One of the most important of these is the peak bone mass achieved in adult life. Thus, postmenopausally, a woman may experience a fast rate of bone loss but may not suffer fracture if she had a high, adult peak bone mass. Conversely, a woman with a slow rate of postmenopausal bone loss may suffer fracture because her adult peak bone mass was low.

But this correlation between peak bone mass and subsequent rate of loss postmenopausally is not sufficiently close to predict fracture risk. At present, the best predictor of bone mass at age 70 years is bone mass at age 50 years. Therefore, screening during the early postmenopausal years to detect women at high risk of osteoporotic fracture in later life must involve some assessment of bone density (bone densitometry).

Peak bone mass is largely genetically determined, hence family history of osteoporosis in predicting fracture risk is rather important. However, it can be affected by various lifestyle factors. Women with prolonged periods of amenorrhoea during the reproductive era, heavy tobacco and alcohol consumption are at a greater risk of osteoporosis. Other lifestyle factors, however, may increase peak bone mass. High parity and gravity dependent exercises (walking, running but not yoga or swimming) are beneficial.

The other major factor affecting fracture risk is likelihood of falling. This will not be considered further here.