Finding People At Risk

Osteoporosis, measured on a densitometry x-ray , is a ‘risk factor’ for fracture, just as high cholesterol is a risk factor for having a heart attack.

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Finding out more about your risk factors can be helpful because there may be actions you can take to reduce these risks and ultimately make the ‘fragility fractures’ that mostly occur in older age less likely.

Osteoporosis diagnosed on a bone-density scan is, in fact, a risk factor for fracture.

Some risk factors seem to affect your bone density, as measured on a bone-density scan. Others, such as old age, affect your bone strength and risk of fracture but in a way that doesn’t always show up on a bone-density scan.

Your doctor will often use your risk factors to build up a picture of your overall fracture risk (i.e. the chance of you having a fragility fracture as a result of osteoporosis). If your current risk of fracture is high, a drug treatment will be recommended to strengthen your bones and reduce your fracture risk. 

Some risk factors, such as being someone who falls a lot or being very thin with little protective padding over your hips, don’t directly affect bone strength but still increase your fracture risk. They can often be tackled via lifestyle changes.

Are there any risk factors that I can change?

A BMI (body mass index) below 19kg/m2 is considered a risk factor for osteoporosis and fractures.

Low body weight: low body weight makes osteoporosis and fractures more likely because you have lower amounts of bone tissue overall. Older people with low body weight also have less fat padding around the hips to cushion the impact of a fall, which makes fractures more likely. Although some aspects of your body type are inherited, you have the potential to change your weight, which can affect your risk of osteoporosis and fractures.

Smoking: current smokers are more likely to break bones. Smokers tend to have a lower body weight and women who smoke have an earlier menopause, which increases osteoporosis risk. However, smoking seems to have a direct effect on the bone-building cells too.

Alcohol: excessive alcohol—more than the recommended amounts described—appears to be a significant risk factor for osteoporosis and fractures. Alcohol appears to affect the cells that build and break down bone and even small amounts can cause unsteadiness and increase the chance you will fall. Some research has suggested that men with an excessive alcohol intake may also have had less nutritious diets, which may have made osteoporosis more likely.

Falling: older people who are at risk of falling are more likely to have fractures, especially of the hip, after the age of 75 years. Although falling feels like something that happens to you and that you have no control over, there is a surprisingly large number of ways to stop yourself being someone who falls in later life.

Exercise and osteoporosis

Other factors, such as eating healthily and getting sufficient vitamin D, may affect your bone strength but, so far, research has been unable to prove that they are as significant as the factors listed in this section. However, as part of an overall healthy lifestyle, they are important.

Are there any other risk factors?

Some risk factors cannot be changed but it’s important to know about them as some research suggests they make it much more likely you will have fragile bones and fractures in later life. It’s important to understand that, often, osteoporosis and fractures aren’t caused by something you have ‘done’ or could have changed. Their cause may just be part of your genetic makeup or, like many medical conditions, something that happens but where we don’t fully understand why.

Genes: our genes determine our risk of osteoporosis to a large extent although there isn’t a simple genetic test for osteoporosis. Research has shown that if one of your parents had a broken hip, you are more likely to have a fragility fracture yourself.

Age: bone loss increases in later life so by the age of 75 years, about half of the UK population will have osteoporosis as measured on a bone density scan. As you get older, bones become more fragile and generally more likely to break, whatever your bone density as measured on a scan. This is partly because of generally reduced bone strength but also the result of an increased risk of falling as we get older.

Gender: osteoporosis and fractures are more common in women than men. Women tend to live longer, which makes fractures more likely, but in each age group, the fracture risk is higher. Men have bigger bones and bone size in itself seems to protect against fracture. In addition, at around the age of 50, women experience the menopause, at which point their ovaries almost stop producing the sex hormone oestrogen, which helps to keep bones strong.

Race: Afro-Caribbean people are at a lower risk of osteoporosis and fractures than those of Caucasian or Asian origin because their bones are bigger and stronger.

Previous fractures: if you have already broken bones easily, including in the spine, you are much more likely to have fractures in the future; having already broken bones easily is one of the most obvious indicators that your bones are fragile. In fact, research has shown that after one fragility fracture, you are two to three times more likely to have another.

What medicines increase my risk?

Some medications (see below) are linked with an increased risk of osteoporosis and/or fractures. Once you know about these, you can discuss with your doctor the ways to limit their effects. Your doctor may review your medicines and possibly change the dose or even the drug (don’t make any changes without talking to your doctor first). Sometimes an osteoporosis drug or a supplement can be prescribed to help protect your bones from the effect of these medicines. However, if you are only taking the drug at a low dose or for a limited period, your doctor may be able to reassure you the effect on your bones is insignificant.

  • Glucocorticoid (‘steroids’) tablets for other medical conditions for over three months.
  • Anti-epileptic drugs.
  • Breast cancer treatments, such as aromatase inhibitors.
  • Prostate cancer drugs that affect either the production of the male hormone, testosterone, or the way it works in the body.

Other medicines may increase risk but more research is needed:

  • Drugs to reduce inflammation of the stomach and oesophagus, called proton pump inhibitors (PPIs).
  • Diabetic drugs in the glitazone group, including pioglitazone injectable progestogen.
  • Contraceptives such as medroxyprogesterone acetate, known as Depo Provera.
  • Some drugs used for mental health problems, such as tricyclic antidepressants and particularly selective serotonin reuptake inhibitors (SSRIs).

Others at risk include people who have undergone gender re-assignment, especially if hormone replacement therapy is discontinued.

Depo Provera ® and other hormonal contraceptives and osteoporosis

Anti-epileptic drugs and osteoporosis

Glucocorticoids (“steroids”) and osteoporosis

Breast cancer treatments and osteoporosis

Transsexual people and osteoporosis

Are there any medical conditions that increase my risk?


Some medical conditions are associated with an increased risk of osteoporosis and/or fracture. Knowing you are at risk means you can discuss with your doctor how your other condition is being managed and treated. Proper care of these conditions will often reduce the effect on your bone health. Examples of these conditions are:

  • rheumatoid arthritis
  • low levels of the sex hormone, oestrogen, in women as a result of early menopause or having a hysterectomy with removal of ovaries (before 45), anorexia nervosa or Turner’s syndrome; excessive exercise can also reduce hormone levels
  • low levels of the sex hormone, testosterone, in men can occur for a number of reasons including following surgery for some cancers; some rare conditions that men are born with, such as Klinefelter syndrome or Kallman syndrome, also lower testosterone levels
  • hyperthyroidism, in which levels of thyroid hormone are abnormally high
  • parathyroid disease, in which levels of parathyroid hormone are abnormally high
  • conditions that affect the absorption of food, such as Crohn’s or coeliac disease
  • conditions that cause long periods of immobility, such as stroke.

Other conditions may be associated with osteoporosis, such as diabetes, HIV (AIDS), liver disease, cystic fibrosis, dementia and Parkinson’s disease. Organ transplant recipients and people with some respiratory diseases may also be at more risk, although more research is needed to understand why.

Thyroid disease and osteoporosis

Hyperparathyroidism and osteoporosis

Anorexia nervosa and osteoporosis

Coeliac disease and osteoporosis