What are lifestyle and risk factors that affect bone health?
A risk factor of osteoporosis is anything that increases your chance of getting the disease. Having one or more risk factors does not mean that you will have osteoporosis. However, the more risk factors you have, the greater your chance of developing osteoporosis.
Who is affected by osteoporosis? Osteoporosis is common in Australia. Women and men can be affected, with up to 25% of cases in men. Early investigation of risk factors can prevent osteoporosis.
Your bones require calcium, vitamin D and exercise on a regular basis. Lifestyle choices like smoking and excessive alcohol intake are bad news for bones. It is also important to be aware of particular risk factors for low bone density that you cannot change.
Known risk factors for developing osteoporosis
Are you 50 years old or older?
Bone density typically peaks around age 30 and remains relatively stable from about age 25 to 50, with bone formation and breakdown occurring at similar rates. After age 50, however, bone loss often speeds up, especially around menopause, as bone breakdown begins to outpace bone formation. While those aged 50 and above are generally at higher risk for osteoporosis, it can also develop in younger individuals depending on various risk factors.
Do you have a family history of osteoporosis?
Bone health can be strongly inherited so consider your family history of osteoporosis. Check if anyone in your family (particularly parents or siblings) has been diagnosed with osteoporosis. This includes parents or siblings who have experienced a broken bone (from a minor fall) or rapidly lost height, which can indicate being at risk of osteoporosis.
Have you had a recent fracture (inc. chip, break, crack) within 2 years? Or history of fragility fractures?
Breaking a bone from a minor bump or fall should be investigated in anyone over 50 years. Poor bone health may be the contributing factor for the fracture. People who have already sustained an osteoporotic fracture are almost twice as likely to have a second fracture compared to people who are fracture free. In most cases treatment should be prescribed to prevent the high likelihood of future fractures.
Download the Fact Sheet: Breaking a Bone + Bone Health printable information.
After the age of 40, have you lost more than 3 cm in height (i.e. 1.25 inches)?
If you’ve lost over 3cm in height it may be a sign of vertebral (spine) fractures caused by osteoporosis. Vertebral fractures may cause a curved spine or humped back, presenting as height loss.
Have low levels of physical activity?
Adults with a sedentary lifestyle lose bone more rapidly, and studies have shown that sedentary older adults are more likely to have a hip fracture than those who are more active. Research has demonstrated that when it comes to our bones, not all exercise is equal. Bones benefit when a certain amount of impact or strain is placed on them, making specific types of exercise most beneficial.
The ability of an exercise to have an impact on bone depends on the specific way that stress is applied to the bone during the exercise. Exercise is also important for muscle development, essential to maintain mobility. Exercise must be ongoing to have a proper benefit.
Have diagnosed medical conditions or take medications that can affect bone health?
- Low Hormone Levels: Early Menopause in Women or Low Testosterone in Men
Hormone levels play a key role in maintaining bone strength. Women are particularly at risk of developing osteoporosis due to the sharp drop in oestrogen levels that occurs during menopause. This hormonal shift accelerates bone loss, leading to a reduction in bone density of around 2% per year for several years after menopause. Similarly, low testosterone levels in men can also lead to decreased bone mass over time. Download the Fact Sheet: Menopause + Bone Health printable information. - Coeliac disease, inflammatory bowel disease and other malabsorption disorders
Download the Fact Sheet: Coeliac Disease + Bone Health printable information.
- Diabetes and certain medication treatments.
Download the Fact Sheet: Diabetes + Bone Health printable information.
- Certain breast cancer or prostate cancer treatments.
Download the Fact Sheet: Prostate Cancer + Bone Health printable information.
Download the Fact Sheet: Breast Cancer + Bone Health printable information.
- Anorexia nervosa
Download the Fact Sheet: Anorexia Nervosa + Bone Health printable information.
- Corticosteroids – commonly used for asthma, rheumatoid arthritis or other inflammatory conditions
Download the Fact Sheet: Glucocorticoids + Bone Health printable information.
- Thyroid conditions – overactive thyroid or parathyroid
Download the Fact Sheet: Thyroid Conditions + Bone Health printable information.
- Rheumatoid arthritis
Download the Fact Sheet: Rheumatoid Arthritis+ Bone Health printable information.
- Chronic liver or kidney disease
- Certain epilepsy, antidepressant or HIV treatment
Download the Fact Sheet: Epilepsy + Bone Health printable information.
- Pregnancy-associated osteoporosis (transient osteoporosis in pregnancy) – though a rare condition.
Download the Fact Sheet: Pregnancy + Bone Health printable information.
Smoking
While the harmful effects of smoking on heart and lung health are well known, fewer people realise that smoking also negatively impacts bone health. Current and former smokers have a higher risk of fractures compared to those who have never smoked. Smoking can reduce bone mass, interfere with calcium absorption, and affect hormone levels important for bone maintenance.
Excessive alcohol intake
Excessive alcohol consumption is a significant risk factor for poor bone health and osteoporosis. Alcohol can interfere with the body’s ability to absorb calcium and other nutrients essential for maintaining strong bones. It can also affect hormone levels, including oestrogen and testosterone, which are important for bone formation and maintenance. Chronic heavy drinking may also increase the risk of falls, leading to fractures. Alcohol intake is considered excessive when it exceeds more than two standard drinks per day every day.
Calcium and Vitamin D
Low calcium intake: Calcium is essential for building and maintaining strong bones. Adults need around 1,000 mg per day, ideally from dietary sources. This increases to 1,300 mg daily for women over 50 and men over 70, as bone loss accelerates with age.
Low vitamin D levels: Vitamin D helps the body absorb calcium effectively. A lack of sun exposure — especially during winter or in people who spend little time outdoors — can lead to low vitamin D levels. Individuals at risk of deficiency should have their vitamin D status assessed.
Body build and weight
People with a small or thin body frame are at increased risk of developing osteoporosis. This is partly because they have lower peak bone mass, meaning they start with less bone to lose as they age.
On the other hand, obesity may also impact bone health. Research suggests that hormonal changes associated with excess body fat can negatively affect bone quality, even though body weight alone may sometimes appear protective.