As India’s population ages, osteoporosis is quietly driving a rising burden of fractures, pain and disability, often without any warning signs until bones become dangerously fragile. In this authored article, Dr Jayateerth Kulkarni (Senior Consultant, Orthopaedics, Fortis Hospital, Bengaluru) explains why osteoporosis remains underdiagnosed, highlights key risk factors in the Indian context, and discusses how early detection, appropriate treatment, and public awareness can collectively change the trajectory of bone health in the country.
Osteoporosis, often referred to as the ‘silent bone disease’, is a condition that reduces bone strength and makes bones more prone to breaking, even with a small fall or strain. In India, this condition is gradually becoming a major public health concern among older adults. With an ageing population, changing lifestyle habits and inadequate awareness, the risk of osteoporosis is rising faster than ever.
Prevalence in India
A study conducted by the International Osteoporosis Foundation (IOF) estimated that around 50 million people in India are either osteoporotic or have low bone mass. The occurrence is higher among women, particularly postmenopausal women, because hormonal changes after menopause accelerate bone loss. Research also states that around one in three Indian women and one in eight men over the age of 50 suffer from osteoporosis; however, men are often under-diagnosed because bone health screening is rarely recommended for them unless a fracture occurs.
Several lifestyle factors contribute to this difference between genders. Women in India, in particular, tend to have a lower intake of calcium and vitamin D due to their dietary habits and limited sun exposure, while cultural clothing practices, predominantly indoor living and lack of physical activity further contribute to poor vitamin D status. For men, bone loss may occur later in life owing to smoking, alcohol use and inactivity, and early bone development in both genders can be affected by poor nutrition during adolescence, which limits peak bone mass.
Screening and risk assessment
Early detection is crucial. Unfortunately, awareness about osteoporosis screening is very low in India. Dual‑energy X‑ray absorptiometry (DEXA) scans, which employ dual‑energy X‑ray technology, are the most precise method for bone mineral density (BMD) measurement, but they are commonly done only after the occurrence of a fracture.
Simple risk‑assessment tools like the FRAX score, which predicts the 10‑year fracture risk based on age, sex, BMI and other clinical risk factors, can successfully identify individuals at high risk. Routine screening is advocated for postmenopausal women over 50, men over 65, and those with risk factors like long‑term steroid use, rheumatoid arthritis or a family history of fractures.
Effective osteoporosis management requires a combination of medical treatment, lifestyle modification and patient education. Doctors and healthcare teams should actively engage patients through counselling, regular follow‑ups and reminders about medication schedules, while group educational programmes and digital health platforms can be used to support better adherence and self‑monitoring.
Lifestyle recommendations for prevention
Osteoporosis prevention should start much earlier than at the point of diagnosis.
- Calcium‑rich diet: Include dairy products, ragi, sesame seeds, leafy greens and fortified foods in the diet.
- Vitamin D: Aim for at least 15–20 minutes of sunlight exposure daily or take supplements, if necessary, as advised by a doctor.
- Regular exercise: Weight‑bearing and resistance exercises like walking, jogging and light strength training can help make bones stronger.
- Quit smoking and limit alcohol: Both smoking and excessive alcohol intake harm bone health and increase fracture risk.
- Healthy weight maintenance: Both being underweight and being overweight can negatively affect bone health.
Emerging therapies and policy support
Newer drugs are showing promising results in improving bone quality and reducing fracture risk. Agents like denosumab, a monoclonal antibody, and teriparatide, a bone‑forming agent, have significantly improved outcomes in patients with severe osteoporosis.
India does not yet have an organised national screening programme for osteoporosis, but many organisations, such as the Indian Menopause Society and the Indian Society for Bone and Mineral Research, are urging authorities to promote awareness and provide guidelines. Government initiatives that include bone health under preventive health check‑ups, and insurance coverage for DEXA scans and osteoporosis medications, can make a significant difference in early detection and management.
