Osteoporosis: will I be at risk?

Peak bone mass is reached between 18 and 25 years of age, and the loss of bone mass that occurs later in life, especially after menopause in women and after age 50 in men, appears to be associated with lifestyle and health status. Because osteoporosis often progresses asymptomatically until a fragility fracture occurs, all modifiable clinical risk factors should be identified and maintained under clinical supervision, particularly after age 50 years, and especially in patients with a family history of osteoporosis/osteoporotic fracture. The occurrence of a previous fragility fracture, regardless of location (wrist, humerus, vertebral, and hip fracture), significantly increases the risk of a new fracture, regardless of age.

Fracture risk assessment in individuals under 50 years of age is, however, recommended in the presence of relevant clinical risk factors.

The risk factors include:

• Age over 65 years
• Previous vertebral fracture
• Fragility fracture after age 40 years
• Parental history of hip fracture
• Low BMI
• Weight loss of greater than 10% of age 25 years
• Low dietary calcium intake
• Smoking
• Excessive caffeine intake (>2 cups per day)
• Excessive alcohol intake (>3 units per day)
• Early menopause (<40 years)
• Hypogonadism
• Primary hyperparathyroidism
• History of clinical hyperthyroidism
• Rheumatoid arthritis
• Long-term use of oral glucocorticoids (>5 mg prednisolone per day or equivalent for more than 3 months)
• Chronic antiepileptic therapy
• Chronic heparin therapy
• Prolonged immobilisation and paralysis (e.g., ankylosing spondylitis or spinal cord injury, Parkinson's disease, stroke, muscular dystrophy)

Increased propensity to fall.

The definition of an osteoporotic fracture is not always clear, and the terms osteoporosis, fragility fracture, and osteoporotic fracture are often used ambiguously. Fractures resulting from trauma in the same plane or falls that would not normally cause a healthy bone to fracture are broadly considered osteoporotic. Falls are, therefore, the main risk factor for most osteoporotic fractures, with the exception of vertebral fractures. Most fall episodes tend to occur during the day and in the individual's usual home. In postmenopausal women, the occurrence of a previous fragility fracture constitutes a highly significant risk factor regardless of age and should be a criterion for initiating anti-osteoporotic therapy.

As osteoporosis is a silent disease, the occurrence of a bone fracture, regardless of location, usually represents the first symptom of the disease. Although the incidence of these fractures generally increases markedly with age, the respective rate varies according to the fracture and characteristics of the population at risk. In this context, any recent fracture in individuals over 50 years of age should be considered a sentinel event, representing an important warning sign that requires immediate evaluation and treatment. Appropriate and timely intervention after a “sentinel” fracture is critical to mitigate recurrent fractures, disability, and premature death.

Be aware of these signs and consult your doctor.

For more information, please contact Grupo HPA Saude on (+351) 282 420 400.