Risk Factors for Low Bone Mass: Clinical Implications

Cigarette smoking, alcohol consumption, exercise, and diet are among the risk factors examined in most studies of chronic disease. In this issue of Annals, these alterable behaviors and many other potential risk factors are examined as possible factors influencing the probability of having low bone mass. How can these data be used clinically? It has been presumed that certain risk factors can be used to identify patients with low bone mass and high risk for fracture. Although there are many factors significantly associated with bone mass in elderly women, the variability remains too great to accurately classify potential candidates for therapy to prevent further bone loss. An understanding of risk factors can, however, be used to assist in clinical decisions when uncertainty exists, to direct patients toward lifestyle changes that may improve their chances for avoiding osteoporotic fractures, and to relieve unfounded fears. Decisions about therapy to prevent osteoporosis will still be based primarily on measurements of bone mass, and perhaps other characteristics derived from these scans, but information on risk factors may enhance the ability to use these data.

The search for risk factors for various diseases is the primary goal of much observational research. The value in examining risk factors may be identifying causes of disease, understanding relationships among various factors reported to be involved in the disease process, and defining subgroups of patients at unusual risk who might require special attention.

In this issue of Annals, Bauer and colleagues [1] report on risk factors for low bone mass in women older than 65 years. Cauley and colleagues [2] examine the association between thiazide treatment, bone mass, and fractures in …