Treating someone with established osteoporosis is difficult and the real key to managing this disease is by preventing it!

Identifying your risk factors early can help stop bone loss sooner rather than later when it may be more difficult to treat.

Because there are no real symptoms until a fracture happens, we call it the Silent Disease. You cannot feel your bones thinning – it is similar to not feeling a high cholesterol level and the first sign is a heart attack! To wait for symptoms (a broken bone) may be too late.


Be Proactive and Find Out your Risk!

Common, modifiable risk factors


We all know the damage smoking does to your heart and lungs, but few know that compared to non-smokers, smokers have an increased risk of hip fractures by up to 1.8 times

Excessive alcohol use

If you drink more than 2 units of alcohol per day, you have a 40% increased risk of suffering an osteoporotic fracture. Moderate drinking is beneficial to overall health and your bones

Excessive leanness and poor nutrition

A Body Mass Index of below 19 is considered underweight and a risk factor for osteoporosis- especially if you follow a low kilojoule diet low in bone- health nutrients like calcium, protein and vitamin D. Poor nutrition in the elderly is concerning because they are also more prone to falls and fractures.

Vitamin D deficiency

Vitamin D, usually made in the skin after sun exposure, is essential for the absorption of calcium and therefore bone health. Few foods contain vitamin D and we tend to spend less time in the sun and if we d, we wear sunblock, or sit in offices the whole day. The elderly also spend more time indoors and vitamin D deficiency has become a global problem.

Frequent Falls

Ninety percent of hip fractures occur because older people fall. Poor eyesight, impoaierd balance, dementia, medication etc all increase the risk for falling.

Insufficient exercise

If you don’t exercise you lose muscle mass and also bone density. Regular weightbearing and muscle strengthening exercises are therefore very important for bone health. Especially in the elderly where immobility often leads to a hip fracture due to poor muscle strength and reflexes.

Eating Disorders

Eating disorders like anorexia and bulimia can lead to extreme weight loss and due to the fact that important bone healthy nutrients like calcium, protein and vitamin D are not included, patients are malnourished, and their bone health suffers.

Recent loss of height

If you have lost more than 3 cm in the past year, it can be a sign of vertebral (spine) fractures due to osteoporosis.

Next time we’ll talk about the non- modifiable risk factors.

Recognise the Risk: Factors you cannot Change

The overall risk of developing osteoporosis is greatly influenced by age, gender and ethnicity. Ageing still remains one of the biggest risk factors for developing osteoporosis and the older you are, the bigger your risk!

Although the majority of patients with hip fractures are still women, men also get this disease and about 25% of hip fractures occur in older men and men are more likely to be disabled or die after a hip fracture (probably due to the fact that they have more co-morbid diseases than older women).

The following risk factors should convince you to have your bone health checked out!

Family History

If you have chosen your parents badly (one of them had a broken bone!) and you share their lifestyle and diet which will determine your peak bone density, chances are good that you may develop osteoporosis.

Previous fragility fracture

If you have already had a fracture following minimal trauma (when you fall from less than a standing height), your chances of breaking another bone, doubles. Anyone who suffers a fragility fracture after the age of fifty, needs to be assessed for osteoporosis. Treatment could prevent future fractures.

Certain Medications

Some medications have side effects that could be harmful to bone, or increase the risk of fractures due to an increase in falls.

Patient taking any of the following medications should discuss their bone health with their doctors.

  • Glucocorticoids (oral or inhaled for e.g. asthma, arthritis)
  • Certain immune-suppressants (phosphatase inhibitors, calcineurin etc)
  • Thyroid hormone treatment (excessive doses are harmful to bone)
  • Certain steroid hormones (LH releasing hormone agonists, medroxyprogesterone acetate)
  • Aromatase inhibitors (used in breast cancer)
  • Certain anti-epileptic drugs
  • Lithium
  • Proton-pump inhibitors

Hypogonadism in men

Young men with low testosterone levels usually have low bone mass which can be reversed through testosterone replacement therapy. At any age acute hypogonadism due to e.g. orchidectomy for prostate cancer, accelerates bone loss in men at a similar rate than that of post-menopausal females and they need to be treated for this.


Postmenopausal women and those who have had their ovaries removed, or have experienced an early menopause (before age 45), needs to be extra vigilant and live bone-healthy lifestyles. Hormone replacement therapy can be taken to slow down the rapid bone loss that follows the menopause.

Certain medical disorders

  • Rheumatoid arthritis
  • Nutritional problems/gastrointestinal problems
  • Chronic kidney disease
  • HIV
  • Hematological diseases/malignancy (e.g. breast cancer, prostate cancer
  • Hypogonadal syndromes (Turner’s syndrome/ Klinefelter syndrome etc)
  • Endocrine disorders (e.g. Diabetes, Cushing’s syndrome, hyperparathyroidism)

Chronic immobility

If you have some of these risk factors and are concerned about your bone health, please consult your doctor and get tested!


National Osteoporosis Foundation of South Africa NOFSA  –
International Osteoporosis Foundation IOF –,