Osteoporosis International

, 20:1

Risk factors for low bone mass in healthy 40–60 year old women: A systematic review of the literature


    • Osteoporosis Research ProgramWomen’s College Hospital
    • Osteoporosis Research ProgramWomen’s College Hospital
  • M.-A. Lam
    • Osteoporosis Research ProgramWomen’s College Hospital
  • G. A. Hawker
    • Osteoporosis Research Program and Department of MedicineWomen’s College Hospital
  • J. McGowan
    • Institute of Population HealthOttawa Health Research Institute
    • Department of Medicine and Family MedicineUniversity of Ottawa
  • A. Papaioannou
    • Division of Geriatrics, Department of MedicineHamilton Health Sciences and McMaster University
  • A. M. Cheung
    • Department of MedicineUniversity Health Network and University of Toronto
  • A. B. Hodsman
    • Division of NephrologyDepartment of Medicine, St. Joseph’s Health Care
  • W. D. Leslie
    • Departments of Medicine and RadiologyUniversity of Manitoba
  • K. Siminoski
    • Department of Radiology and Diagnostic Imaging and Division of Endocrinology and Metabolism, Department of MedicineUniversity of Alberta
  • S. A. Jamal
    • Osteoporosis Research Program and Department of MedicineWomen’s College Hospital

DOI: 10.1007/s00198-008-0643-x

Cite this article as:
Waugh, E.J., Lam, M., Hawker, G.A. et al. Osteoporos Int (2009) 20: 1. doi:10.1007/s00198-008-0643-x



Based on a systematic review of the literature, only low body weight and menopausal status can be considered with confidence, as important risk factors for low BMD in healthy 40–60 year old women. The use of body weight to identify high risk women may reduce unnecessary BMD testing in this age group.


BMD testing of perimenopausal women is increasing but may be unnecessary as fracture risk is low. Appropriate assessment among younger women requires identification of risk factors for low BMD specific to this population.


We conducted a systematic literature review of risk factors for low BMD in healthy women aged 40–60 years. Articles were retrieved from six databases and reviewed for eligibility and methodological quality. A grade for overall strength of evidence for each risk factor was assigned.


There was good evidence that low body weight and post-menopausal status are risk factors for low BMD. There was good or fair evidence that alcohol and caffeine intake, and reproductive history are not risk factors. There was inconsistent or insufficient evidence for the effect of calcium intake, physical activity, smoking, age at menarche, history of amenorrhea, family history of OP, race and current age on BMD.


Based on current evidence in Caucasians, we suggest that, in healthy women aged 40–60 years, only those with a low body weight (< 70 kg) be selected for BMD testing. Further research is necessary to determine optimal race-specific discriminatory weight cut-offs and to evaluate the risk factors for which there was inconclusive evidence.


BMDBone densityOsteoporosisRisk factorsSystematic review

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2008