Abstract
Nonskeletal risk factors either impact bone mineral density (BMD), fracture risk, or both. Weight, height, and body mass index (BMI) relate positively to BMD and inversely to fracture rates. Lean mass may be an important determinant of premenopausal bone mass, but fat mass is strongly related to postmenopausal BMD. Obesity is related to higher bone mass and lower rates of osteoporosis related fractures – but other fractures (humerus and ankle) may occur at higher rates. Weight loss is needed to reduce the risk of comorbid conditions, but is also detrimental to the skeleton. Smoking and excessive alcohol intakes have adverse skeletal effects, whereas moderate alcohol intake is associated with higher BMD. Lower serum estradiol is associated with lower BMD. Homocysteine elevations are related to increased fracture risk. The risk of fracture appears to vary with the different antihypertensive medications. Visual impairment increases the odds of a fracture and cataract surgery appears to lower this risk.
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