If my tests show osteoporosis in my hip, what is the likelihood that I have bone loss in other bones? Does osteoporosis ever affect the skull bone?

If your hip shows osteoporosis, it is likely that other bones have diminished bone density as well. If you are a White woman, your body singles out your hip—it loses one-third of its bone mineral density between the ages of about 30 and 80. However, other bones usually don't start to lose density until the age of menopause, or in men at a comparable age, unless you have other medical or lifestyle reasons for having osteoporosis. Approximately 4% of postmenopausal White women aged 50 to 59 have osteoporosis of the hip, and 6% of the same group have osteoporosis in the wrist. And after age 80 in postmenopausal women, osteoporosis of the hip jumps up to 52% and in the wrist to 78%! So if you are a postmenopausal woman with osteoporosis of the hip, it is very likely that you have osteoporosis of other bones, particularly the wrist.

Although you are definitely at risk for a vertebral fracture if you have been diagnosed with osteoporosis of the hip, osteoporosis of the spine is more difficult to measure because certain conditions interfere with getting accurate measurements. Measuring your spine for osteoporosis will be more difficult if you have arthritis or fractures of the spine because they interfere with the accuracy of the imaging of the spine.

More important than having osteoporosis, you will be more at risk for fracturing any bone in your body. And this includes, although rarely, your skull bone. If you have been diagnosed with osteoporosis, it is critical that you take all necessary precautions to prevent falls (see Question 79).

What do my results say about my future risk for fracturing a bone?

Because fractures are the biggest problem associated with osteoporosis, it is important to know what your results say about your risk for fracture. It's also important to know that there is risk to fracturing your bones whether you are diagnosed with osteoporosis or not (meaning you may have it but don't know it). The lifetime risk of fracturing your hip, spine, or forearm is 40% in White women and 13% in White men. If you include the potential for fracturing other bones, your risk is increased even further. For women, the lifetime risk of fracturing a hip is equivalent to or more than the combined lifetime risk of developing breast, uterine, or ovarian cancer.

If your BMD testing shows that your bones are "normal," you are not at increased risk of fracturing a bone unless your score is between 0 and —1.0. Because scores are expressed in standard deviations, any score less than 0 represents an increased risk; the risk is small if your score is between 0 and —1.0, but it still exists.

If your T-score indicates that you have osteopenia, you could be 4 times more likely to fracture a bone. But low bone mass as defined by your T-score is not the only factor that puts you at increased risk for a fracture. Your clinician should help you understand that your age, family history of osteoporosis, previous fractures, risk of falling, and the risk of injury are other important factors when considering your risk for fracture.

As you age, your risk of fracturing any bone increases. If you are diagnosed with osteoporosis, your risk goes up even further. So if your T-score indicates that you have osteoporosis, you could be 8 times more likely

As you age, your risk of fracturing any bone increases.

to fracture a bone. If you are over 50 years of age, you have a 50% chance of suffering a fracture related to osteoporosis. And 750,000 spinal fractures occur each year. These fractures occur in people previously diagnosed with osteoporosis as well as in those who never knew they had it.

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