Risk factors for low bone mass in healthy 40–60 year old women: A systematic review of the literature
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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.
KeywordsBMD Bone density Osteoporosis Risk factors Systematic review
The authors gratefully acknowledge Osteoporosis Canada for coordinating this project.
No sources of support were received for this project.
Conflicts of interest
- 2.NIH (2000) Osteoporosis prevention, diagnosis and therapy. NIH consensus statements 17:1–45Google Scholar
- 3.WHO (2003) Prevention and management of osteoporosis. Report of a WHO Study Group (ref type: report). World Health Organization, Geneva, Technical Report Series 919:1–165Google Scholar
- 4.Jagal SB (2002) Bone density testing. In Stewart DE, Ferris L, Hyman I et al (eds) Ontario Women’s Health Status Report (ref type: report). 113–120Google Scholar
- 5.Osteoporosis Action Plan Committee (2003) Osteoporosis Action Plan: an osteoporosis strategy for Ontario. Report of the Osteoporosis Action Plan Committee to the Ministry of Long-term Care (ref type: report). 1–86Google Scholar
- 7.Sackett DL, Haynes RB, Guyatt GH et al (1991) Clinical epidemiology: a basic science for clinical medicine. Little, Brown and Company, BostonGoogle Scholar
- 22.National Osteoporosis Foundation (1999) Physician’s Guide to Prevention and Treatment of Osteoporosis. Excerpta Medica Inc, Bell Mead, New JerseyGoogle Scholar