Risk Factors for Osteoporosis

The etiology of osteoporosis is multifactorial. Age, sex, race, lifestyle, and overall health are all factors:

Age -- The older an individual is, the greater his/her risk of osteoporosis.

Gender -- Women are more likely to develop osteoporosis than men. Women have less bone mass than men and lose bone mass earlier and more rapidly because of hormonal changes during menopause. This does not mean, however, that osteoporosis is not a threat to men. It is estimated that up to one-third of all hip fractures occur in men, while compression fractures affect perhaps one-half as many men as women. Osteoporosis among men is becoming an increasingly serious public health problem as the population ages.

Race -- Caucasian and Asian individuals have a greater risk of developing osteoporosis than people of other races, with Northern Europeans and North Americans at greatest risk. However, African Americans and Hispanics are also at significant risk from the disease.

Heredity -- Family history is also a factor in the development of osteoporosis. Studies have shown that young women whose mothers have suffered vertebral fractures often have reduced bone mass themselves, but a family history of the disease is also considered a risk factor for men.

Menopause/Menstrual History -- Early menopause (either natural or surgically induced) increases a woman's risk of osteoporosis. In addition, amenorrhea (resulting from anorexia, bulimia, or excessive physical exercise) may cause bone mass loss.

Bone Structure/Body Weight -- Small-boned, thin women have a lower bone mass than other women and thus are at greater risk from the disease.

Low Testosterone Levels -- Men with testosterone deficiency are at greater risk.

Endocrine Disorders -- Hyperthyroidism (having an overactive thyroid gland, such as in Grave's disease) and hyperparathyroidism (excessive parathyroid hormone production) can both cause osteoporosis.

Medications -- Common medications that can cause osteoporosis when administered over a prolonged period of time include corticosteroids (such as Prednisone), heparin, anti-seizure medications such as Dilantin and phenobarbital, immunosuppressive drugs, and even antacids that contain aluminum. Steroids are the second most common cause of osteoporosis (next to decreased estrogen levels), and the American College of Rheumatology estimates that 35% of persons who get steroid-induced osteoporosis are men.

Immobility -- Prolonged periods of immobility substantially increase an individual's risk of developing osteoporosis.

Inadequate Calcium Intake -- Calcium consumption in childhood, adolescence, and early adulthood appears to affect peak bone mass. Findings are mixed on the effectiveness of calcium supplements among menopausal and older women in preventing osteoporosis.

Inadequate Physical Activity -- Although vigorous exercise early in life has been shown to increase bone mass, it is yet unknown whether this advantage produces lifelong protection from menopausal or senile osteoporosis. It is clear, however, that prolonged weight-bearing exercise does reduce bone loss and the risk of falling (and thus the fractures that can result from falls).

Cigarette Smoking -- Studies have shown that cigarette smokers have lower bone density than nonsmokers. Smoking has also been associated with an increased risk of hip and wrist fractures.

Excessive Alcohol Intake -- Alcohol has a direct toxic effect on osteoblasts, the cells responsible for bone formation, leading to a decrease in replacement bone. Heavy drinkers also have high levels of corticosteroids in their blood. These hormones are produced by the adrenal glands and are an additional risk factor for osteoporosis.

Excessive Caffeine Intake -- Studies have indicated that heavy caffeine consumption can have a deleterious effect on bone mass.

Depression -- New studies have indicated that women who are suffering from depression have lower bone density than nondepressed women, perhaps resulting from higher levels of corticosteroids in their blood.