In a community health screening for osteoporosis risk, which factor would be MOST closely associated with increased risk?

• A. Obesity
• B. High bone mineral density
• C. African American race
• D. Early menopause

Answer: (D)

Estrogen protects bones by reducing bone resorption, so when menopause occurs, a drop in estrogen accelerates bone loss and lowers bone mineral density over time. If menopause happens earlier, the bones are exposed to lower estrogen levels for a longer period, leading to a greater lifetime loss of bone density and a higher risk of osteoporosis and fractures. Obesity tends to be not a strong risk factor for osteoporosis and can even be somewhat protective for bone density due to higher mechanical loading and estrogen from adipose tissue; high bone mineral density indicates stronger bones and lower risk, and African American race is typically associated with higher bone density, not increased risk. Therefore, early menopause best fits as the factor most closely linked to increased osteoporosis risk.