Osteoporosis Risk Calculator

Osteoporosis Risk Chart calculates a person's risk for osteoporosis. It also predicts if the person requires a special X-ray test called 'bone densitometry or DEXA scan' to confirm the score index from the results of the chart.

We recommend that you take this test after the age of 40 years. Please answer all the questions. The test is almost 80% accurate in predicting osteoporosis.

Generally as we age, the risk of osteoporosis increases and this results in increased risk of fracture such as fracture of the hip bone or wrist bone. The good news is that osteoporosis is reversible by exposure to sunlight and taking Calcium and Vitamin D supplements.

What is Osteoporosis?

Osteoporosis is defined as low bone mineral density caused by altered bone microstructure, which predisposes patients to low-impact, fragility fractures. These fractures significantly decrease the quality of life, increasing morbidity, mortality, and disability (1^✔).

Who is at Risk for Osteoporosis?

Bone loss naturally occurs with increasing age and declining sex hormones, leading to a loss of bone mineral density and increased fracture risk.

Several factors contribute to osteoporosis, including:

• Advanced Age: Aging is a significant osteoporosis age risk factor
• Low Body Weight (<128 pounds)
• Female Gender: Osteoporosis risk factors in women include hormonal changes like menopause
• Family History of osteoporosis
• Smoking: Smoking and osteoporosis are closely linked, as smoking accelerates bone loss from smoking
• Alcohol Consumption: Alcohol and osteoporosis impair bone health and calcium absorption
• Low Physical Activity
• Early Menopause
• Corticosteroid Use
• Secondary Osteoporosis: Caused by diseases or medications.
• Prior Fractures after age 40 from minor trauma
• Osteoporosis modifiable risk factors include quitting smoking, reducing alcohol intake, and improving physical activity to lower risk factors for broken bones
• Obesity may sometimes increase bone density, but it is still an osteoporosis obesity risk factor due to poor bone quality

Women and Osteoporosis Risk

Over 50% of postmenopausal white women will experience osteoporosis-related fractures, while white men face a 20% lifetime risk.

However, in men, the one-year mortality rate after a hip fracture is twice that of women. Black men and women have lower rates of osteoporosis compared to white individuals, but once diagnosed, their fracture risk is similar.

Amenorrhea lasting over a year, often caused by low estrogen, low body weight, or excessive exercise, can lead to rapid bone loss. This highlights the importance of hormonal balance and maintaining a healthy weight to preserve bone density and reduce fracture risk (2^✔).

Symptoms and Stages of Osteoporosis

Osteoporosis is often called the "silent disease" because symptoms may not appear until a fracture occurs. Common symptoms include:

• Back Pain: Often caused by vertebral fractures
• Loss of Height: Gradual height reduction due to spinal compression
• Stooped Posture: Known as kyphosis or “dowager’s hump.”
• Fragile Bones: Increased susceptibility to fractures, even from low-impact falls

Stages of Osteoporosis

Osteoporosis progresses through four stages, weakening bones over time and increasing fracture risk. Early stages often show no symptoms (3^✔).

Stage 1:

• Bone loss and formation occur at the same rate
• New bone does not outpace bone loss
• No symptoms are present

Stage 2 (Osteopenia):

• Bone loss exceeds bone formation, leading to lower bone density
• No symptoms, but bones are weaker
• Risk of developing osteoporosis can be reduced with lifestyle changes

Stage 3:

• Diagnosed as osteoporosis
• Bone loss accelerates, increasing fracture risk
• Minor falls may cause fractures

Stage 4:

• Severe osteoporosis with a high risk of fractures
• Symptoms are Height loss, Stooped posture

Tests for Osteoporosis

Bone Density Test

Bone mineral density (BMD) testing is essential in diagnosing osteoporosis, with primary osteoporosis primarily related to aging, and secondary osteoporosis resulting from specific conditions that may be reversible.

The dual energy X-ray absorptiometry (DXA) is the preferred method for measuring bone density, and it provides important metrics for assessing fracture risk.

A typical bone density chart shows how bone mass changes with age. For healthy adults, bone density peaks in the early 30s and begins to decline with age, accelerating especially in women post-menopause.

FRAX Assessment: Fracture Risk Evaluation

FRAX is a clinically used tool that helps assess a person's 10-year probability of experiencing a major osteoporotic fracture (such as hip, spine, forearm, or shoulder fractures) and specifically a hip fracture. It was developed by the World Health Organization (WHO) to assist clinicians in determining whether further diagnostic testing or treatment is needed for osteoporosis prevention(4^✔,5^✔).

Difference between FRAX and DXA Tool

FRAX (Fracture Risk Assessment Tool)

• Estimates 10-year fracture risk using clinical risk factors, not bone density (BMD)
• Cost-effective for determining when to perform a DXA scan or start treatment
• Considers factors like age, smoking, and alcohol use, offering a comprehensive fracture risk assessment

DXA (Dual-Energy X-Ray Absorptiometry)

• Measures BMD directly at the hip or spine, diagnosing osteoporosis accurate
• Expensive but precise for bone strength evaluation and fracture detection
• Often combined with FRAX for better fracture risk prediction and treatment planning

Bone Density and Osteoporosis Risk Chart

Age	Bone Density (T-Score Range)	Risk Category
20-30	+1.0 to -1.0	Normal
30-40	-1.0 to -1.5	Osteopenia
40-50	-1.0 to -2.0	Osteopenia
50-60	-1.5 to -2.5	Osteopenia / Osteoporosis
60-70	-2.5 or below	Osteoporosis
70+	-2.5 or below with fractures	Severe Osteoporosis

(6^✔)

Treatment of Osteoporosis

• Osteoporosis treatment focuses on lifestyle changes, medications, and fracture prevention
• Patients should be encouraged to engage in weight-bearing activities, improve balance through exercises like yoga, and quit smoking and alcohol
• Calcium and vitamin D3 supplementation is essential, with vitamin D levels normalized in deficient patients
• For treatment, bisphosphonates (alendronate, risedronate, zoledronic acid) are commonly prescribed as first-line therapy, reducing fracture risk by up to 70%
• Denosumab, selective estrogen receptor modulators, and anabolic agents like teriparatide may also be used. Hormonal replacement therapy is an option for some women
• Treatment is often guided by a T-score of -2.5 or lower, and in cases of fragility fractures, therapy is recommended without further testing
• Regular monitoring is necessary, especially after long-term use of bisphosphonates, to prevent complications such as atypical femur fractures
• Proper osteoporosis prevention and careful management of medications, including proton pump inhibitors, are critical

Osteoporosis Facts and Figures