Modifiable risk factors for bone health & fragility fractures

Osteoporosis is an ageing disorder characterised by poor micro -structural architecture of the bone and an increase in the risk of fragility fractures, which often leads to hospitalisation and even-tually a loss of mobility and independence. By 2050, it is estimated that more than 30 million people in Europe will be affected by bone diseases, and European hospitalisation alone can approxi-mately cost up to 3.5 billion euros each year [1]. Although inherited variation in bone mineral density (BMD) is pre-determined by up to 85% [2], there is a window of opportunity to optimise BMD and reduce fracture risk through key modifiable lifestyle factors during the life course. An optimal diet rich in micronutrients, such as calcium, vitamin D, and potassium, has long been considered an important modifiable component of bone health, which is attributed to their direct roles within bone metabolism. Recently, there has been emerging evidence to sug-gest that protein and even an adequate intake of fruit and vege-tables may also play an important role in improving BMD [3,4]. Maintaining a physically active lifestyle is not only protective from non-communicable diseases such as cardiovascular disease but it also has been shown to lessen the risk of fractures later in life, thereby making it an imperative modifiable factor for bone health, particularly as it also supports peak bone mass attainment during childhood/adolescence and can facilitate the maintenance of bone mass throughout adulthood [5]. Other key lifestyle factors that could be potentially modified to reduce the risk of osteoporosis or osteoporotic fractures later in life include smoking status, alcohol intake, and body composition [6]. Therefore, the principle aim of this review is to highlight the recent evidence pertaining to modifiable lifestyle factors that contribute to optimal bone health and the prevention of fragility fractures in later life.(c) 2022 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons. org/licenses/by/4.0/).

Automated summary

Osteoporosis is an ageing disorder characterized by poor bone microstructure and increased risk of fractures. Modifiable lifestyle factors such as diet, physical activity, and smoking status can optimize bone health and reduce fracture risk. Adequate intake of micronutrients and protein, along with maintaining an active lifestyle, are crucial. Other factors like alcohol intake and body composition can also be modified to reduce the risk of osteoporosis and fractures.