Women's Health Specialists of St. Louis
Obstetrics and Gynecology

Articles - Risk Factors for Osteoporosis

We all know that post menopausal women are at increased risk for osteoporosis. In fact, it is estimated that approximately 15% of Caucasian women will have a hip fracture by age 50. By age 90, one third of all women will suffer from a hip fracture. These numbers are significant as hip fractures are associated with prolonged loss of mobility and even death. The problem is that most women are not actively trying to prevent osteoporosis until it is too late. Women should not wait until they are menopausal to begin calcium supplementation. In addition to age-related bone loss, there are many other factors that contribute to a womans bone density. Some women have never reached peak bone mass or may gradually be losing bone mass over time because of lifestyle, chronic illness, or even medications. For example, medications such as heparin, Depo-Provera, and corticosteroids are all associated with accelerated bone loss. Some chronic illnesses are also associated with increased risk. These include: type 2 diabetes, hyperthyroidism, cystic fibrosis, and inflammatory bowel disease. Social factors such as sedentary life style, cigarette smoking, alcoholism, low body weight (less than 127 lbs), personal history of fracture as an adult, and lifelong low calcium intake all put women at risk. Women with these risk factors or a family history of a first degree relative with osteoporosis should be screened. Women who have early menopause or had both of their ovaries removed before age 45 also need to consider themselves at increased risk.

Screening may be performed for those women who are at risk or for any woman who is menopausal. There are many available devices for screening. The most basic device uses single-photon absorptiometry. This is the heel scan that may be performed in an office or at health fairs. Ideally, precise screening for osteoporosis should include evaluation of the hip and the spine. Dual-photon absorptiometry may be performed at the hip or spine but this screening tool is fast becoming replaced by dual x-ray absorptiometry. This is often referred to as DXA or Dexa and is now the preferred method of screening. This method uses very low dose x-rays to precisely measure bone density at the hip and spine. The device also has the added benefit of screening the spine laterally for women who have a history of fractures and for very accurately determining body composition such as the calculation of total body fat.

All pre-menopausal women regardless of risk should ingest at least 1200mg of calcium a day. Post-menopausal women and other women at increased risk should take at least 1500mg of calcium a day. Recent studies suggest that many post-menopausal women are vitamin D deficient as well. These women should consider calcium supplementation as well as 800IU of vitamin D daily. A lesser known fact is that women with vitamin B12 deficiency are at increased risk for osteoporosis and should supplement with at least 0.4 mg of B 12 a day.

Osteoporosis is usually preventable with appropriate supplementation and weight bearing exercise. It is a major cause of loss of height and function in elderly women. It is a lifelong process that can be prevented and should not be considered a natural process of aging. As a society we need to stop thinking of it as an old lady disease and practice lifelong surveillance and prevention.