Age, race and family history are among the factors that can increase the likelihood of developing osteoporosis.

Osteoporosis and Bone Density Testing Risk Factors

Risk Factors

A number of factors can increase the likelihood that you'll develop osteoporosis, including:

  • Your sex. Fractures from osteoporosis are about twice as common in women as they are in men. That's because women start out with lower bone mass and tend to live longer. They also experience a sudden drop in estrogen at menopause that accelerates bone loss. Slender, small-framed women are particularly at risk. Men who have low levels of the male hormone testosterone also are at increased risk. The risk of osteoporosis in men is greatest from age 75 on.

  • Age. The older you get, the higher your risk of osteoporosis. Your bones become weaker as you age.

  • Race. You're at greatest risk of osteoporosis if you're white or of Southeast Asian descent. Black and Hispanic men and women have a lower, but still significant, risk.

  • Family history. Osteoporosis runs in families. For that reason, having a parent or sibling with osteoporosis puts you at greater risk, especially if you also have a family history of fractures.

  • Frame size. Men and women who are exceptionally thin or have small body frames tend to have higher risk because they may have less bone mass to draw from as they age.

  • Tobacco use. The exact role tobacco plays in osteoporosis isn't clearly understood, but researchers do know that tobacco use contributes to weak bones.

  • Lifetime exposure to estrogen. The greater a woman's lifetime exposure to estrogen, the lower her risk of osteoporosis. For example, you have a lower risk if you have a late menopause or you began menstruating at an earlier than average age. But your risk of osteoporosis is increased if your lifetime exposure to estrogen has been deficient, such as from infrequent menstrual periods or menopause before age 45.

  • Eating disorders. Women and men with anorexia nervosa or bulimia are at higher risk of lower bone density in their lower backs and hips.

  • Corticosteroid medications. Long-term use of corticosteroid medications, such as prednisone, cortisone, prednisolone and dexamethasone, is damaging to bone. These medications are common treatments for chronic conditions, such as asthma, rheumatoid arthritis and psoriasis. If you need to take a steroid medication for long periods, your doctor should monitor your bone density and recommend other drugs to help prevent bone loss.

  • Thyroid hormone. Too much thyroid hormone also can cause bone loss. This can occur either because your thyroid is overactive (hyperthyroidism) or because you take excess amounts of thyroid hormone medication to treat an underactive thyroid (hypothyroidism).

  • Selective serotonin reuptake inhibitors (SSRIs). Research published in 2007 showed lower bone mineral density among both men and women currently using SSRIs compared with study participants not taking these antidepressants. However, these results don't necessarily mean that SSRIs cause bone loss or osteoporosis. More research is needed to fully understand the association between SSRI use and low bone density. Evidence does not currently indicate that you should stop using SSRIs because of concerns about bone loss.

  • Other medications. Long-term use of the blood-thinning medication heparin, the cancer treatment drug methotrexate, some anti-seizure medications, diuretics and aluminum-containing antacids also can cause bone loss.

  • Breast cancer. Postmenopausal women who have had breast cancer are at increased risk of osteoporosis, especially if they were treated with chemotherapy or aromatase inhibitors such as anastrozole and letrozole, which suppress estrogen. This isn't true for women treated with tamoxifen, which may reduce the risk of fractures.

  • Low calcium intake. A lifelong lack of calcium plays a major role in the development of osteoporosis. Low calcium intake contributes to poor bone density, early bone loss and an increased risk of fractures.

  • Medical conditions and procedures that decrease calcium absorption. Stomach surgery (gastrectomy) can affect your body's ability to absorb calcium. So can conditions such as Crohn's disease, celiac disease, vitamin D deficiency, anorexia nervosa and Cushing's disease — a rare disorder in which your adrenal glands produce excessive corticosteroid hormones.

  • Sedentary lifestyle. Bone health begins in childhood. Children who are physically active and consume adequate amounts of calcium-containing foods have the greatest bone density. Any weight-bearing exercise is beneficial, but jumping and hopping seem particularly helpful for creating healthy bones. Exercise throughout life is important, but you can increase your bone density at any age.

  • Excess soda consumption. The link between osteoporosis and caffeinated sodas isn't clear, but caffeine may interfere with calcium absorption and its diuretic effect may increase mineral loss. In addition, the phosphoric acid in soda may contribute to bone loss by changing the acid balance in your blood. If you do drink caffeinated soda, be sure to get adequate calcium and vitamin D from other sources in your diet or from supplements.

  • Chronic alcoholism. For men, alcoholism is one of the leading risk factors for osteoporosis. Excess consumption of alcohol reduces bone formation and interferes with the body's ability to absorb calcium.

  • Depression. People who experience serious depression have increased rates of bone loss.

Tests and Diagnosis

Osteopenia refers to mild bone loss that isn't severe enough to be called osteoporosis, but that increases your risk of osteoporosis. Doctors can detect osteopenia or early signs of osteoporosis using a variety of devices to measure bone density.

  • Dual energy X-ray absorptiometry (DEXA) - This is the best test method and is quick, simple and gives accurate results. It measures the density of bones in your spine, hip and wrist — the areas most likely to be affected by osteoporosis — and it's used to accurately follow changes in these bones over time.

  • Ultrasound

  • Quantitative computerized tomography (CT) scanning

Should you have a test?

If you're a woman, the National Osteoporosis Foundation recommends that you have a bone density test if you aren't taking estrogen and any of the following conditions apply to you:

  • You're older than age 65, regardless of risk factors.

  • You're postmenopausal and have at least one risk factor for osteoporosis, including having fractured a bone.

  • You have a vertebral abnormality.

  • You use medications, such as prednisone, that can cause osteoporosis.

  • You have type 1 diabetes, liver disease, kidney disease, thyroid disease or a family history of osteoporosis.

  • You experienced early menopause.