Bone health: be aware of osteoporosis risk factors

 

Osteoporosis is a condition in which loss of bone density and deterioration in bone quality causes bones to become weaker and more fragile. This decrease in bone strength increases the risk of bone fractures. It is a very common condition in older adults, especially women. Osteoporosis Canada’s statistics show that one in three women and one in five men will have a fracture due to osteoporosis during their lifetime.

Osteoporosis rarely has any symptoms, so it’s important to be aware of risk factors.

Dr. Sandra Kim, medical director of the Centre for Osteoporosis and Bone Health at Women’s College Hospital, explains that one of the major risk factors for osteoporosis is advancing age, and the condition becomes more common in people over 50. Women have particular risks around this age as they advance through menopause.

“Osteoporosis risk increases particularly in the menopausal phase because estrogen is actually good for your bones,” Dr. Kim explains. “So when a woman goes through menopause and her ovaries decrease the amount of estrogen production – and eventually post-menopause when there is no more estrogen production – the bones go through a rapid phase of bone loss for the first few years of menopausal transition.”

Women whose bone mass was low before menopause are at particular risk for developing osteoporosis as they lose bone during and after menopause. People who are of smaller body size also tend to have lower bone mass, so may be at higher risk of developing osteoporosis with advancing age.

Family, health and lifestyle

Other risk factors for osteoporosis include family history, medical conditions and certain medications.

“If you have a family history of osteoporosis, in particular having a parent who has had broken bones – in particular a hip fracture – then you would be someone at higher risk of having osteoporosis in your lifetime,” Dr. Kim says.

Medications that can affect bone health include steroids, long-term use of anticonvulsant medications, and aromatase inhibitor therapy used to treat conditions like breast cancer.  

“There are certain medical conditions that affect your bone health as well, and this would include inflammatory conditions such as rheumatoid arthritis, inflammatory bowel disease and parathyroid disease,” Dr. Kim says.

Lifestyle factors can also affect bone health.

“Other risk factors include being a current smoker, and excess alcohol consumption,” Dr. Kim says. For bone health purposes, excess alcohol is considered more than three drinks per day. “Those are two modifiable risk factors that you can work on to decrease your risk of osteoporotic fractures.”

Risk assessment and testing

Bone density testing measures bone mass, and can indicate whether someone has osteoporosis or is at risk. It’s an important test because low bone mineral density rarely has any symptoms, until a fracture occurs.

“Bone mineral density testing is recommended for all men and women who are age 65 and older regardless of what your risk factors are. So if you’ve never had a bone density scan, and you’re 65 years old or older, whether you’re a man or woman, you should have a screening bone density test done,” Dr. Kim says. “However if you’re younger than age 65 and have a risk factor for osteoporosis or fractures (such as being on offending medications that affect bone health, if you’ve broken bones before with minimal trauma, if you have a strong family history of osteoporosis, if you have medical conditions that affect your bone health) then you are someone who probably needs to have a bone density test earlier than the recommended screening time of age 65.”

However, it’s a good idea to start thinking about bone health well before age 65.

“Most of us think of osteoporosis risk once you’re about 50 years old or older, and definitely for women, when going through menopausal transition. So that’s a good time to be assessed for osteoporosis risk factors by your family doctor to determine if you need an earlier bone density screening test – earlier than the usual screening time of age 65,” Dr. Kim says.

That assessment should include any indication of height loss.

“One of the most common osteoporotic fracture is a spine fracture, and the majority of spine fractures occur spontaneously and are silent, meaning that people don’t even experience pain. They may only experience height loss over time or develop a hunched posture over time,” Dr. Kim says. “Being assessed for height loss is important with your general assessments with your primary caregiver because if you’ve had significant height loss it may be a red flag that you’ve had a silent osteoporotic spine fracture.”