A Genetic Exploration of Bone Density and Fracture Risk

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A Genetic Exploration of Bone Density and Fracture Risk

Date of Content: January 4, 2024
Written by: Jess Gayo
Reviewed by: Maarit Tiirikainen, PhD


What is Bone Density?

Have you ever wondered why some people seem to bounce back from falls effortlessly while others face the risk of fractures? It’s not just luck; it’s in your genes. Bone density refers to the amount of mineralized bone tissue in a given volume, serving as a critical indicator of skeletal strength and resilience. The density of bones is primarily influenced by the deposition of minerals like calcium and phosphorus within the bone matrix, forming a sturdy and rigid structure. This intricate balance is crucial for maintaining skeletal integrity and preventing fractures.

Quantitatively assessed through techniques such as dual-energy X-ray absorptiometry (DXA), bone density is expressed in grams per square centimeter. Peak bone density is typically achieved during early adulthood, but genetic factors play an important role in determining an individual’s baseline bone density. Specific genes regulate the development and turnover of bone tissue, impacting overall skeletal health.

Understanding the genetics of bone density is crucial in unraveling the mechanisms behind conditions like osteoporosis, where bone density decreases, leading to increased fracture susceptibility. As research delves deeper into the intricate interplay of genetic factors influencing bone health, insights gained hold the promise of personalized interventions and preventive measures to mitigate the risks associated with low bone density and fractures. 

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Bone Density & Fracture Risk

What is Fracture Risk?

Fracture risk is the probability of sustaining a bone fracture, a multifactorial outcome influenced by various biological, environmental, and genetic factors. Key determinants of fracture risk include bone density, bone quality, and the mechanical forces applied to the bone. Low bone mineral density (BMD), as measured by tools like dual-energy X-ray absorptiometry (DXA), is a well-established risk factor for fractures, especially in conditions like osteoporosis.

Apart from BMD, bone quality encompasses factors such as microarchitecture, mineralization, and collagen composition. Integrating these elements is crucial for bone strength and fracture resistance. Age, sex, and lifestyle factors such as nutrition and physical activity also contribute significantly to fracture risk.

Accurate assessment and understanding of fracture risk are imperative for preventive strategies and interventions, especially in aging populations where fractures pose significant health burdens. Incorporating genetic insights alongside traditional risk factors enhances the precision of fracture risk prediction models, paving the way for targeted approaches to fracture prevention and management.

How Does Your Bone Density Affect Your Fracture Risk?

The relationship between bone density and fracture risk is well-established, with lower bone mineral density (BMD) correlating strongly with increased susceptibility to fractures, particularly in weight-bearing bones.

The mechanical properties of bone are intricately linked to its density, and diminished density compromises structural integrity. Conditions such as osteoporosis, characterized by reduced BMD, significantly elevate fracture risk. Osteoporotic fractures, often occurring in the hip, spine, and wrist, are associated with increased morbidity and mortality, particularly in the elderly.

Genetics plays a crucial role in shaping an individual’s bone density. Variations in genes regulating bone formation, resorption, and mineralization contribute to inter-individual differences in BMD. Understanding the genetic basis of bone density not only elucidates the pathophysiology of conditions like osteoporosis but also allows for personalized risk assessments.

Maintaining optimal bone density is a complex interplay of genetics, nutrition, physical activity, and hormonal balance. Strategies aimed at preserving bone health involve lifestyle modifications, nutritional interventions, and, in some cases, pharmacological treatments. Integrating genetic insights into fracture risk assessments enhances the precision of preventive approaches, guiding tailored interventions to mitigate the impact of low bone density on fracture susceptibility.

What Affects Bone Density and Fracture Risk?

Genetics plays a pivotal role, with numerous genes identified as influencers of bone density and fracture susceptibility. Polymorphisms in genes associated with bone metabolism, structure, and mineralization contribute to inter-individual variations in fracture risk.

Genetic Factors

In one particular study using UK Biobank data, genetic factors influencing bone mineral density (BMD) were explored in a very large group of people. Phenotypic data on 394,929 individuals revealed a total of 142,417 DNA variants associated with estimated heel BMD (eBMD), identifying 1,362 independent SNPs clustered into 899 genome loci. Notable loci include genes WNT16, RSPO3, CCDC170, ESR1, and SPTBN. SNPs in these genes showed genome-wide significant associations with eBMD.

A polygenic risk score (PRS) was developed, and one particular score called LASSO4 PRS demonstrated the highest correlation with eBMD. This score, based on 22,886 predictors, outperformed a PRS model from previous work. Combining the LASSO4 PRS with physiological covariates, a novel BMD Osteoporosis Genetic (BOG) risk score was created. The combined score exhibited a higher correlation with eBMD (0.496) than either LASSO4 or physiological covariates alone.

What are polygenic risk scores and why they are important?

Individuals with lower BOG scores had significantly lower eBMD, emphasizing its potential as a predictive tool. The BOG score also demonstrated an association with osteoporosis risk, indicating its utility in identifying individuals at heightened risk for bone-related issues. The study also suggests that understanding genetic factors, particularly using the BOG score, could enhance predictions of BMD and associated risks for personalized health management.

Environmental Factors

Environmental factors influence bone density and fracture risk, interacting with genetic and hormonal elements to shape skeletal health. Several key factors contribute to variations in bone density and fracture susceptibility, with lifestyle and environmental considerations playing significant roles.

  1. Nutrition: Adequate nutrition is essential for bone health. Calcium and vitamin D are critical for mineralization, and deficiencies can compromise bone density. Calcium, primarily derived from dairy products, leafy greens, and fortified foods, is a key component of the bone matrix. Vitamin D, obtained through sunlight exposure and dietary sources, facilitates calcium absorption. Insufficient intake of these nutrients can lead to decreased bone density and increased fracture risk.
  2. Physical Activity: Weight-bearing exercises and resistance training exert mechanical forces on bones, stimulating bone formation and maintaining density. Sedentary lifestyles, on the other hand, contribute to bone loss. Regular physical activity is associated with higher bone mineral density, enhancing overall skeletal strength and resilience.
  3. Hormonal Factors: Hormones such as estrogen and testosterone play pivotal roles in bone metabolism. Estrogen, particularly in women, has a protective effect on bone density. Menopause-related estrogen decline in women is linked to accelerated bone loss and increased fracture risk. Similarly, low testosterone levels in men are associated with decreased bone density.
  4. Body Weight: Body weight is a critical factor influencing bone density. Low body weight, as seen in conditions like anorexia nervosa or excessive exercising, is often associated with reduced bone mass. Conversely, obesity may not necessarily translate to improved bone health, as excess adiposity can have complex effects on bone metabolism.
  5. Smoking and Alcohol Consumption: Both smoking and excessive alcohol intake have detrimental effects on bone density. Smoking interferes with bone remodeling, reducing bone formation and increasing fracture risk. Alcohol disrupts calcium metabolism and can impair bone density. Chronic alcohol abuse is linked to conditions such as osteoporosis and increased fracture susceptibility.
  6. Medications: Certain medications can impact bone health. Prolonged use of glucocorticoids, often prescribed for inflammatory conditions, can lead to bone loss. Anticonvulsants, heparin, and some cancer treatments may also affect bone density.
  7. Environmental Toxins: Exposure to environmental toxins, such as heavy metals like lead and cadmium, can negatively impact bone health. These substances can interfere with bone metabolism and contribute to decreased bone density.

Understanding the intricate interplay between genetic and environmental factors is essential for comprehensive fracture risk assessment. Implementing lifestyle modifications, ensuring proper nutrition, and minimizing exposure to detrimental environmental influences can collectively contribute to maintaining optimal bone density and reducing the likelihood of fractures.

How is Bone Density Related to Weight Changes?

Bone density is closely linked to weight changes, as the mechanical loading of bones influences their adaptation and density. Weight-bearing activities subject bones to stress, prompting bone-forming cells (osteoblasts) to deposit mineralized tissue, thereby increasing bone density. Conversely, weight loss or reduced mechanical loading, as seen in conditions like anorexia nervosa or prolonged bed rest, can lead to bone loss due to decreased osteoblastic activity and increased osteoclastic bone resorption.

Body weight serves as a surrogate marker for the mechanical forces experienced by bones during daily activities. Higher body weight generally correlates with greater bone mineral density (BMD) because the skeletal system adapts to support the increased load. However, excessive body weight, as seen in obesity, may not necessarily translate to improved bone health, as the relationship between bone density and adiposity is complex.

Understanding the dynamic interplay between weight changes and bone density is crucial for assessing skeletal health. Both inadequate and excessive weight can impact bone metabolism, highlighting the importance of maintaining a healthy weight through balanced nutrition and weight-bearing physical activity to optimize bone density and overall skeletal strength.

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How Do You Measure Fracture Risk?

Fracture risk is assessed through a combination of clinical evaluation and quantitative measurements, primarily focusing on bone health parameters. The gold standard for assessing fracture risk is dual-energy X-ray absorptiometry (DXA), which measures bone mineral density (BMD). Lower BMD, indicative of reduced bone mass, is a well-established predictor of increased fracture risk, particularly in postmenopausal women and the elderly.

Clinical risk factors, such as age, sex, family history, and previous fracture history, are integral components of fracture risk assessment. Additionally, tools like the FRAX® algorithm combine clinical risk factors with BMD measurements to estimate the 10-year probability of major osteoporotic fractures.

Recent advancements include the integration of genetic markers associated with bone metabolism into risk assessment models, offering a more personalized approach. Understanding the intricate interplay between genetic, clinical, and BMD factors allows for a comprehensive evaluation of fracture risk, guiding preventive strategies and interventions tailored to an individual’s specific risk profile.

What are the Symptoms of Decreasing Bone Density?

Decreasing bone density, often associated with conditions like osteoporosis, may not manifest noticeable symptoms until fractures occur. However, as bone density diminishes, subtle signs and symptoms may emerge:

  • Height Loss: Progressive bone loss in the spine can lead to vertebral compression fractures, resulting in a gradual reduction in height.
  • Posture Changes: Vertebral fractures may cause changes in posture, such as a stooped or hunched appearance, known as kyphosis.
  • Back Pain: Fractures in the spine can cause persistent back pain, a common symptom of osteoporosis.
  • Bone Fractures: Individuals with decreased bone density are at an increased risk of fractures, especially in weight-bearing bones like the hip, spine, and wrist.
  • Decreased Grip Strength: Osteoporosis can affect the bones in the hands, leading to decreased grip strength.
  • Tooth Loss: Studies suggest a potential association between low bone density and tooth loss, particularly in postmenopausal women.
  • Receding Gums: Reduced bone density may contribute to changes in the supporting structures of teeth, leading to receding gums.

Bone density loss is often asymptomatic until fractures occur. Early detection through bone mineral density testing is crucial for assessing skeletal health and initiating preventive measures. Regular monitoring and appropriate interventions, including lifestyle modifications and pharmacological treatments, can mitigate the impact of decreased bone density and reduce the risk of fractures. Individuals experiencing these symptoms, especially those with risk factors, should consult healthcare professionals for timely evaluation and intervention.

Who are the Most at Risk of Fractures Due to Lack of Bone Density?

Certain populations are more susceptible to fractures due to low bone density, with various risk factors contributing to this increased vulnerability. 

  • Postmenopausal Women: The decline in estrogen levels during menopause accelerates bone loss, significantly increasing fracture risk. Estrogen plays a crucial role in maintaining bone density, and its reduction contributes to osteoporosis.
  • Elderly Individuals: Aging is associated with a natural decrease in bone density, making older adults more prone to fractures. The aging process affects bone turnover, leading to a gradual reduction in bone mass.
  • Individuals with Family History: Genetic factors strongly influence bone density. Individuals with a family history of osteoporosis or fractures may have a higher predisposition to low bone density.
  • Small Body Frame: Individuals with smaller body frames may have lower peak bone mass, making them more susceptible to fractures, especially if other risk factors are present.
  • Low Body Weight: Low body weight, often seen in conditions like anorexia nervosa or excessive exercising, is associated with reduced bone density and increased fracture risk.
  • Hormonal Disorders: Conditions affecting hormonal balance, such as hyperthyroidism or hyperparathyroidism, can negatively impact bone density and elevate fracture risk.
  • Chronic Medical Conditions: Conditions like rheumatoid arthritis, inflammatory bowel disease, and chronic kidney disease can affect bone health, leading to decreased bone density and increased susceptibility to fractures.
  • Long-Term Medication Use: Prolonged use of certain medications, such as glucocorticoids, anticonvulsants, and some cancer treatments, can contribute to bone loss and heightened fracture risk.

Identifying individuals at risk for fractures due to low bone density is crucial for preventive strategies. Regular screening, lifestyle modifications, and, in some cases, pharmacological interventions can help mitigate the impact of decreased bone density and reduce the likelihood of fractures in these high-risk populations. Consulting healthcare professionals for personalized assessments and interventions is essential for optimizing skeletal health.

How to Increase Bone Density and Lessen Fracture Risk

Optimizing bone density and reducing fracture risk involves a multifaceted approach that combines lifestyle modifications, nutritional interventions, and, in some cases, medical treatments. Here are evidence-based strategies:

  1. Adequate Calcium Intake: Calcium is a crucial mineral for bone health, and insufficient intake can lead to decreased bone density. Dairy products, leafy greens, fortified foods, and supplements when necessary, contribute to maintaining optimal calcium levels.
  2. Vitamin D Supplementation: Vitamin D is essential for calcium absorption and bone mineralization. Adequate sunlight exposure and vitamin D-rich foods like fatty fish, eggs, and fortified products, along with supplements if needed, support bone health.
  3. Regular Weight-Bearing Exercise: Weight-bearing exercises, including walking, running, and resistance training, stimulate bone formation and help maintain bone density. Engaging in at least 150 minutes of moderate-intensity aerobic exercise per week, along with muscle-strengthening activities, is recommended.
  4. Balanced Nutrition: A well-balanced diet with sufficient nutrients, including protein, vitamins (especially vitamin K), and minerals, supports overall bone health. Consuming a variety of fruits, vegetables, whole grains, and lean proteins is crucial.
  5. Limiting Alcohol Consumption: Excessive alcohol intake has been associated with decreased bone density and increased fracture risk. Moderation is key, with guidelines suggesting up to one drink per day for women and up to two drinks per day for men.
  6. Quit Smoking: Smoking adversely affects bone health by interfering with bone remodeling. Quitting smoking is essential for preserving bone density and reducing fracture risk.
  7. Maintain a Healthy Body Weight: Both underweight and obesity can impact bone health. Maintaining a healthy body weight through a balanced diet and regular physical activity is crucial for optimal bone density.
  8. Fall Prevention Strategies: Implementing measures to prevent falls is vital, especially for the elderly. This includes home safety modifications, strength and balance exercises, and regular vision check-ups.
  9. Medical Treatments: Medical interventions may be necessary for individuals at high risk or with diagnosed osteoporosis. Bisphosphonates, hormone replacement therapy (HRT), and other medications can be prescribed to enhance bone density and reduce fracture risk. However, these treatments should be carefully considered based on an individual’s health profile.
  10. Bone Density Testing and Monitoring: Regular bone mineral density (BMD) testing, typically performed through dual-energy X-ray absorptiometry (DXA), allows for early detection of bone loss. Monitoring changes in BMD over time guides the effectiveness of interventions and adjustments to the treatment plan.

Individuals should consult healthcare professionals for personalized advice based on their risk factors and health status. Implementing a comprehensive approach that addresses lifestyle, nutrition, and potential medical interventions is crucial for optimizing bone density and reducing the risk of fractures throughout the lifespan.

LifeDNA’s Bone Density and Fracture Risk Trait Report

Know more about your bone health with LifeDNA’s Bone Density and Fracture Risk Trait Report. Our comprehensive genetic analysis delves deep into your unique genetic profile, providing valuable insights into factors influencing bone density and fracture susceptibility. Backed by rigorous scientific research, this report empowers you to take proactive steps toward optimizing your skeletal health.

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  • Bone density, influenced by genetics, is the key to skeletal strength.
  • Fracture risk is multifactorial, influenced by genetics, environment, and biology. Low bone mineral density (BMD) is a significant risk factor, especially in osteoporosis.
  • Genes play a vital role in determining an individual’s baseline bone density.
  • Weight-bearing activities increase bone density and weight loss or reduced loading can lead to bone loss.
  • Some symptoms of decreasing bone density include height loss, posture changes, back pain, fractures, decreased grip strength, tooth loss, and receding gums. Early detection through BMD testing is crucial.
  • Postmenopausal women, elderly individuals, those with a family history, small body frame, low body weight, hormonal disorders, chronic conditions, and long-term medication use are those who are most at risk of fractures and lower bone density.
  • Fortifying bone health strategies may include adequate calcium intake, vitamin D supplementation, weight-bearing exercise, balanced nutrition, limiting alcohol, quitting smoking, maintaining a healthy weight, fall prevention, medical treatments, and regular BMD testing.


  1. https://medlineplus.gov/bonedensity.html
  2. https://www.radiologyinfo.org/en/info/dexa
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2827823/
  4. https://myhealth.alberta.ca/Health/Pages/conditions.aspx?hwid=tp23004spec&lang=en-ca#:~:text=Low%20bone%20density%20(sometimes%20called,and%20strong%20the%20bones%20are.
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4016236/#:~:text=Endocrine%20factors%20and%20body%20composition,weight%20reduction%20regulate%20bone%20loss.
  6. https://www.niams.nih.gov/health-topics/osteoporosis#:~:text=Symptoms%20of%20Osteoporosis,or%20hunched%20posture%20(kyphosis).
  7. https://www.endocrine.org/-/media/endocrine/files/patient-engagement/hormones-and-series/hormones_and_your_bones_what_you_need_to_know.pdf
  8. https://ciocenter.com/blog/tips-to-increase-bone-health-and-reduce-fracture-risk/#:~:text=Ways%20to%20increase%20bone%20health,minimizing%20the%20risk%20of%20falls.&text=Consume%20adequate%20calcium%20(1000%2D1500,different%20for%20each%20age%20group.
  9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6316542/
  10. https://www.uptodate.com/contents/bone-density-testing-beyond-the-basics#:~:text=Dual%2Denergy%20x%2Dray%20absorptiometry%20%E2%80%94%20Experts%20agree%20that%20the,and%20forearm)%20with%20minimal%20radiation.

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*Understanding your genetics can offer valuable insights into your well-being, but it is not deterministic. Your traits can be influenced by the complex interplay involving nature, lifestyle, family history, and others.

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