Table 3.

Sexual dimorphism in major risk factors and biochemical markers for risk assessment and stratification in screening for osteoporosis

Risk factors/Biochemical markers	Women	Men
Unchangeable risk factors
Older age, family history of osteoporosis, family history of fractures, previous fracture, small bone frame size, white or Asian ethnicity	✔	✔
Alterations in major sex hormone levels
A decline in estrogen at menopause Reduction in testosterone levels with aging	✔ ✖	✖ ✔
Lifestyle-related risk factors
Sedentary lifestyle or lack of physical activity, excessive alcohol consumption, cigarette smoking	✔	✔
Dietary risk factors
Inadequate calcium intake, Insufficient nutrients	✔	✔
Long-term use of some medications
Glucocorticoids Medications to reduce estrogen levels for breast cancer treatment Androgen deprivation therapy for the treatment of prostate cancer Thyroid hormone medication for an underactive thyroid	✔ ✔ ✖ ✔	✔ ✖ ✔ ✔
Underlying medical conditions and diseases
Diabetes mellitus, hypogonadism, thyroid disorders, hyperparathyroidism, inflammatory diseases, chronic kidney disease, chronic liver disease, cancer, eating disorders, celiac disease, VD deficiency, psychological stress	✔	✔
Serum biochemical markers for risk assessment of osteoporosis
Serum osteocalcin, BALP, PINP for bone formation, CTX-I and NTX- I for bone resorption	✔	✔
Urinary biochemical markers for risk assessment of osteoporotic fractures
The urinary ratio of native (alpha) to isomerized (beta) CTX for risk of fractures, including hip, vertebral, and nonvertebral fracture	✔	✖

✓ evidence available, ✖ insufficient or lack of evidence

BALP bone-specific alkaline phosphatase, CTX-I carboxyterminal cross-linked telopeptide of type I collagen, NTX-I amino-terminal cross-linked telopeptide of type I collagen, PINP N-terminal propeptide of type I procollagen