Prevalence, Family History, and Prevention of Reported Osteoporosis in U.S. Women Julie Robitaille, PhD, Paula W. Yoon, ScD, Cynthia A. Moore, MD, Tiebin Liu, MSPH, Margarita Irizarry-Delacruz, MPH, Anne C. Looker, PhD, Muin J. Khoury, MD Background: Osteoporosis is a major public health concern and has been associated with a family history positive for the condition. However, data on the behaviors of individuals with such a family history are scarce. The objectives of this study were to assess the relationship between the prevalence of reported physician-diagnosed osteoporosis and family history in a represen- tative sample of U.S. women, examine whether osteoporosis risk factors account for this relationship, and evaluate the likelihood that women at high risk of osteoporosis due to family history report preventive behaviors. Methods: The prevalence of reported osteoporosis was estimated in 8073 women aged 20 years in the National Health and Nutrition Examination Survey, 1999 –2004. Information on osteoporosis in first-degree relatives and grandparents was obtained during interviews. Results: The prevalence of osteoporosis in participants was 7.94%. In 19.8% of them, a positive family history was reported and was significantly and independently associated with osteoporosis (AOR 2.35, 95% CI=1.87, 2.96). This association was stronger when two or more relatives were affected (AOR 8.48, 95% CI=4.50, 15.99). After stratification by age, the association was observed only in women aged 35 years. Women with a family history of osteoporosis were more likely than those with none to report preventive behavior, such as taking supplements of calcium, vitamin D, or both; physical activity; and estrogen use. Conclusions: These findings indicate that family history is a significant, independent risk factor for osteoporosis in U.S. women aged 35 years. Further studies are warranted to evaluate family history as a convenient and inexpensive tool for identifying women at risk of osteoporosis and for promoting the adoption of preventive behaviors. (Am J Prev Med 2008;35(1):47–54) © 2008 American Journal of Preventive Medicine Introduction O steoporosis is a major public health concern, especially as the U.S. population ages. In 2002, it was estimated that over 10 million people have osteoporosis; approximately 80% of whom are women. 1 More importantly, hip fractures, a common osteoporotic injury, are associated with high morbidity and mortality. In a recent estimate, 26.5% of people with a first hip fracture die within the year. 2 Evidence suggesting that a positive family history is a significant risk factor for osteoporosis is rapidly accu- mulating. 3–12 Besides its importance in identifying peo- ple at high risk for osteoporosis, evaluation of family history may offer great potential for education about risk factors and motivation for adopting preventive practices. 13 Thus, the use of family history could be a tool for targeting subgroups of the population who are at higher risk for osteoporosis and may benefit most from interventions. 13 Current guidelines do not place much emphasis on family history as a significant risk factor. Although the Surgeon General’s report on bone health recognized family history as a red flag for osteoporosis, the U.S. Preventive Services Task Force (USPSTF) indicated that there is insufficient scientific evidence to support the use of positive family history to identify women aged 65 years at high risk for osteo- porosis. 14,15 The National Osteoporosis Foundation recognizes a history of fragility fracture in a first-degree relative as a risk factor only in postmenopausal women and has made no recommendations for premenopausal women. 16 Identifying people at high risk for osteopo- rosis could be an important public health tool for targeting prevention strategies in this subpopulation. From CDC, the National Center on Birth Defects and Developmental Disabilities (Robitaille) and the National Office of Public Health Genomics (Yoon, Moore, Liu, Irizarry-Delacruz, Khoury), Atlanta, Georgia; and the National Center for Health Statistics (Looker), Hyattsville, Maryland Address correspondence and reprint requests to: Julie Robitaille, PhD, Institute of Nutraceuticals and Functional Foods, Pavillon des Services, Room 2749, Laval University, 2440 Hochelaga Boulevard, Québec City, Québec, Canada G1V 0A6. E-mail: julie.robitaille@ fsaa.ulaval.ca. 47 Am J Prev Med 2008;35(1) 0749-3797/08/$–see front matter © 2008 American Journal of Preventive Medicine • Published by Elsevier Inc. doi:10.1016/j.amepre.2008.03.027