Osteoporosis Risk Factors: ACCESS Your Bone Health
- Donald St Pierre, MSN, RN-BC
- Nov 8, 2025
- 5 min read
Osteoporosis is a disease that makes bones thin, weak, and easier to break. It’s sometimes called a “silent disease” because many people don’t know they have it until they break a bone from a simple fall or even a small bump (National Institute on Aging [NIA], 2022; International Osteoporosis Foundation [IOF], 2024).
Worldwide, millions of adults—especially women after menopause and older men—are living with osteoporosis or low bone mass, which raises the chance of hip, spine, and wrist fractures (Bone Health and Osteoporosis Foundation [BHOF], 2022; JAMA, 2025).
The good news:Some risk factors are in your control. That’s where the word ACCESS on the tee shirt comes from.
What Does ACCESS Stand For?
Health educators and nurses use the word ACCESS to remember six key osteoporosis risk factors:
A – Alcohol useC – Corticosteroid useC – Calcium lowE – Estrogen lowS – SmokingS – Sedentary lifestyle (not active enough)
This simple list comes from a common nursing mnemonic for osteoporosis risk factors (Nursing.com, 2024) and is strongly supported by major bone-health organizations and research.
Let’s break each one down in plain language.
A – Alcohol Use
Drinking a lot of alcohol over time can:
Slow down the cells that build bone
Throw off hormones that help calcium work in the body
Lead to poor nutrition and low vitamin D or protein
All of this can lower bone density and increase the risk of fractures (IOF, 2024; Kanis et al., Osteoporosis International, 2005).
Takeaway: Heavy drinking is not just hard on the liver—it’s hard on bones, too.
C – Corticosteroid Use
Some people need corticosteroid medicines (like prednisone) for asthma, autoimmune diseases, or other conditions. Long-term use of these medicines can:
Decrease bone formation
Increase bone breakdown
Raise the risk of osteoporosis and fractures (BHOF, 2022; IOF, 2024).
Takeaway: If you need steroids for more than a few months, ask your provider what you can do to protect your bones while still treating your illness.
C – Calcium Low
Bones need calcium as a major building block.
A lifetime of low calcium intake can:
Reduce peak bone mass
Speed up bone loss later in life
Increase fracture risk (IOF, 2024; HealthLink BC, 2024).
Sources of calcium include:
Dairy (milk, yogurt, cheese)
Fortified plant milks and juices
Leafy greens like kale, some fish with bones
Takeaway: Getting enough calcium—preferably from food—is one of the simplest ways to support bone strength.
E – Estrogen Low
Estrogen is a hormone that helps protect bone. When estrogen levels drop:
Bone breakdown speeds up
Bone mineral density can fall quickly
This is why women after menopause are at higher risk, and why conditions that lower estrogen (like some hormone problems or some cancer treatments) can also weaken bones (NIA, 2022; WV Dept. of Health, 2024).
Takeaway: If you’ve gone through menopause, lost your period for a long time, or are on treatments that lower estrogen, ask your provider about bone density testing and protection.
S – Smoking
Cigarette smoking is bad for nearly every organ—and that includes bones.
Studies show that people who smoke:
Tend to have lower bone density
Have a higher risk of fractures, especially hip fractures (IOF, 2024; Kanis et al., 2005).
Smoking may also interfere with estrogen and calcium balance, making bone loss worse (HealthLink BC, 2024).
Takeaway: Quitting smoking is one of the most powerful things you can do for your bones (and your heart and lungs).
S – Sedentary Lifestyle (Not Active Enough)
Bones are living tissue. They get stronger when you use them.
A lifestyle with very little movement—lots of sitting, not much walking or exercise—can:
Reduce bone mass
Make muscles weaker
Increase the risk of falls and fractures (IOF, 2024; European Review, 2021).
The most helpful moves are:
Weight-bearing exercise: walking, dancing, hiking, stair climbing
Strength training: light weights, resistance bands, body-weight exercises
Takeaway: Move your body most days of the week. Even short walks and simple strength exercises can help.
Why Teens and Young Adults Should Care
Some people think osteoporosis is only an “old lady disease.” Not true.
Bones grow and strengthen most during childhood, teen years, and early 20s.
If you don’t build strong bones early, you start adulthood at a lower bone bank.
That’s why choices like:
Smoking or vaping
Heavy drinking
Skipping calcium-rich foods
Spending all free time sitting
Can set teens and young adults up for weaker bones later.
Message for teens:
“The habits you build now decide how strong your bones will be when you’re 40, 60, or 80.”
When Should Adults Get Checked?
Guidelines from the U.S. Preventive Services Task Force recommend bone density screening (DXA scan) for (USPSTF, 2025):
All women 65 and older
Younger postmenopausal women who have risk factors (like ACCESS items, low body weight, or prior fractures)
Other expert groups also recommend evaluating men and women over 50 who have had fragility fractures (breaks from a minor fall) or strong risk factors (BHOF, 2022; JAMA, 2025).
If you’re not sure about your risk, talk with your healthcare provider about:
Your family history
ACCESS risk factors
Whether a bone density test makes sense for you
Tee Shirt: Education You Can Wear (ACCESS Osteoporosis Tee)
Your osteoporosis teen shirt with the cartoon grandma and word ACCESS is more than just cute—it’s bone-health education on a hoodie or tee.
On the shirt, ACCESS stands for:
A – Alcohol use
C – Corticosteroid use
C – Calcium low
E – Estrogen low
S – Smoking
S – Sedentary lifestyle
Every time a teen (or adult) wears that shirt:
Friends may ask:
“What does ACCESS mean?”
You or they can explain it as six key risk factors for osteoporosis, backed by real organizations like IOF, BHOF, and NIA.
A quick hallway conversation might help someone:
Think twice about smoking or heavy drinking
Remember to move more
Or ask a doctor about bone health
Because your design is colorful and teen-friendly, it turns a “boring” topic into something people actually look at and remember.
You can place this shirt in the Awareness / Bone Health / Teen Health section of the NurseMob shop as “ACCESS Osteoporosis Risk Factors – Education You Can Wear.”
Key References
Bone Health and Osteoporosis Foundation. (2022). Clinician’s guide to prevention and treatment of osteoporosis.
European Review for Medical and Pharmacological Sciences. (2021). Osteoporosis: risk factors, pharmaceutical and non-pharmaceutical management.
HealthLink BC. (2024). Osteoporosis risk factors.
International Osteoporosis Foundation. (2024). Risk factors for osteoporosis and fractures and Modifiable risk factors.
Kanis, J. A., et al. (2005). Smoking and fracture risk: a meta-analysis. Osteoporosis International, 16(2), 155–162.
National Institute on Aging. (2022). Osteoporosis: What you need to know.
Nursing.com. (2024). Risk factors for osteoporosis – ACCESS nursing mnemonic.
Schousboe, J., et al. (2025). Osteoporosis: A review. JAMA
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