Osteoporosis risk factors: who is at higher risk of weak bones

Why it is called a silent disease

The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) calls osteoporosis a "silent" disease because there are typically no symptoms until a bone is broken. Fractures can happen in any bone but are most common in the hip, the vertebrae of the spine and the wrist. Osteoporosis is the major cause of fractures in postmenopausal women and in older men (NIAMS).

Bones weakened by osteoporosis can break from a minor fall, such as a fall from standing height, or even from normal stresses like bending, lifting or coughing. Signs of a spine fracture include severe back pain, loss of height or a stooped posture (NIAMS).

Risk factors and where to check them

NIAMS says many people with osteoporosis have several risk factors, while others have none they know of. Some risk factors cannot be changed, and others may be (NIAMS).

Risk factors you cannot change

• Sex. Osteoporosis is more likely in women, who have lower peak bone mass and smaller bones than men. Men are still at risk, especially after the age of 70 (NIAMS). MedlinePlus notes that it is more common in women, especially after menopause (MedlinePlus).
• Age. With age, bone loss speeds up and new bone growth slows (NIAMS). MedlinePlus says osteoporosis is most common in people over age 50 (MedlinePlus). For many women, it starts to develop a year or two before menopause (NIAMS).
• Body size. Slender, thin-boned women and men are at greater risk because they have less bone to lose (NIAMS) (MedlinePlus).
• Race. White and Asian women are at highest risk. African American and Mexican American women have a lower risk, but NIAMS says they are still at significant risk. White men are at higher risk than African American and Mexican American men (NIAMS) (MedlinePlus).
• Family history. Your risk may be higher if one of your parents has a history of osteoporosis or hip fracture (NIAMS) (MedlinePlus).

Risk factors you may be able to change

• Hormones. Low estrogen after menopause, low estrogen from missed periods before menopause (due to hormone disorders or extreme physical activity), and low testosterone in men can raise the risk (NIAMS).
• Diet. From childhood into old age, a diet low in calcium and vitamin D can raise the risk of osteoporosis and fractures. Excessive dieting or poor protein intake may add to bone loss (NIAMS). For what supplements do and do not do, see the vitamin D and calcium fracture check.
• Medicines. NIAMS lists long-term use of glucocorticoids and adrenocorticotropic hormone, antiepileptic medicines, hormone treatments for breast and prostate cancer, proton pump inhibitors, selective serotonin reuptake inhibitors and thiazolidinediones (NIAMS). Do not stop a prescribed medicine without talking to your provider.
• Other conditions. Some endocrine and hormonal diseases, digestive diseases, rheumatoid arthritis, certain cancers, HIV/AIDS and anorexia nervosa can raise the risk (NIAMS) (MedlinePlus).
• Lifestyle. Low physical activity and long periods of inactivity add to bone loss and raise the risk of falling. Chronic heavy drinking is a significant risk factor, and smoking is linked to osteoporosis and fracture (NIAMS).

Steps that help

NIAMS lists these steps to help prevent the disease and fractures: weight-bearing exercise such as walking, drinking alcohol only in moderation, quitting smoking or not starting, taking prescribed medicines, and a diet rich in calcium and vitamin D (NIAMS). MedlinePlus says the best thing to do is to eat a healthy diet rich in calcium and vitamin D, and that regular physical activity, limiting alcohol and not smoking also help (MedlinePlus).

Because a fall is how many fractures happen, fall risk factors, the fall risk check and the SARC-F sarcopenia screen for muscle strength are worth a look as well.

When screening is advised

MedlinePlus explains that osteoporosis is often found during routine screening, and summarizes the US Preventive Services Task Force (USPSTF) advice: screen women age 65 and older, and postmenopausal women under 65 who have risk factors. For men, it is not yet clear whether regular screening helps (MedlinePlus) (USPSTF 2025). The osteoporosis screening check walks through those steps.

To check for osteoporosis, a provider will ask about past fractures, may check height, posture, balance and muscle strength, will likely order a bone density scan, and may use a short questionnaire that estimates the chance of breaking a bone in the next 10 years (MedlinePlus).

Common questions

Can I have osteoporosis with no risk factors?

Yes. NIAMS says some people who develop osteoporosis do not have any specific risk factors (NIAMS).

Do men get osteoporosis?

Yes. More women get it, so many men think they are not at risk, but NIAMS says older men and women from all backgrounds are at risk (NIAMS).

I broke a bone from a minor fall. Should I ask about osteoporosis?

A break from a fall from standing height is the kind of fracture NIAMS links to fragile bones (NIAMS). It is worth asking your provider whether a bone density test makes sense for you.