article is to review factors associated with women's risk of developing skeletal fragility and subsequent osteoporosis. Many factors have been implicated, but the evidence for some is unsubstantial. Low premenopausal bone mineral density (BMD), a decrease in BMD, and an increase in bone fragility -- which occur as a result of both aging and the menopause -- are major determinants of subsequent risk for osteoporotic fracture. In addition, low body mass index (BMI), low calcium intake, low physical activity, and smoking can affect BMD. The relative importance of the effects these physical and lifestyle factors have on BMD in midlife women is not fully established. The impact of gynecologic history (parity, lactation, oral contraceptive use, age of menarche) on BMD is uncertain.

A number of epidemiologic studies in osteoporotic populations have attempted to determine what factors place some individuals at high risk of fracture. Skeletal fragility and falls are the 2 most potent factors leading to osteoporotic fractures. The discussion in this article is limited to factors associated with the risk of skeletal fragility (measured as bone mineral density [BMD]) in women, and excludes factors associated with falls.

In addition to age, the following factors have been reported to place women at risk of skeletal fragility: early natural or surgical menopause; low levels of estrogens; low levels of testosterone; low peak bone mass and an increased rate of bone loss; low body weight and height; low levels of vitamin D; low calcium intake; high caffeine intake; low levels of physical activity; smoking; alcohol abuse; Caucasian or Asian racial group; a family history of osteoporosis; and use of certain drugs, eg, corticosteroids and anticonvulsants.[1] Other gynecologic variables have also been implemented in the pathogenesis of osteoporosis, including parity, breast feeding, late menarche, and menstrual cycle irregularities.


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