Bone Health and Osteoporosis

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Risk Factors
Osteoporosis is due to a combination of factors. Older age and female sex are significant risk factors; after menopause, the risk of osteoporosis becomes much higher. Osteoporosis is also more likely in people with family members who have osteoporosis, as well as in thin, Caucasian, and Asian women. Girls and women who have a history of eating disorders including frequent dieting and poor nutrition are more likely to get osteoporosis. High-protein and low-calcium diets along with other bad lifestyle choices such as smoking and drinking excessively contributes to osteoporosis as well. Also, women who are inactive or do not participate in regular weight-bearing and resistive exercise are more likely to develop osteoporosis. Having a diagnosis of osteoporosis means your risk of fracture is four times greater than if you do not have it.

Risk Factors for Osteoporosis Fractures
(Charts adapted from the National Osteoporosis Foundation)

Permanent	Modifiable
Having a fragility fracture* as an adult	Cigarette smoking
A close relative with a fragility fracture*	Not having a period for more than six months
Caucasian or Asian race	Diet low in calcium
Postmenopause	More than two alcoholic drinks per day
Female gender	Falling, poor balance
Lifelong history of absent periods	Low levels of activity
Bad eyesight (increasing fall risks)	Frail health
Early menopause (before age 45)	Weak muscles
Lifelong history of eating disorders	Hormone imbalance
Chronic health problems	Low-calorie or poor nutrition diet

*Fragility fracture = a fracture occurring from a fall from standing height or lower

There are also certain medical conditions that make osteoporosis more likely, due to both the underlying disease and also due to side effects of medications for treatment. The most common medications that directly affect bone health are corticosteroids, often used to treat asthma, arthritis, and immune disorders. Women with hormone imbalances such as Cushing's disease, hyperparathyroidism, hyperthyroidism, and genetic sex hormone deficiency are also at higher risks. Also, diseases that cause disabilities to limit walking such as multiple sclerosis and spinal cord injuries can lead to thinning bones.

Risk Factors for Osteoporosis That Cannot Be Changed

Factor	Explanation
Older age	With age, bone density decreases.
	15 percent of women in their 50s have osteoporosis; 50 percent of women in their 80s have it.
Female sex	Women have a much greater risk than men.
	Women have thinner lighter bones, less muscle mass to protect them, and are hormonally more susceptible.
Family history	Genetics pre-programs a body to be susceptible to certain things such as osteoporosis and greater rate of fractures.
Small size	Small, thin people are more at risk.
	Muscle and fat protect and strengthen bones.
Other medical risks	Certain medical problems such as hypothyroid and hormonal imbalances lead to higher risks of osteoporosis.

Risk Factors for Osteoporosis That Can Be Changed

Factor	How
Low activity level	Those less active and less on their feet have weaker bones.
	Bones get stronger the more they are used.
Low-calcium diet	Calcium is necessary for bone formation; it is the basic substance of bones.
Smoking, excess alcohol	Excess alcohol and tobacco interfere with bone formation.
Not having periods during	Estrogen is needed for the delicate balance of hormones
reproductive years	to form and maintain bones.
High-protein diets	High-protein diets interfere with calcium absorption.

The Role of Hormones
Estrogen is important to the bones' ability to absorb and retain calcium, maintaining structure and protecting bones from becoming weak. A regular menstrual period is the result of estrogen circulating through the body; therefore, women who do not get their periods regularly are at increased risk of having osteoporosis secondary to decreased estrogen levels. After menopause, estrogen levels decrease as well, contributing to the increased risk of osteoporosis. This is one reason estrogen supplements have been prescribed after menopause (other reasons include reducing uncomfortable side effects of menopause such as hot flashes). However, estrogen supplements only prevent osteoporosis and risk of fractures, they do not treat it. Although women who take estrogen after menopause actually do develop less fractures, the Women's Health Initiative, a groundbreaking study concluded in 2002, revealed that after five years of continuous treatment with hormone supplements, women can have slightly higher risks of breast cancer, blood clots, stroke, and uterine cancer. Therefore, prescribing estrogen supplements for postmenopausal women is no longer the treatment of choice. (If you are taking estrogen supplements after menopause, they should be at the lowest doses possible and taken along with progesterone to preserve a more natural body hormone balance; also, try not to take them for more than five years.)