In the period of growth, a vital and positive influence on bone mass and physical activity is sufficient intake of calcium (at least 1000 mg daily). Lack of exercise, limited calcium intake, chronic inflammatory processes and administration of certain medicines on the contrary lead to a small increase in bone mass and cause one to achieve a low peak bone mass.

The skeleton is at peak bone density between 25 to 30 years. Around the 30th year, there is a negative bone balance, often resulting in a bone loss of 1% per year regardless of gender. Measurement of the trabecular bone in individuals between 20 and 80 years of life points to reducing the density by about 50 %. Calcium is stored in bone tissue during the day and night, and is slowly secreted into the bloodstream. In a study with different bone biopsies, it was shown that bone loss is more or less the same at all sites of the skeleton, although it is likely at a higher loss in the vertebral bodies and proximal femur.

In postmenopausal women, reduced estrogen levels were associated with increased bone loss of up to 4 % per year, which means that women can lose up to 40% of their bone volume in the period between the 40th to 70th years, and men can lose only 12%. The maximum amount of bone mass in childhood is determined genetically, and its elimination appears to be one of the main risk factors. The measurement of bone mineral relative to the expected average value of a certain age can be expressed in age specific standard deviations, known as the Z-score.

Individuals with a reduction of one standard deviation from the T-score of -1 have approximately 2 times a greater risk of fractures in the rest of their life than others, with an average bone mineral value. The increased risk of decline in BMD is only in untreated individuals. Reductions in BMD findings require additional follow-up examinations to clarify the possible causes. It should be noted that some relatively common diseases such as thyrotoxicosis, or vitamin D deficiency in older people may not become clinically manifest, and for this reason both of these causes should be excluded by appropriate laboratory tests. On the contrary, a relatively small increase in BMD for such treatment may mean a significant reduction in fracture risk, but an increase in BMD in an individual can not be used to determine the reduction in fracture risk prediction.

In an overview of risk factors, a large number of diseases are associated with an increased risk of osteoporosis, many of which are already identified from the medical history or physical examination. The first symptoms of osteoporosis should lead the physician to be vigilant and conduct a targeted search for the possible risk factors. An example is osteoporosis before the 50th year, and osteoporosis in men. Low bone mineral content due to the age of the patient can serve as a guide in the search for the secondary causes of this disease in both men and women.

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