Who is at risk of osteoporosis and broken bones?
Healthy Bones Questionnaire
The factors that can put people at risk of osteoporosis and fractures include:
Genes - Our bone health is largely dependent on the genes we inherit from our parents. In fact, if one of your parents has broken a hip, you may be more susceptible to developing osteoporosis and fragile bones.
Age - Bone loss increases in later life so by the age of 75 about half of the population will have osteoporosis. As we get older bones become more fragile and more likely to break.
Gender - Women have smaller bones than men and they also experience the menopause which accelerates the process of bone turnover. The female hormone oestrogen has a protective effect on bones. At the menopause (normally around the age of 50) the ovaries almost stop producing this hormone reducing the protection it gives to bones.
Race – People who are Black Afro Caribbean are at a lower risk because they have bigger and stronger bones.
Low body weight – If you have low BMI (body mass index) below 19g/m2 you are at greater risk of developing osteoporosis.
Previous fractures - If you have already broken bones easily, including in the spine, then you are much more likely to have fractures in the future.
Some medical conditions increase your risk:
- Rheumatoid arthritis
- Low levels of the sex hormone oestrogen in women as a result of early menopause, having a hysterectomy with removal of ovaries (before the age of 45), anorexia nervosa or Turners syndrome. Excessive exercise can also reduce hormone levels
- Low levels of the sex hormone, testosterone, in men following surgery for some cancers. Some rare conditions that men are born with such as Klinefelters disease or Kallmans syndrome also lower testosterone levels
- Hyperthyroidism when levels of thyroid hormone are abnormally high
- Parathyroid disease when levels of parathyroid hormone are abnormally high
- Conditions that affect the absorption of food such as Crohns or coeliac disease
- Conditions that cause long periods of immobility
Other conditions may be associated with osteoporosis such as diabetes and HIV (AIDS). People who have had an organ transplant or who have experienced respiratory diseases may also be at increased risk, as well as people who have undergone gender reassignment especially if hormone therapy is discontinued.
Some medicines increase your risk:
- Taking corticosteroid 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.
Some medicines may increase risk but more research is needed:
- Injectable progestogen contraceptives –medroxyprogesterone acetate (Depo provera)
- Some drugs used for mental health problems (particularly psychosis)
Osteoporosis and fractures can also affect children and young people as well as pregnant women. However, these conditions are extremely rare. For more information on rare types of osteoporosis and other related conditions, click here.
Other risk factors include:
Smoking – current smokers are more likely to break bones
Alcohol - intake of more than 3 units daily
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.
I think I might be at risk. What should I do?
You cannot see or feel your bones getting thinner and many people are unaware of any problems until they break a bone or start to lose height.
If you think you have risk factors for osteoporosis and fractures then you can discuss this further with your GP.
You may need a special scan which measures bone density, called a dual energy x-ray absorptiometry (DXA) scan. It is a simple, painless procedure and is recommended for those considered to be at high risk of breaking a bone due to osteoporosis, who may need a drug treatment to strengthen their bones.
Osteoporosis diagnosed from a bone density scan does not necessarily mean that at the time you are at high risk of breaking a bone. A drug treatment is therefore not always necessary. Other factors, such as your age, will need to be taken into account.
The World Health Organisation has developed a fracture risk assessment tool (FRAX) particularly for Health Professionals to help identify individuals' risk of fracture. A group of UK experts called the National Osteoporosis Guideline Group (NOGG) has suggested when further investigations or drug treatments might be necessary.
Smoking, alcohol intake and eating disorders, can be tackled by making changes to your lifestyle and seeking help for other problems.
Sometimes risks of fracture are so high, especially when bones have broken easily after the age of 75, drug treatments may be prescribed without a scan.
Are you at risk?
This leaflet covers specific information on scans and tests. The role of dual energy x-ray absorptiometry (DXA) scan of the hip and spine as the most common method of measuring bone density to diagnose osteoporosis is explained and how a peripheral DXA (pDXA) scan may sometimes be used. The T score result is explained in relation to normal bone density, osteopenia and osteoporosis. Who might benefit from having a scan and when scans are used to monitor bone density levels are discussed. The use of the fracture risk assessment tool called FRAX which can be used to identify people at highest risk of fracture is also mentioned. The roles of quantitative ultrasound scanning (QUS) and computed tomography (CT) scanning in measuring bone strength or density are described, and the use of magnetic resonance imaging (MRI), radioisotope bone scanning and normal x-rays in identifying spinal and other fractures are discussed. Blood and urine tests to measure biochemical bone markers, calcium and vitamin D levels and kidney function are explained.
Sex hormones, oestrogen and testosterone necessary for bone health, as once they decline or are stopped (as in hormone therapy for a transsexual person) bone density begins to be lost. The transsexual person is treated with sex hormones and is at risk of developing osteoporosis if the sex hormones are discontinued.
The thyroid gland in the neck produces thyroid hormones that regulate the speed at which our body cells work. If the thyroid gland is overactive and thyroid hormone levels are high, hyperthyroidism occurs. Excess thyroid hormone hastens the rate of bone turnover which can increase the risk of osteoporosis.
This leaflet looks at how the parathyroid glands control the levels of calcium and phosphorus in the blood, and how hyperparathyroidism (an over active parathyroid gland) can draw increasing amounts of calcium from the bones into the blood stream and be a possible cause of osteoporosis.
This factsheet gives information on the effect of the contraceptive injection medroxyprogesterone acetate (Depo Provera) on bone health.
Coeliac disease is a condition that affects the small intestine and reduces the ability to absorb gluten. Foods containing gluten can cause inflammation of the gut resulting in diarrhoea and weight loss. As a result of this, minerals such as calcium may be poorly absorbed. If untreated this condition can lead to osteoporosis.
This factsheet explains how anti-epileptic drugs (such as sodium valproate, carbamazipine, phenytoin, gabapentin and lamotrigine), might affect bone and risk of fracture. It explores how these drugs effect the way vitamin D is absorbed and what can be done to help prevent bone density loss.
Anorexia nervosa and bulimia nervosa (eating disorders) can lead to lower bone mineral density (osteoporosis) linked to lower oestrogen levels and loss of menstrual periods (amenorrhoea). Some young women in particular may be at risk of osteoporosis. Hormone replacement therapy (HRT) and the combined oral contraceptive pill are inconclusive treatments. Excessive exercise with loss of normal periods will also affect bone.
This factsheet discusses the link between breast cancer treatments and osteoporosis. It contains information on breast cancer drugs including tamoxifen and those from the aromatase inhibitor group such as anastrazole (Arimidex), letrozole (Femara) and exemestane (Aromasin) and explains their effect on bone health.
More information from us
Our osteoporosis helpline can offer you advice and support by telephone, email, or letter.
For more details about the information in these publications, you can visit Leaflets and Booklets page.
For further support you may want to visit our online osteoporosis discussion forum.