Osteoporosis - Part 2: Risk Assessment
by Dr. Jason Kwok
You can listen to an audible version of this article.
Osteoporosis is not a sudden onset disease, but rather a gradual decrease in bone mass over years. Patients may not feel any symptoms until they experience a fracture, which is why osteoporosis is known as the "silent thief." By the time a fracture occurs and osteoporosis is diagnosed, it has often reached a severe stage. Therefore, the most effective way to prevent fractures due to osteoporosis is to detect the decrease in bone mass as early as possible. Risk assessment can help to take appropriate preventive measures in a timely manner. Osteoporosis Canada provides a risk assessment questionnaire that includes the following questions:
(A.)
• Are you 65 years of age or older?
• Have you had a bone fracture after age 40 due to minor trauma?
• Did your father or mother have a hip fracture?
• Do you smoke?
• Do you often drink beverages containing three or more alcohol servings per day?
• Do you need to take medication containing steroids?
• Do you have any diseases that can cause a decrease in bone mass or fractures (such as rheumatoid arthritis, celiac disease, gastric bypass surgery, chronic obstructive pulmonary disease, chronic liver disease)?
• Did you experience early menopause (before age 45)?
• Have you missed several menstrual periods not due to pregnancy or menopause?
• Is your current weight less than 60 kg or 132 pounds?
• Has your weight decreased by more than 10% since you were 25 years old?
• Have you recently had an X-ray that showed a vertebral fracture?
• Have you had an X-ray that showed low bone density?
• Have you experienced erectile dysfunction, decreased libido, or other symptoms due to low testosterone levels?
(B.)
• Have you shrunk in height by 2 cm (3/4 inch) or more when measured by healthcare personnel or 6 cm (2 1/2 inches) or more compared to when you were younger?
• Do you have a hunched back?
The Osteoporosis Canada recommends that people over 50 years of age with one or more of the above items should consult their family physician to check for spinal fractures, which usually only require a lumbar X-ray.
(C.)
Frequent falls can lead to fractures.
• Have you fallen two or more times in the past year?
• Do you sway or have difficulty balancing when walking?
• Do you need to use both hands to get up from a sitting position?
• Do you need to use walking aids such as a cane, walker, or wheelchair when walking?
If you have one or more of the above items indicating a risk of falling, appropriate measures should be taken to prevent falls. 
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