Time trends in osteoporosis risk factor profiles: a comparative analysis of risk factors, comorbidities, and medications over twelve years

The aim of this article was to identify prevalent osteoporosis risk factors, medications and comorbidities associated with bone mineral density (BMD). Furthermore to evaluate changes in risk factor profiles over 12 years. 6285 women consecutively referred to an osteoporosis specialist clinic were included. Information of potential risk factors was obtained by questionnaire and clinical examination. Additional information on medication use, comorbidities and fractures were obtained from national registries. An association (< 0.05) between well-known risk factors negatively influencing bone health was established in a real-life setting. The prevalence of osteoporosis and proportion of patient's having comorbidity's associated with osteoporosis were increasing during the inclusion period (start 23.8 %, end 29.7 %). Increasing age (OR = 1.05), current smoking (OR = 1.18), estrogen deficiency (OR = 1.7), hyperthyroidism (OR = 1.5), previous major osteoporotic fracture (OR = 1.7), former osteoporosis treatment (OR = 3.5), higher BMI (OR = 0.87), use of calcium supplementation (OR = 1.2), high exercise level (OR = 0.7), and use of thiazide diuretics (OR = 0.7) were identified as predictors of osteoporosis by DXA. Rheumatoid arthritis (OR = 2.4) and chronic pulmonary disease (OR = 1.5) was associated with site-specific osteoporosis by DXA at the total hip. Current use of loop diuretics (OR = 1.7) and glucocorticoid use (OR = 1.04-1.06) were associated with both total hip and femoral neck T-score <-2.5. Our data confirms an independent negative association with BMD of many established risk factors, certain comorbidities, and medications. Exercise level, use of loop diuretics, and prevalent chronic pulmonary disease, risk factors not included in fracture risk calculators were associated with osteoporosis by DXA. Time trends indicate risk profile is dynamic, with increasing focus on secondary osteoporosis.