Osteoporosis produces no pain, no stiffness and no warning. The first sign is usually a fracture from a fall that should not have broken anything, or from no injury at all.
It is common in Indian women, substantially underdiagnosed, and treatable.
What Happens to Bone
Bone is living tissue that is constantly broken down and rebuilt. Until around the age of thirty, building exceeds breakdown and bone mass increases. After that the balance gradually reverses.
In women, oestrogen protects bone, and its fall at menopause accelerates loss sharply for several years. This is why osteoporosis affects women far more often and earlier than men.
The bone that remains is not just thinner but structurally weaker, with the internal scaffolding becoming sparse and fragile. That is why fractures occur from forces that would not previously have caused them.
Who Is at Risk
Several factors substantially increase risk, and knowing yours determines whether you should be screened.
- Being postmenopausal, particularly with early menopause before forty five
- Age over sixty five in women, or seventy in men
- A parent who had a hip fracture
- Low body weight
- Long term steroid use, which is a major and often overlooked cause
- Smoking and heavy alcohol intake
- Sedentary lifestyle
- Vitamin D deficiency, extremely common in India
- Rheumatoid arthritis, thyroid overactivity, coeliac disease, chronic kidney disease
- Previous fracture from a minor fall after age fifty
That last point is the strongest single predictor. A wrist fracture at fifty five from a stumble is a warning that should trigger assessment, and it frequently does not.
Vitamin D Deficiency Is Nearly Universal Here
It surprises people that a country with abundant sunshine has widespread vitamin D deficiency, but studies consistently find it in a large majority of urban Indians.
The reasons are practical: indoor work and study, covering clothing, avoiding the sun during peak hours, air pollution reducing UVB penetration, and darker skin requiring longer exposure to produce the same amount.
Vitamin D is required for calcium absorption. Taking calcium without adequate vitamin D achieves considerably less. Testing is available through our laboratory and correction is straightforward.
The DEXA Scan
Bone density is measured by a DEXA scan, which takes about fifteen minutes, involves lying still, and uses a very low radiation dose.
The result is a T score comparing your bone density to a healthy young adult.
- Above minus 1: normal
- Minus 1 to minus 2.5: osteopenia, meaning reduced density
- Below minus 2.5: osteoporosis
Osteopenia is not automatically treated with drugs. It prompts attention to calcium, vitamin D, exercise and risk factors, with treatment considered when other risks are present.
Calcium and Vitamin D: How Much and From Where
Dietary sources are preferable where possible, and Indian diets contain more calcium than people assume.
- Calcium target: around 1000 to 1200 mg daily for adults over fifty
- Sources: milk and curd, paneer, ragi which is exceptionally rich, sesame seeds, almonds, drumstick leaves, amaranth, and small fish eaten with bones
- Vitamin D: supplementation is usually needed, since diet rarely suffices and sun exposure is inadequate for most
- Sun exposure: around twenty to thirty minutes on arms and face, midmorning, several times weekly
Split calcium supplements into doses of 500 mg or less, since absorption is limited at higher single doses. Take them with food. Very high calcium supplementation is not beneficial and may carry cardiovascular concerns, so aim for the target rather than exceeding it.
Exercise That Builds Bone
Not all exercise strengthens bone. Bone responds to load and impact, which means swimming and cycling, while excellent for general health, do little for bone density.
- Weight bearing: walking, stair climbing, dancing, and light jogging where joints allow
- Resistance training: the most effective for bone, using weights or bands two or three times weekly
- Balance training: tai chi or yoga, which reduces falls and therefore fractures
Preventing falls matters as much as strengthening bone. Fracture requires both weak bone and a fall, and the fall is often the more modifiable half.
Preventing Falls at Home
Most fragility fractures happen at home, and simple modifications prevent many of them.
- Remove loose rugs and trailing wires
- Improve lighting, particularly on stairs and the route to the bathroom at night
- Install grab rails in the bathroom, which is where most falls occur
- Use non slip mats in wet areas
- Wear supportive footwear indoors rather than loose slippers
- Review medications that cause dizziness or drowsiness
- Have vision and hearing checked annually
- Treat postural dizziness on standing
Indian bathrooms with wet floors and a step at the entrance are a specific hazard worth addressing directly.
Medication and Why It Is Often Stopped Too Soon
Where osteoporosis is established, or after a fragility fracture, drug treatment substantially reduces further fractures.
Bisphosphonates are the usual first choice, taken weekly or monthly by mouth or annually by infusion. Oral forms require specific instructions: take on an empty stomach with plain water, and remain upright for thirty minutes to prevent oesophageal irritation.
Treatment is usually continued for three to five years and then reviewed. The most common problem is that patients stop after a few months because they feel no different, which is expected since osteoporosis has no symptoms.
After a hip or spine fracture, treatment is particularly important, as the risk of a second fracture is highest in the following year. Our orthopaedics department assesses patients following fragility fractures.
The most useful action is to treat a low trauma fracture after fifty as a diagnosis in itself rather than an accident. Get a DEXA scan, correct vitamin D, do resistance exercise, and make the home safer. All of that prevents the fracture that genuinely changes a life, which is the hip.
For bone density assessment, contact our orthopaedics department in T. Nagar, Chennai.
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