Identifying those at risk of osteoporosis

Factors which increase the likelihood of developing low bone density (BMD)

  • Age
  • Caucasian or Asian race
  • Sedentary lifestyle
  • Smoking
  • Low body weight
  • Family history of osteoporosis
  • Excessive alcohol intake
  • Excessive caffeine
  • Prolonged calcium-deficient diet
  • Long term use of certain medications
    • Glucocorticoids
      Thyroxine (in excessive amounts)
      heparin
      antiepileptic drugs
      proton pump inhibitors (like omeprazole, pantoprazole etc)
      Serotonin re-uptake inhibitors (fluoxetine, paroxetine etc)
  • Oestrogen deficient states
  • early surgical or natural menopause (before age 45)
    pre-menopausal amenorrhoea > 6 months not due to pregnancy
  • Other predisposing factors:
  • liver disease
    malabsorption
    thyroid disease
    hypogonadism in men
    primary hyperparathyroidism
    rheumatoid arthritis
    chronic renal failure

Risk factors for fractures independent of BMD

  • Previous fracture (one vertebral fracture increases risk 5x; 2 or more vertebral fractures increase risk 12x)
  • Maternal history of hip fracture (increases risk 2x)
  • Age
  • Greater height (a longer hip axis)
  • Increased likelihood of falling

The presence of one or more clinical risk factors for low bone density should raise concern about the potential for osteoporosis and consideration for bone density measurement.