9 Risk Factors for Osteoporosis (and Which Ones You Can Control)

Osteoporosis is so common among older adults that some people believe it’s inevitable. However, many people have risk factors for osteoporosis and don’t even realize it. Being more aware of these risk factors—some of which are modifiable—can help more people make lifestyle choices that reduce their risk.

In general, the key to preventing osteoporosis is maintaining bone mass. Your bones are living tissue that constantly undergo the process of bone remodeling. Bone resorption breaks down old bone, and bone deposition adds new bone tissue. As you age, resorption naturally starts to outpace deposition, and certain lifestyle factors can speed up resorption even further.

Risk Factors for Osteoporosis

You can categorize risk factors for osteoporosis as either modifiable or nonmodifiable. Modifiable risk factors are typically part of your lifestyle, whereas nonmodifiable risk factors often stem from genetics or other characteristics you were born with.

Here are the primary risk factors for osteoporosis that you should know about:

1. Low levels of sex hormones

Low estrogen in women and low testosterone in men can lead to increased bone loss. That’s why the risk for osteoporosis increases for women after menopause. The sharp drop in estrogen levels leads to faster bone resorption.

2. Sedentary lifestyle

Remember, bone tissue is living tissue. For this reason, exercise strengthens the muscles *and* bones. In general, doctors usually recommend weight-bearing and resistance exercises for keeping bones strong. Learn more about exercise to prevent osteoporosis here.

3. Anorexia nervosa (and malnourishment in general)

Undereating tends to deprive the bones of the nutrients it needs to maintain bone mass (see #6). Additionally, low body weight can also affect sex hormone levels, which could result in increased bone resorption. (The drop in sex hormone levels is also why people with anorexia nervosa may stop menstruating.)

4. Smoking

Cigarette smoking may increase the risk of osteoporosis in a couple different ways. First of all, it can inhibit your body’s absorption of calcium, an important mineral for bone health. As a result, your body doesn’t actually get to use all the calcium you consume. Additionally, cigarette smoking may lower estrogen levels in women, resulting in increased bone loss.

5. Too much alcohol

Excessive alcohol consumption is also linked to bone loss. Unfortunately, this appears to have a significant effect during adolescence and young adulthood. Researchers often consider this period a crucial time for building up bone mass, but it’s also when many people experiment with large amounts of drinking.

6. Low intake of calcium and vitamin D

There are many nutrients that help support bone health, but two of the most important are calcium and vitamin D. Your body stores the vast majority of its calcium in your teeth and bones. When you don’t get enough calcium from the food you eat to carry out vital functions, your body may steal it from your bones. This can then result in bone loss.

As for vitamin D, it helps your body absorb the calcium that you eat. Learn more about eating a bone-boosting diet here.

7. Genetic risk factors for osteoporosis

Here is where things start to fall out of your control. Osteoporosis is more common in women, especially people with smaller body frames. Slender and thin-boned women generally have less bone mass to begin with, so they’re more vulnerable to the bone loss that happens as you age.

Osteoporosis is also more common in white Americans and Asian Americans, and it’s less common in African Americans and Mexican Americans. Finally, it’s more common in people with a family history of osteoporosis and fractures.

8. Older age

As mentioned before, bones generally thin and weaken as you age, so your risk naturally increases as you get older. That said, avoiding other risk factors for osteoporosis can act as a buffer to reduce the risk, despite your age.

9. Certain medications

Unfortunately, there are a handful of medications that appear to increase bone loss. For example, long-term use of steroid medicines or certain stomach acid drugs may increase the risk of osteoporosis. That’s why it’s important for you and your doctor to weigh the risks and benefits before starting any new medicine.

Preventing Osteoporosis

As you can see, many of the risk factors for osteoporosis may actually be in your control. Making healthy lifestyle choices—like eating a balanced diet, avoiding smoking, and exercising regularly—help keep bones strong. For more tips on preventing osteoporosis and managing your risk factors, talk to your doctor.

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Written by:

Lauren Smith, MA

Lauren Smith, MA, has worked in health journalism since 2017. Before joining GoodRx, she was the senior health editor and writer for HealthiNation.

Reviewed by:

Alexandra Schwarz, MD

Alexandra Schwarz, MD, is a board-eligible sleep medicine physician and a board-certified family medicine physician. She is a member of both the AASM and the ABFM.

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