How do I know if I am at risk of osteoporosis?

Osteoporosis creeps up on you without any warning signs: your bones gradually lose their strength until a fracture suddenly occurs. Fortunately, the risk factors are well established, so you can assess for yourself whether you need to be alert.

The greatest risk factors are age and sex. The older you are, the greater the risk, for both men and women. Women are more vulnerable, especially after menopause. Without oestrogen, bone loss accelerates considerably. Women whose ovaries were removed at a young age face additional risk because oestrogen production stops early in their case.

Certain medications and conditions significantly raise the risk. Long-term use of corticosteroids such as prednisone is a well-known cause of bone loss, in men as well as women. In men, abnormally low testosterone production is the most common underlying cause; testosterone treatment can then improve bone density. Have you ever had a bone fracture without a hard impact or fall, or does osteoporosis run in your family? If so, your risk of further fractures is increased.

Lifestyle also plays a role, though a somewhat smaller one. Smoking, excessive alcohol consumption, little physical activity, and insufficient calcium or vitamin D all raise the risk. A low body weight or small frame is also a factor; people who are overweight appear to have some protection where bone density is concerned, although excess weight brings its own risks.

Bone density is measured with a DXA scan, the standard tool for diagnosis. Screening is recommended for all women aged 65 and older. Younger women who have gone through menopause and men with risk factors are also eligible. Note: osteoporosis in men is greatly underestimated. Around 40% of all bone fractures occur in men, yet only one in ten men with osteoporosis receives adequate treatment. Do you recognise several risk factors in yourself? Discuss this with your doctor and ask about a DXA scan if appropriate.