Osteoporosis

Osteoporosis is when bones become thinner and more fragile than normal, so they break easily — often from a minor fall or even bending over. It is largely silent until a fracture happens. Indian women and men are affected at younger ages than Western populations, partly because diets are often low in calcium and vitamin D.

Who is at higher risk

• Women after menopause.
• Men over 70.
• Low body weight.
• Family history of osteoporosis or hip fracture.
• Long-term steroid use, some epilepsy medicines, some cancer treatments.
• Early menopause, absent periods in young women.
• Overactive thyroid, rheumatoid arthritis, coeliac disease, chronic liver/kidney disease.
• Smoking, heavy alcohol, sedentary lifestyle.
• Low calcium and vitamin D — extremely common in Indians.

Common fracture sites

• Wrist — usually after a fall on outstretched hand.
• Spine — can happen with simple activities; can cause gradual height loss and a stooped back.
• Hip — often serious, requires surgery; significant impact on independence in older adults.

Diagnosis

DEXA scan (bone mineral density scan) is the standard test. A FRAX calculator estimates 10-year fracture risk. Blood tests for calcium, vitamin D, thyroid, and parathyroid hormone help identify contributing factors. DEXA is widely available in Indian cities; costs range from ₹1,500-₹3,000 at most centres.

Prevention and treatment

• Calcium 1000-1200 mg per day — milk, curd, paneer, ragi, leafy greens, small fish with bones, til (sesame); supplements if diet is insufficient.
• Vitamin D — daily sun exposure on face and arms for 15-20 minutes; supplements are often needed in India given the high prevalence of deficiency.
• Weight-bearing exercise — walking, climbing stairs, strength training.
• Avoid smoking, limit alcohol.
• Medicines — bisphosphonate-class tablets or injections, denosumab, teriparatide — prescribed based on fracture risk. Generic options are affordable in India.
• Fall prevention — good lighting, remove loose rugs, well-fitting footwear, handrails, eye checks (see Falls page).

If you or a parent has had a "small" fracture after 50 — wrist, vertebra, hip — ask about DEXA. One fracture predicts another; most second fractures are preventable with treatment.