Risk Factors for Osteoporosis

The following are brief explanations regarding the main risk factors for osteopenia and/or Osteoporosis and of being at risk of a fracture.

Some factors are much higher risk than others, and not all risk factors listed have had extensive research done. However we are listing them all to ensure that anyone who may be at risk is aware.

There are factors that determine a person’s risk of developing or having Osteoporosis and there are factors that place a person at high risk for a fracture (broken bone). These may overlap but are not necessarily the same.

Research shows that most fractures occur within the moderate to marked osteopenia range. It is essential that the cause/s be found and addressed as well as the osteopenia/Osteoporosis. If you have a condition or are on a medication that is not listed here, please check with your doctor to ensure that you are not at risk.

Genetic – Family History
Research shows that 60% of a person’s bone is influenced by genetics, especially in laying down the amount of bone during childhood.

A broken bone due to a trip and fall in an adult
It is not normal at any age to break a bone from a trip and fall, from a standing position or less. Any adult who has broken a bone under these circumstances should be investigated and Osteoporosis ruled out.

A broken bone due to a trip and fall in a child
As children’s bones are not fully developed, it is quite common for children to break bones. If this occurs frequently, it is important to find the cause/s and rule out Osteoporosis.

Upper, middle or low back pain
If a person has sudden, severe pain in the low, middle or upper back, a vertebral fracture should be ruled out. This can be done either by an LVA (Lateral Vertebral Assessment) as part of a DXA scan, if this is available or by a plain lateral X-ray. The LVA should preferably be asked for on the referral, particularly if the patient has lost height.

Loss of height
Sudden loss of height is a sign that the person may have a compressed (fractured) vertebrae (bone/s in spine). It is not normal to lose more than 2 cm in height as you age.

Dowagers Hump on upper back
If it is due to Osteoporosis, the vertebrae in the spine are collapsing and unless treatment is initiated the person is at substantial risk for additional fractures within the next 1-2 years, which is known as the “Domino effect”. This also can place an older person at a high risk to fall, as their centre of gravity has changed, due their head being forward.

Risk of a fracture
As a person’s age, their risk of falling increases and therefore, also their risk of breaking a bone/s. The following place a person at a higher risk of a fracture:

History of prior falls
Muscle weakness
Walking impairment
Balance affected
A persons age
Those who use an assistive device, e.g a stick or a walking frame
Blindness or visual impairment
Cognitive impairment
Please see the fall prevention section for further information.

Steroids
Increase bone loss, especially during the first six months of treatment.

Past or present eating disorder
These include Anorexia, Bulimia or frequent dieting.

Impaired mobility (bed bound or wheelchair) for 6 weeks or longer
When a person is non weight bearing there are no stresses put on the bone, which is necessary to stay strong and healthy, therefore bone can be lost. If this happens during pre-puberty / teenage years it can significantly decrease the amount of bone laid down.

Multiple Sclerosis
If mobility (walking/weight bearing) is affected, bone may not be stimulated and treatment is usually steroids, which can affect bone.

Parkinson’s
If mobility (walking/weight bearing) is affected, bone may not be stimulated, which can result in bone loss.

Underweight for your height
Can place a person at a higher risk than those who are at a normal weight for their height.

Not enough calories for amount of exercise
May cause bone loss due to low levels of sex hormone levels.

Physiological Stress
Inadequate nutrition, poor absorption, excessive exercise, inadequate rest periods or excessive competitions can lead to physiological stress. This affects sex hormones, which can increase bone loss and may also lead to increased cortisol levels.

Psychological stress
Due to any cause, particularly if it is associated with inadequate nutrition and poor absorption, will often result in increased cortisol and prolactin levels in the blood, which can increase bone loss.

Cortisol
High levels of cortisol can increase bone loss, usually seen in people with: Cushing’s syndrome, a person on steroids, such as Prednisolone or an athlete who is overtraining.

Hyper-Prolactinaemia
High levels of prolactin, decreases sex hormone levels which can affect bone.

Acromegaly
This is an endocrine disorder, which is due to an increased secretion of growth hormone after puberty, which results in skeletal changes which may place a person at risk of Osteoporosis.

Cushing’s Syndrome
It is an endocrine disorder which is associated with increased levels of cortisol, which can result in increased bone loss.

Hyperparathyroidism
This causes an increase in the secretion of the parathyroid hormone, which can cause an increase in bone loss. It can either be primary or secondary.

Primary hyperparathyroidism
This is due to excessive secretion of the parathyroid gland.

Secondary hyperparathyroidism
This may be the result of severe renal disease or low levels of vitamin D.

Hyperthyroid
Excessive thyroxine can increase bone loss.

Hypothyroid
Excessive Eltroxin can increase bone loss.

Any type of Turner’s Syndrome
Only one X (XO) instead of 2 X (XX)
Results in low oestrogen levels, which may affect bone.

Klinefelter’s Syndrome
Extra X chromosome in males (XXY), no sperms and may have low levels of testosterone which may affect bone.

Vegetarian
If daily amounts of calcium, vitamin D and protein are not met, bone loss may occur. Increased intestinal motility (diarrhoea) can affect hormones, which can affect bone.

Excessive Fibre
Over 40 grams a day can increase intestinal motility (diarrhoea) which can affect hormones, which can increase bone loss.

Vegan
If daily amounts of calcium, vitamin D and protein are not met, bone loss may occur. Increased intestinal motility (diarrhoea) can affect hormones, which can increase bone loss.

High Caffeine Intake
Increased calcium excretion in urine, can cause the body to take calcium from the bone.

Intolerance to dairy products
Can result in low levels of calcium and increased parathyroid activity and therefore bone loss can occur.

Low daily Calcium intake
If a person is not getting enough calcium in their daily diet, the body will start to take it from bone. Calcium is also important for the normal working of muscles and nerves.

Vitamin D
You need Vitamin D to absorb Calcium, low levels of vitamin D can result in high parathyroid hormone levels, which can increase bone loss.

Smoking
Increased risk of bone loss due to toxins which can affect bone.

Excessive Alcohol
May cause dietary and liver problems and low levels of sex hormones, which can affect bone.

Gastrectomy
May lead to a difficulty in absorption of nutrients, which could then place a person at risk.

Small bowel resection
May lead to a difficulty in absorption of nutrients, which could than place a person at risk.

Coeliac disease
Due to the problem with absorption, bone loss can occur. Please log on the Coeliac Society of Ireland’s website for further information http://www.coeliac.ie/
Crohn’s disease
The disease itself places a person at risk and the main treatment for it is steroid based, which can affect bone.

Ulcerative Colitis
Due to the problem with absorption and treatment, bone loss can occur.

Haemochromatosis
Excessive iron is deposited in liver and other organs, which may result in low levels of sex hormones, which can affect bone.

Liver disease
As the metabolism of sex hormones are affected, this may increase the risk of Osteoporosis.

Primary Biliary Cirrhosis
Affects liver and hormones which can affect bone.

Kidney disease
Can sometimes cause secondary Hyperparathyroidism, which can cause bone loss.

Bone Marrow Disorders
Multiple Myeloma, Systemic Mastocytosis, Disseminated carcinomatosis, all may increase bone loss.

Rheumatoid Arthritis
Steroids and the inflammation from the disease itself can affect bone.

Connective Tissue Disorders
May have abnormal bone collagen which can increase a persons risk.

Osteogenesis Imperfecta
A genetic abnormality which affects collagen in the bone, characterized by bones that break easily, often from no apparent cause.

Marfan Syndrome
May have an increased risk due to abnormal collagen.

Metabolic Disorders
Such as Homocystinuria are extremely rare, due to an enzyme deficiency, which may affect collagen metabolism, and therefore place a person at risk of developing Osteoporosis.

Ehlers-Danlos Syndrome
This is a rare skin disorder, that is usually treated with steroids which can affect bone.

Polymyalgia
It is a connective tissue disease, which results in pain in muscles and is often associated with low levels of vitamin D. Steroids is one of the treatments for this disease which can affect bone.

Systemic Lupus
Steroids are one of the treatments for this disease, which can affect bone.

Scoliosis
It is an abnormal curvature of the spine which may predispose a person and also can result in reduced mobility.

Diabetes
Those with poorly controlled diabetes appear to be at a higher risk especially those with peripheral neuropathy.

Epilepsy
Anticonvulsants may affect calcium absorption and the circulating levels of vitamin D in the blood.

Cystic Fibrosis
Steroid Treatment can affect bone.

Prolactin Raising drugs
High levels of prolactin, results in reduced secretion of the sex hormones, estrogen and progesterone, which can affect bone.

Medications for Depression
Some medications for depression may increase the levels of prolactin in women and men. This can result in menstrual disturbances in women and loss of libido in men. Please check with your doctor.

Aromatase inhibitor
These are used in the treatment of cancer of the breast and cancer of the prostate, to decrease sex hormones levels, however they can both affect bone.

GnRH analogues
Are sometimes used for the treatment of cancer of the prostate, cancer of the breast in females and endometriosis in females. It decreases the libido in males and females, which could place them at risk.

Organ transplant
The treatments are usually immunosuppresants and steroids which both affect bone.

Additional Risk Factors for Women

If your First period was after age 15
Late production of sex hormones which can affect bone.

A person going through the Menopause
Levels of oestrogen drop which can affect bone.

An early menopause (under 45 years)
Levels of oestrogen drop which can affect bone.

Surgical menopause, an ovary/ovaries removed or hysterectomy
Oestrogen levels will drop which can cause bone loss.

Depot Provera
Contraceptive which affects bone and can increase risk of Osteoporosis, especially if taken during the adolescent years, when bone is being formed.

Pre-menstrual tension
Is usually the result of low progesterone levels which may affect bone.

Irregular periods or loss of periods for more than 4 months – other than pregnancy
This can be a sign that your hormones may be out of balance.

Additional risk factors for Men

The Most common cause in Males is Testosterone Deficiency
Low levels of Testosterone = Hypogonadism

Hypogonadism
When a person experiences one or all of the following: loss of sex drive, loss of erections, depression or fatigue

Testes removed
This may cause low levels of testosterone which may affect bone.

Mumps after puberty
This may cause low levels of testosterone which may affect bone.

Injury or infection to testes
This can cause low levels of testosterone which may affect bone.

The following medications/treatments may increase bone loss

Chemotherapy
Toxic affect on tissues, results in low hormone levels.

Radiation
Toxic affect on tissues, result in low hormone levels.

Thyroxine
Increases metabolism and bone loss.

Excessive Eltroxin
Increases metabolism and bone loss

Corticosteroids
For example Prednisolone, Prednisone, Cortisone, Delta Cortril can affect bone.

Aromatase inhibitors
Aromatase inhibitors decrease sex hormones in females with breast cancer, such as Arimedex and GnRh analogues for prostate cancer in males, which affect bone.

Anticonvulsants
Some anticonvulsants decrease calcium absorption which will affect bone.

Post Organ Transplant Therapy
Toxic affect on tissues, may result in low hormone levels which affect bone.

Chronic Heparin
Increased bone loss due to activity of osteoclasts, which remove bone.

Warfarin
Increases bone loss.

Antipsychotic medications
Some increase prolactin levels in the blood, which affects bone.

Long Term Lithium Therapy
May increase bone loss.

Calciuretic Diuretics (water pills)
Some of these can affect bone.

If you are on any medication or have a condition that is not listed above, please check with your doctor to see if it can put you at risk of developing osteoporosis.