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RISK FACTORS

FOR

OSTEOPOROSIS

Risk factors which cannot be influenced (Unmodifiable)


1- Genetic. 2- Factors controlling development and growth of the skeleton. 3- Race. 4- Gender. 5- Age. 6- Height & Weight (Body Frame). 7- Family History. 8- Pregnancy & Lactation.

Risk factors which can be influenced (Modifiable)


1- Chronic inactivity. 2- Microgravity. 3- Excessive sport. 4- Low body weight ( Low body mass index) 5- Obesity. 6- Low lifelong calcium intake. 7- State of depression. 8- Cigarette smoking.

Risk factors which can be influenced (Modifiable)


9- Excessive alcohol intake. 10- Nutritional Factors. 11- Hormones. 12- Medications. 13- Homocysteine. 14- Endocrinal disorders. 15- Education & knowledge.

Risk factors which cannot be influenced (Unmodifiable)


1- Genetic. 2- Factors controlling development and growth of the skeleton. 3- Race. 4- Gender. 5- Age. 6- Height & Weight (Body Frame). 7- Family History. 8- Pregnancy & Lactation.

= As mother so daughter. = Genetic factors account for 80% of the variance in BMD. = Loci such as Vit. D, oestrogen receptors and collagen type 1@ locus are promising genetic determinants of bone mass. = Gene-gene and gene-environment interactions are determinants of bone density and risk of osteoporosis.

Risk factors which cannot be influenced (Unmodifiable)


1- Genetic. 2- Factors controlling development and growth of the skeleton. 3- Race. 4- Gender. 5- Age. 6- Height & Weight (Body Frame). 7- Family History. 8- Pregnancy & Lactation.

= Deposition, accural and retention of mineral in bone from the embryonic stage onwards throughout life. = Parental skeletal size. = Growth hormone gene. = Weight in infancy and adult bone mass. = Genomic polymorphism and other factors in osseous metabolism. = Causation genes e.g. loci connected to height.

Risk factors which cannot be influenced (Unmodifiable)


1- Genetic. 2- Factors controlling development and growth of the skeleton. 3- Race. 4- Gender. 5- Age. 6- Height & Weight (Body Frame). 7- Family History. 8- Pregnancy & Lactation.

= Caucasians tend to have the lowest bone mass. = Hip fractures are far more common among whites than non-whites. = Afro-american women tend to have the highest bone density and lose bone less rapidly as they age.

Risk factors which cannot be influenced (Unmodifiable)


1- Genetic. 2- Factors controlling development and growth of the skeleton. 3- Race. 4- Gender. 5- Age. 6- Height & Weight (Body Frame). 7- Family History. 8- Pregnancy & Lactation.

= Women have a greater risk for most fractures than men. = The rate of spine and hip fractures in women is two to three times greater than in men. = This is attributed to the fact that men have a higher BMD than women, as well as differences in body size, bone size and width.

Risk factors which cannot be influenced (Unmodifiable)


1- Genetic. 2- Factors controlling development and growth of the skeleton. 3- Race. 4- Gender. 5- Age. 6- Height & Weight (Body Frame). 7- Family History. 8- Pregnancy & Lactation.

= Between 30 and 40 years of age, ossesous remodelling i.e. resorption and formation are balanced. = Thereafter bone loss occurs in women than in men by a rate of 0.5-1% per year after the age of 30. It can reach up to 5% per year after menopause.

Risk factors which cannot be influenced (Unmodifiable)


1- Genetic. 2- Factors controlling development and growth of the skeleton. 3- Race. 4- Gender. 5- Age. 6- Height & Weight (Body Frame). 7- Family History. 8- Pregnancy & Lactation.

= Women with hip fractures have been reported to be taller than those without. = Body weight & body mass index (BMI) are positively related to BMD and inversely related to osteoporosis and fracture rates. = A high prevalence of micronutrient deficiency in obese women who are trying to loose weight (Vit. D included). = After bariatric surgery, post-operative complications such as inadequate diet and malabsorption can lead to micronutrient defic.

Risk factors which cannot be influenced (Unmodifiable)


1- Genetic. 2- Factors controlling development and growth of the skeleton. 3- Race. 4- Gender. 5- Age. 6- Height & Weight (Body Frame). 7- Family History. 8- Pregnancy & Lactation.

= Family history is an independent risk factor for osteoporosis. = Osteoporosis & osteoporotic fractures runs in families. = Genetic factors play a major role in achieving a peak bone mass and bone loss in old age.

Risk factors which cannot be influenced (Unmodifiable)


1- Genetic. 2- Factors controlling development and growth of the skeleton. 3- Race. 4- Gender. 5- Age. 6- Height & Weight (Body Frame). 7- Family History. 8- Pregnancy & Lactation.

= A woman nursing a baby secretes about 500 mg calcium daily into the milk. = After nursing 5 babies, she will have secreted 300 gm of calcium, almost one third of the bound calcium in her skeleton. = If Glucocorticoids are given during pregnancy, calcium and Vitamin D supplementation is essential. = In general, there is a decrease in bone density during pregnancy & breast feeding, but bone density is restored to normal after birth and weaning.

Risk factors which can be influenced (Modifiable)


1- Chronic inactivity. 2- Microgravity. 3- Excessive sport. 4- Low body weight ( Low body mass index) 5- Obesity. 6- Low lifelong calcium intake. 7- State of depression. 8- Cigarette smoking.

Risk factors which can be influenced (Modifiable)


9- Excessive alcohol intake. 10- Nutritional Factors. 11- Hormones. 12- Medications. 13- Homocysteine. 14- Endocrinal disorders. 15- Education & knowledge.

Risk factors which can be influenced (Modifiable)


1- Chronic inactivity. 2- Microgravity. 3- Excessive sport. 4- Low body weight ( Low body mass index) 5- Obesity. 6- Low lifelong calcium intake. 7- State of depression. 8- Cigarette smoking.

= Insufficient physical movement is the single most important risk factor for osteoporosis. = Young bed-ridden patients may loose up to 30% of their bone mass in few months which may require years to regain it back. = An immobilized arm in plaster for three weeks because of a wrist fracture , bone loss up to 6% can occur. = A study of patients restricted to bed rest showed that trabecular bone was lost at a rate of 1% per week.

Immobilization with rapid bone loss: = Paralysis after spinal injuiries. = Hemiplegia after cerebrovascular events. = Paraplegia of the lower half of the body. = Immobilization after fractures of the lower extremities at any age. = Juvenile obesity. = Weightlesseness in Astronauts.

Risk factors which can be influenced (Modifiable)


1- Chronic inactivity. 2- Microgravity. 3- Excessive sport. 4- Low body weight ( Low body mass index) 5- Obesity. 6- Low lifelong calcium intake. 7- State of depression. 8- Cigarette smoking.

= Astronauts lose about 1% of their bone mass every month. = Weightlessness induce Osteocytic apoptosis and this in turn attracts Osteoclasts to bone during space flights. = Two mechanisms were observed in space flights under microgravity i.e. demineralization of bone as well as inhibition of Osteoblasts.

Risk factors which can be influenced (Modifiable)


1- Chronic inactivity. 2- Microgravity. 3- Excessive sport. 4- Low body weight ( Low body mass index) 5- Obesity. 6- Low lifelong calcium intake. 7- State of depression. 8- Cigarette smoking.

= Female athletes are liable to develop osteoporosis later in life. = Constant and lengthy training as well as strict control of diet & weight both lead to an extreme reduction in body fat and a drop in levels of oestrogen. = Consequently, menstrual periods become irregular or cease and the risk of fractures is increased.

Risk factors which can be influenced (Modifiable)


1- Chronic inactivity. 2- Microgravity. 3- Excessive sport. 4- Low body weight ( Low body mass index) 5- Obesity. 6- Low lifelong calcium intake. 7- State of depression. 8- Cigarette smoking.

= Slim women, Thin bones. = Underweight women have a risk of fractures, while overweight women are rarely affected by osteoporosis. = Increased weight strengthens bones, while the oestrogen metabolites produced by the fat cells further protects the bones from developing osteoporosis. = Thinness mania & aneroxia nervosa leads to an increase in fracture risk.

Increased fracture risk in thin women: = Decreased mechanical loading of the skeleton. = Hypogonadism. = Reduced production of oestrogen by fat cells. = Low insulin & IGF-I levels. = Less impact-absorbing fat padding over the greater trochanter .

Risk factors which can be influenced (Modifiable)


1- Chronic inactivity. 2- Microgravity. 3- Excessive sport. 4- Low body weight ( Low body mass index) 5- Obesity. 6- Low lifelong calcium intake. 7- State of depression. 8- Cigarette smoking.

= Obesity & Osteoporosis are two diseases that share several common genetic and environmental factors. = Bone remodelling & adiposity are both regulated via the hypothalamus and the sympathetic nervous system, adipocytes and osteoblasts are derived from a common mesenchymal precursor cell. = Obesity is closely related to insulin and diabetes. = Increased risk of osteoporosisn occurs after bariatric surgery due to various factors.

Risk factors which can be influenced (Modifiable)


1- Chronic inactivity. 2- Microgravity. 3- Excessive sport. 4- Low body weight ( Low body mass index) 5- Obesity. 6- Low lifelong calcium intake. 7- State of depression. 8- Cigarette smoking.

= The average adult ingests about 500 mg. of calcium daily. = The greater Ca intake in childhood and adolescent years, the higher the peak mass, making the bone less susceptible to fracture with normal aging. = Decreased Ca intake over ys., increases PTH levels which will stimulate bone to release Ca from its stores leading to osteoporosis.

Risk factors which can be influenced (Modifiable)


1- Chronic inactivity. 2- Microgravity. 3- Excessive sport. 4- Low body weight ( Low body mass index) 5- Obesity. 6- Low lifelong calcium intake. 7- State of depression. 8- Cigarette smoking.

= Women with severe longstanding depression have 6% less bone mass. Contributing factors include: * High levels of stress hormone. * High level of gonadal steroids. * Various anti-depressant drugs. * Lack of adequate appetite and poor nutrition. * Increased alcohol intake. * Co-morbid conditions. * Reduced physical activity. * Lack of motivation.

Risk factors which can be influenced (Modifiable)


1- Chronic inactivity. 2- Microgravity. 3- Excessive sport. 4- Low body weight ( Low body mass index) 5- Obesity. 6- Low lifelong calcium intake. 7- State of depression. 8- Cigarette smoking.

= Bone Terrorist number One. = Women who smoke one pack a day during adulthood have 5-10% less BMD at the age of menopause. = Smoking increases the lifetime of vertebral fractures by 13% in women and 32% in men. = For hip fractures 31% for women and 40% for men. 10-20 % of all hip fractures in women are attributable to smoking. = Nicotine inhibits oestrogen secretion, stimulates oestrogen breakdown in the liver & depletes the body of certain nutrients such as Vit. C.

= Smoking impairs the bone protective effects of nutritional Ca in PM women. = Smoking increases the bodys toxic burden of cadmium, lead & many other toxic substances which interfere with calcium absorption & mineralization thus impairing its protective effect. = Smoking inhibits osteoblasts function and diminishes blood circulation in bone.

Risk factors which can be influenced (Modifiable)


9- Excessive alcohol intake. 10- Nutritional Factors. 11- Hormones. 12- Medications. 13- Homocysteine. 14- Endocrinal disorders. 15- Education & knowledge.

= Genuine alcoholism increases the risk of osteoporosis & fractures as well as delaying healing of fractures. = Decisive factors include, poor nutrition, lower weight, hepatic damage, lower calcium absorption & decreased levels of oestrogen. = Frequent falling leads to increased susceptibility to fractures.

Risk factors which can be influenced (Modifiable)


9- Excessive alcohol intake. 10- Nutritional Factors. 11- Hormones. 12- Medications. 13- Homocysteine. 14- Endocrinal disorders. 15- Education & knowledge.

= Minerals : Calcium, Phosphorus, Magn-esium, Zinc, Manganese, Copper, Boron & Silica. = Vitamins: D, C, K, B6,B12 & Folic acid. = Proteins. = Essential fatty acids. = Marked protein malnutrition & prolonged Vit D deficiency affect skeletal development and bone mass attained. = Malnutrition is an important risk factor in the elderly. = Some studies have suggested that high intake of animal protein may induce calciuria. = High phosphate diets may induce secondary hyperparathyroidism.

= Hyperlipidaemia and increased lipid oxidation consitute risk factors for osteoporosis. Dietary lipids is now implicated in Ca exclusion, fatty acid metabolism & osteoblast function. = Dietary acid loads induce calciuria and decrease calcium balance. = Carbonated beverages leads also to calciuria as well as excessive caffeine intake. = Phytoestrogens such as in tea & some plants bind to oestrogen receptors and have weak oestrogenic activity.

Risk factors which can be influenced (Modifiable)


9- Excessive alcohol intake. 10- Nutritional Factors. 11- Hormones. 12- Medications. 13- Homocysteine. 14- Endocrinal disorders. 15- Education & knowledge.

= Early menopause is a risk factor. = Insufficient testosterone is a risk factor in men, thus testosterone levels should be measured in young men with osteo. Of unknown aetiology. = Oral contraceptives contain both oestrogen & progestrone and both increase bone mass.

Risk factors which can be influenced (Modifiable)


9- Excessive alcohol intake. 10- Nutritional Factors. 11- Hormones. 12- Medications. 13- Homocysteine. 14- Endocrinal disorders. 15- Education & knowledge.

= Many drugs weaken bones such as: * Glucocorticoids. * Lithium. * Isoniazid. * Anticoagulants. * Antiepileptic drugs. * Antiacids containing Aluminum. * Immunosuppressive drugs such as cyclosporin. * Tamoxifen. = Thiazide diuretics & beta-blockers both exert skeletal benefit & increase BMD.

Risk factors which can be influenced (Modifiable)


9- Excessive alcohol intake. 10- Nutritional Factors. 11- Hormones. 12- Medications. 13- Homocysteine. 14- Endocrinal disorders. 15- Education & knowledge.

= Homocystinuria is an extremely rare inherited cause of osteoporosis due to deficiency in the activity of the enzyme cystathionine B synthetase leading to interference with collagen cross- linking and stimulating osteoclast activity. = Clinical signs occur in childhood such as skeletal fragility, tall stature, genu valgus, sublaxated lenses, capillary fragility and mental retaradation.

Risk factors which can be influenced (Modifiable)


9- Excessive alcohol intake. 10- Nutritional Factors. 11- Hormones. 12- Medications. 13- Homocysteine. 14- Endocrinal disorders. 15- Education & knowledge.

= Hyperparathyroidism due to vitamin D deficiency leading to Ca mobilization from bone. = Thyrotoxicosis leading to increased rate of bone remodelling & hypercalc. = Cushings syndrome. = Insulin dependent diabetes mellitus.

Risk factors which can be influenced (Modifiable)


9- Excessive alcohol intake. 10- Nutritional Factors. 11- Hormones. 12- Medications. 13- Homocysteine. 14- Endocrinal disorders. 15- Education & knowledge.

= Many of the risk factors can be avoided by proper informations. = The emphasis should be on aspects of daily living especially in the elderly. = Risk assessment should be carried out to avoid fractures. = A previous wrist fracture can be considered as a risk factor for future fractures within the subsequent three years.