The evidence for the main risk factors for osteoporosis, such as advanced age, postmenopausal status, corticosteroid use and prior fragility fractures, is robust and consistent. A DXA scan is the recommended tool for establishing the diagnosis, and anyone with multiple risk factors would be wise to discuss this proactively with a doctor. Osteoporosis in men in particular is greatly underestimated and undertreated in practice.
Osteoporosis is a condition in which bones gradually lose density and strength, increasing the risk of fractures. It is not always directly noticeable, but there are clear risk factors that indicate whether you should be extra vigilant.
The strongest risk factors are age and sex. The older you are, the greater the risk, and this applies to both men and women. Women, however, face a considerably greater danger, particularly after menopause. When oestrogen levels drop, bone loss accelerates sharply. All postmenopausal women should be assessed for signs of osteoporosis. Women who have had their ovaries surgically removed at a young age face an additionally elevated risk because oestrogen production stops prematurely.
Certain medications and diseases significantly increase the risk. Long-term use of corticosteroids, such as prednisone, is one of the best-known causes of bone loss and also plays a major role in osteoporosis in men. In men, low testosterone production (hypogonadism) is the most common underlying cause, and testosterone treatment can improve bone density in such cases. If you have previously suffered a fracture without a significant impact or fall, a so-called fragility fracture, or if osteoporosis runs in your family, the risk of further fractures is elevated.
Lifestyle plays a clear but somewhat less powerful role. Smoking, excessive alcohol use, too little physical activity and prolonged bed rest all increase the risk of bone loss. A diet too low in calcium and vitamin D is also linked to a higher risk. Conversely, adequate physical activity, quitting smoking and moderate alcohol consumption offer protection. A low body weight or a small body frame also increases the risk; people who are overweight appear to be somewhat protected in terms of bone density, although excess weight naturally brings other health risks of its own.
Osteoporosis is diagnosed with a DXA scan, a bone density measurement that is considered the gold standard. Screening is recommended for all women aged 65 and over. Younger postmenopausal women and men with risk factors are also eligible for such a measurement. It is worth noting that osteoporosis in men is greatly underestimated: approximately 40 percent of all fractures affect men, yet only one in ten men with osteoporosis receives adequate treatment. If you recognise several risk factors in yourself, it is worthwhile to discuss this with a doctor and, if appropriate, to have a DXA scan performed.
The claims are based on multiple published studies and guidelines (PMIDs 2517695, 30888662, 16448873, 36382763, 7696835, 32773051, 34688418). The strongest associations for age, sex and corticosteroid use are consistent across multiple sources. Data on ethnicity are less representative outside the Caucasian population.