Osteoporosis leads to a decrease in bone mineral density (BMD), resulting in weaker bones that are more prone to fractures (breaks). These fractures can be painful and significantly impact mobility. Most people with osteoporosis have primary osteoporosis, which arises due to a combination of genetic predispositions and lifestyle factors. Others have secondary osteoporosis, caused by underlying medical conditions or specific medications.

Read more about types of osteoporosis.

This article will cover the risk factors associated with osteoporosis. Understanding these risk factors can help identify potential causes of bone loss, guide prevention strategies, and support early intervention to reduce the risk of fractures. By recognizing what might contribute to osteoporosis, you can make informed decisions about your bone health and work with your health care provider on the best ways to protect your bones.

Risk Factors for Osteoporosis

It is important to note that while science is good at finding correlations, or apparent relationships, between factors and disease, correlation does not prove that the factor causes the disease. Many risk factors for osteoporosis are still being studied.

Age

Age is the most significant risk factor for osteoporosis. Risk increases around age 50 and beyond, especially for women, according to StarPearls, due to a decline in hormone levels after menopause.

Hereditary Factors

The risk of developing osteoporosis often runs in families. Several genetic variants are known to influence BMD. Researchers estimate that inherited genetic traits can determine around 50 percent to 80 percent of an individual’s peak BMD, which typically reaches its highest level around the ages of 25 to 30. Higher peak BMD offers better protection against osteoporosis. Those with a family history of osteoporosis — especially if a parent experienced a hip fracture — should consider early screening.

About 50 percent of women and 20 percent of men over age 50 will have an osteoporosis-related fracture at some point, according to research in the European Journal of Rheumatology. According to the Bone Health and Osteoporosis Foundation (BHOF), women have higher rates, partly due to smaller bone structures, which makes bone loss more impactful. Additionally, the decrease in estrogen levels after menopause accelerates bone loss, per the BHOF.

According to research in the journal Maturitas, approximately 5 percent of women experience early menopause (between the ages of 40 and 45), often due to familial patterns.

Ethnicity influences osteoporosis risk. The condition is less prevalent among non-Hispanic Black adults compared with non-Hispanic white adults, Hispanic adults, and Asian adults, according to research in the Journal of Bone and Mineral Research.

Environmental Factors

Researchers have identified many environmental factors linked to the development of osteoporosis.

Diet

Calcium and vitamin D are essential for bone health. Insufficient intake, particularly during the bone-building years of early adulthood, increases the risk. Diets that are excessively high in protein or sodium can also cause the body to lose calcium, impairing bone strength.

Looking to boost your calcium intake? Try these three calcium-rich smoothie recipes.

Physical Activity Levels

A sedentary lifestyle can contribute to the loss of bone mineral density. Engaging in weight-bearing activities during early adulthood helps to achieve a higher peak bone mass and lowers the risk of osteoporosis later in life. These activities include:

• Walking or hiking
• Tennis or other racquet sports
• Weightlifting

Smoking, Alcohol Use, and Caffeine Intake

Heavy smoking has been shown to reduce bone mass, while chronic, excessive alcohol consumption during adolescence and early adulthood significantly decreases bone density. Caffeine may also impact calcium absorption, though evidence is mixed.

Exposure to Toxins

Exposure to the toxic metal cadmium is believed to contribute to the development of osteoporosis. Cadmium is a pollutant present in some water, soil, and plant fertilizer. People are exposed when they smoke tobacco or eat vegetables grown in polluted conditions. Welders and workers in fields such as textiles, plastics, or battery manufacturing may be exposed to cadmium on the job.

Hormonal Changes

Oophorectomy (surgical removal of the ovaries) before age 45 may increase a person’s risk for early menopause. The drop in estrogen contributes to a loss of bone mineral density.

Weight and Body Mass

A healthy weight may help maintain bone density. While obesity has traditionally been seen as protective, rapid weight loss or low body weight can increase the risk of osteoporosis. It is theorized that carrying extra weight may have a similar effect as exercise on increasing bone mineral density, or that fat cells release estrogen — a hormone that reduces the breakdown of bone.

Which Health Conditions Can Cause Osteoporosis?

Many medical conditions can reduce bone mineral density and increase the risk of osteoporosis. These conditions may disrupt hormones that control bone formation or hinder the body’s ability to absorb essential nutrients.

Conditions that can cause secondary osteoporosis include:

• Eating disorders — Conditions such as anorexia nervosa and bulimia can lead to osteoporosis due to malnutrition and severe weight loss, which decrease the intake of calcium and other nutrients essential for bone health.
• Digestive conditions — Disorders like celiac disease and Crohn’s disease impair nutrient absorption, including calcium and vitamin D, which are crucial for maintaining bone density, increasing the risk of osteoporosis.
• Chronic illnesses — Conditions such as chronic obstructive pulmonary disease (COPD), diabetes, kidney failure, and liver disease can contribute to bone loss due to factors like long-term medication use (e.g., corticosteroids), reduced mobility, and imbalanced calcium and vitamin D levels.
• Endocrine disorders — Disorders including Cushing’s disease, hyperparathyroidism (overactive parathyroid gland), and hyperthyroidism (overactive thyroid gland) can disrupt the hormonal balance that regulates bone metabolism, leading to increased bone resorption and decreased bone density.
• Rheumatic conditions — Conditions such as rheumatoid arthritis can lead to osteoporosis due to chronic inflammation and the use of medications like corticosteroids, which can accelerate bone loss.
• Cancers — Conditions such as leukemia and multiple myeloma can directly affect bone marrow, increase bone resorption, and weaken bones, making them more susceptible to osteoporosis.
• Certain surgeries — Procedures like gastric bypass surgery can affect the absorption of calcium and vitamin D, leading to a decrease in bone density and increased risk of osteoporosis.

Which Medications Can Cause Osteoporosis?

Some medications that affect hormone levels or the absorption of nutrients in the digestive system can promote the development of osteoporosis.

Drugs known to cause osteoporosis in some people include:

• Antiseizure drugs including carbamazepine (Tegretol) and phenytoin (Dilantin, Phenytek)
• Breast cancer drugs such as anastrozole (Arimidex), letrozole (Femara), and exemestane (Aromasin)
• Corticosteroids such as prednisone, dexamethasone, or methylprednisolone
• Medroxyprogesterone (Depo-Provera)
• Diuretics (“water pills”) such as furosemide (Lasix, Furoscix)
• Tamsulosin (Flomax) and other drugs for benign prostatic hyperplasia
• Prostate cancer treatment that suppresses androgens (hormones such as testosterone)
• Proton pump inhibitors such as lansoprazole (Prevacid) and esomeprazole (Nexium)
• Some medications for hypertension (high blood pressure)
• Thyroid hormone replacement (at excessive doses)

Talk to Your Doctor

If you have osteoporosis or concerns about your bone health, talking to a health care provider is crucial. Understanding whether your osteoporosis is primary or secondary helps create a tailored treatment plan. Discussing potential causes — like medications, chronic conditions, or lifestyle habits — can identify factors contributing to bone loss. This can ensure you receive the most effective treatment and guidance for protecting your bones. Always consult your provider before changing any medications or treatments.

Talk With Others Who Understand

MyOsteoTeam is the social network for people with osteoporosis and their loved ones. On MyOsteoTeam, more than 62,000 members come together to ask questions, give advice, and share their stories with others who understand life with osteoporosis.

Are you or a loved one diagnosed with osteoporosis? Have you identified the causes? What treatments have you tried? Share your experience in the comments below, or start a conversation by posting on your Activities page.