RISK FACTORS OF OSTEOPOROSIS

Dr.Vaijayanti Lagujoshi 
Consultant Rheumatologist

Osteoporosis is a chronic, debilitating disease whereby the mass and quality of bone are reduced. The bones become porous and fragile, the skeleton weakens, and the risk of fractures greatly increases.

The loss of bone occurs “silently” and progressively, often without symptoms until the first fracture occurs, most commonly at the wrist, spine or hip.

Osteoporotic fractures negatively affect quality of life and often result in pain, loss of function and, in the worse cases, death.

Approximately one out of three women over 50 will have a fracture due to osteoporosis (more than breast cancer) as will one out of five men over 50 (more than prostate cancer).

The risk factors for osteoporosis are categorized into  two categories – modifiable  ,those we can change and fixed/nonmodifiable which we cannot change.

Alcohol : Studies have shown that more than two units of alcohol per day can increase the risk of osteoporotic and hip fractures in both men and women While some of this increased risk is due to decreased bone mineral density, which may be a result of a toxic effect of alcohol on the bone forming cells, some of the risk is also due to other poorly understood factors, which may include general deteriorating health and the increased likelihood of falling, especially in the elderly. 

Smoking : smoking increases the risk of hip fracture by up to 1.5 times. Although the risk of fracture from smoking increases with age, cigarette smoke has an early effect on bones. Studies showed that young male smokers, 18-20 years old, have reduced bone mineral density and an increased risk of osteoporosis later in life.

Low Body Mass Index: The body mass index, or BMI, is a measure of how lean someone is and can be used as a guide to measure his or her osteoporosis risk. Doctors believe that a BMI of 20 to 25 is ideal. Anyone with a BMI of 25 orhigher is considered overweight, and anyone with a BMI over 30 is considered obese. BMI below 19 is considered underweight and a risk factor for osteoporosis.

Medications: Certain medications, particularly steroids, can weaken your bones. In most cases, you have to use these medications for a long time and in very high doses for them to become a threat to your bones. That's not to say that these medications are bad for you—they may be essential to treat your respective condition. Don't stop any treatment or alter the dosage without first consulting your doctor.

Eating disorders : Eating disorders such as anorexia and bulimia can dramatically reduce calcium intake and accelerate mineral loss from bone. The extreme weight loss caused by anorexia and bulimia affect women’s ovaries, which stop producing hormones..o bone loss in much the same way that estrogen deficiency after menopause does

Poor nutrition increases osteoporosis risk

A low BMI is often associated with poor nutrition. Poor nutrition can also affect bone health, particularly when diets are insufficient in calcium. Calcium is an essential part of bone mineral and it is also important for muscles, nerves and othercells in the body.

Vitamin D is also essential, since it helps calcium absorption from the intestines into the blood. At least 800 international units ofvitamin D and 1,000 to 1,200 mg of calciumdaily can protect against osteoporosis.

In children and adults, casual exposure of the face, hands and arms for as little as 10-to-15 minutes a day outside peak sunlight hours (before 10am and after 2pm) is usually sufficient vitamin D for most people.

Lack of exercises is an important modifiable risk factor for osteoporosis .

People who regularly exercise are less likely to have a hip fracture than those with a sedentary lifestyle. Women who sit for more than nine hours a day are 50% more likely to have a hip fracture than those who sit for less than six hours a day. Higher levels of leisure time, sporting activities household chores,and fewer hours of sitting each day were associated
with a significantly reduced relative risk for hip fracture.Bones respond

when they are “stressed,” in other words,when they are forced to bear more weight than they are used to. This can be achieved by “weight bearing” or impact exercises such as walking, running, lifting weights, jumping, or dancing

Although fixed risk factors cannot be changed, we need to be aware of them so we can take steps to reduce bone mineral loss.

Age : Ninety percent of hip fractures occur in people aged 50 and older. This is partly because of reduced bone mineral density  . the  older adults with normal BMD are more likely to suffer a fracture than younger people  as there is an  increased likelihood of sustaining a fracture from a fall.

Gender : Women, particularly post-menopausal women, are more susceptible to bone loss than men because their bodies produce less estrogen. This hormone supports bone formation.

Family history : Scientists are uncovering subtle variations in the human genetic code that make some people more susceptible to bone loss than others. In fact, parental history of fracture is a fixed risk factor that is independent of bone mineral density, suggesting that there are additional factors beyond bone health that make people susceptible to fracture.

Previous fracture : genders almost twice as likely to have a second fracture compared to people who are fracture free., it may be related to an increased propensity to fall or poor ability to protect oneself from injury.

Race/ethnicity : Different ethnicities and races have varying susceptibilities to the condition. The disease is more common in Caucasian and Asian populations, and the incidence of hip and spine fracture is lower in Africans than Caucasians. Possible bone structure differences such as greater peak bone mass, a slower rate of bone loss after menopause, and better quality of bone microarchitecture may explain such differences. However, further studies and research are needed.

Menopause/hysterectomy : Loss of estrogen leads to an increase in bone remodeling. In elderly people this remodeling predominantly results in bone loss rather than formation. Hysterectomy, if accompanied by removal of the ovaries, may also increase the risk for osteoporosis because of estrogen loss

Primary/secondary hypogonadism : Hypogonadal young men with low testosterone levels have low bone density, which can be increased through testosterone replacement therapy. At any age, acute hypogonadism, such as that resulting from orchiectomy for prostate cancer, accelerates bone loss to a similar rate as seen in menopausal women.

Because risk factors vary by age and from person-to-person, there is no one-size-fitsall solution for preventing osteoporosis.

Recognizing osteoporosis risk factors early in life and taking appropriate action can have enormous positive impact on bone health in later years.

Be proactive – fight osteoporosis

Knowing the risks is the first step in the fight against osteoporosis. People who believe they are at increased risk because of one or more modifiable or fixed risk factors, need to work with their doctor to develop a strategy to prevent osteoporosis and keep their bones healthy.