What Is Osteoporosis?
Osteoporosis literally means "porous bone." It is a disease in which bone mineral density and bone quality decline silently over years, until the skeleton becomes so fragile that a minor stumble — or even a forceful cough — can cause a fracture. Bone is living tissue that is constantly being broken down and rebuilt. Up to about age 30 we build more bone than we lose. After that, the balance slowly reverses, and in women the process accelerates sharply after menopause.
The disease is called "silent" for a reason: there are usually no symptoms at all until the first fracture. You cannot feel your bones getting weaker. Pain, stooped posture, and loss of height appear only after vertebrae have already started collapsing. This is why screening — not symptoms — is how osteoporosis should be caught.
The Indian Picture
India has one of the largest osteoporosis burdens in the world, and it strikes here roughly a decade earlier than in Western populations. Several factors converge: widespread vitamin D deficiency despite abundant sunshine (indoor lifestyles, skin covering, pollution), low dietary calcium intake, and limited awareness of screening.
The Numbers
- ~50 million Indians have osteoporosis
- 1 in 2 women over 60 are affected
- ~80% of urban Indians are vitamin D deficient
- Peak fracture age in India: 50–60 years — 10 years earlier than the West
- Average Indian calcium intake: ~400 mg/day vs recommended 1,000–1,200 mg
Why Women Are Hit Harder
- Estrogen protects bone — menopause removes that protection
- Women lose up to 20% of bone mass in the 5–7 years after menopause
- Smaller peak bone mass than men to begin with
- Multiple pregnancies with poor calcium intake deplete reserves
- Early hysterectomy/oophorectomy accelerates loss
Who Is at Risk?
Some risk factors cannot be changed — but knowing them tells you when to screen. Others are fully within your control.
Non-Modifiable
- Age over 50 (women) / 65 (men)
- Female sex, especially post-menopause
- Family history of hip fracture
- Small, thin body frame (BMI < 19)
- Previous fragility fracture — the single strongest predictor
- Rheumatoid arthritis, thyroid disease, chronic kidney disease
Modifiable
- Low calcium and vitamin D intake
- Sedentary lifestyle — bone needs loading to stay strong
- Smoking — doubles fracture risk
- Excess alcohol (>2 drinks/day)
- Long-term steroid use (>3 months of prednisolone ≥5 mg)
- Certain drugs: PPIs, anti-epileptics, aromatase inhibitors
DEXA Scan & Understanding Your T-Score
The gold-standard test is a DEXA scan (dual-energy X-ray absorptiometry) of the hip and spine. It is painless, takes 10–15 minutes, uses less radiation than a chest X-ray, and costs roughly ₹1,500–3,500 in most Indian cities. The result is reported as a T-score — how your bone density compares to a healthy 30-year-old of your sex.
T-score above −1.0 — Normal
Your bone density is in the healthy range. Maintain calcium, vitamin D, and weight-bearing exercise. Repeat DEXA in 3–5 years if risk factors exist.
T-score −1.0 to −2.5 — Osteopenia
Bone density is below normal but not yet osteoporotic. This is the warning zone — the ideal time to act. Lifestyle measures, supplements if deficient, and a repeat scan in 1–2 years. Some high-risk osteopenic patients also merit medication (assessed using the FRAX score).
T-score −2.5 or below — Osteoporosis
Diagnostic of osteoporosis even without a fracture. Pharmacological treatment is indicated alongside calcium, vitamin D, and fall prevention. With treatment, fracture risk can be cut by 40–70%.
Any T-score + fragility fracture — Severe Osteoporosis
A fragility fracture at hip, spine, or wrist establishes the diagnosis regardless of the scan number. Treatment should start promptly — the risk of a second fracture is highest in the first two years after the first.
Who should get a DEXA scan? All women 65+, all men 70+, post-menopausal women under 65 with risk factors, anyone with a fragility fracture after age 40, and anyone on long-term steroids.
Fragility Fractures — Where Bones Break
A fragility fracture is one that occurs from a fall from standing height or less — a force that healthy bone would easily withstand. The three classic sites:
The Big Three
- Spine (vertebral compression) — most common; often silent, causing gradual height loss and a stooped back (dowager's hump)
- Hip (femoral neck / intertrochanteric) — most serious; nearly always needs surgery within 48 hours
- Wrist (distal radius) — often the first warning sign, typically from breaking a fall with an outstretched hand
Why Hip Fractures Matter Most
- 20–30% mortality within one year
- Half of survivors never regain previous mobility
- Early surgery (<48 hrs) significantly improves survival
- Options: fixation with screws/nail, or hip replacement depending on fracture pattern and age
Prevention at Every Age
Osteoporosis prevention is a lifelong project. The bone you bank in your 20s is the reserve you draw on in your 70s.
Calcium — 1,000–1,200 mg daily
Best from food: milk, curd, paneer, ragi (finger millet), sesame seeds (til), green leafy vegetables, and small fish. One glass of milk ≈ 300 mg. Supplements only if diet falls short — split doses of 500 mg absorb better.
Vitamin D — 800–1,000 IU daily
Sunlight on bare skin (face, arms) for 20–30 minutes between 11 AM and 2 PM several times a week, or supplementation. Most Indians need supplements — get your level checked (target >30 ng/mL).
Weight-Bearing & Resistance Exercise
Bone strengthens only when loaded. Brisk walking, stair climbing, dancing, and resistance training 3–4 times a week measurably improve bone density. Swimming and cycling are excellent for the heart but do not load the skeleton.
Fall-Proof Your Home
Most fragility fractures start with a fall. Remove loose rugs, light up staircases, install bathroom grab bars, avoid wet floors, and review medications that cause dizziness. Balance exercises (tai chi, single-leg stance) cut fall risk significantly.
Stop Smoking, Limit Alcohol
Smoking directly poisons osteoblasts (bone-building cells) and doubles fracture risk. Alcohol beyond two drinks a day impairs bone formation and increases falls.
Treatment Options
When osteoporosis is diagnosed, medication is added on top of — never instead of — calcium, vitamin D, and exercise. All decisions are individualised; the summary below is educational, not a prescription.
First-Line: Bisphosphonates
- Alendronate (weekly tablet) or zoledronic acid (once-yearly infusion)
- Slow bone breakdown; reduce spine fracture risk by ~50%, hip by ~40%
- Tablet must be taken fasting with a full glass of water, staying upright 30 minutes
- Usually given for 3–5 years, then reassessed ("drug holiday" possible)
Other Options
- Denosumab — 6-monthly injection; useful when kidneys limit bisphosphonates
- Teriparatide — daily injection that builds new bone; reserved for severe cases
- Romosozumab — newer bone-building antibody for very high-risk patients
- HRT / SERMs — selected younger post-menopausal women
Common Questions
I drink milk daily. Can I still get osteoporosis?
Yes. One glass of milk provides about 300 mg of calcium — a quarter of the daily requirement. And calcium alone cannot compensate for vitamin D deficiency, inactivity, menopause, or steroid use. Diet helps, but it is only one pillar.
Is osteoporosis reversible?
Density can be partially rebuilt — bone-forming drugs like teriparatide can raise spine density by 8–10% — but the goal of treatment is fracture prevention, not a normal scan. Started early, treatment is highly effective at keeping you fracture-free.
Are bisphosphonates dangerous? I read about jaw problems.
Osteonecrosis of the jaw is extremely rare at osteoporosis doses (roughly 1 in 10,000 to 1 in 100,000 patient-years) and mostly linked to high-dose intravenous use in cancer. The risk of hip fracture from untreated osteoporosis is vastly higher. Complete any major dental work before starting, and maintain oral hygiene.
My mother broke her hip. What should I do at 45?
Family history of hip fracture is a major risk factor. Optimise calcium, vitamin D, and resistance exercise now; avoid smoking; and plan a baseline DEXA at menopause (or earlier if other risk factors exist). Prevention in your 40s is worth more than treatment in your 60s.
Do men get osteoporosis?
Absolutely — one in five men over 50 will suffer an osteoporotic fracture, and men who break a hip actually fare worse than women. Screening is advised for all men over 70, and earlier with risk factors such as steroid use, low testosterone, smoking, or alcohol excess.
Check Your Bone Health Before a Fracture Does
If you are post-menopausal, over 65, on long-term steroids, or have had any fracture from a simple fall, a DEXA scan and a focused consultation can map out your fracture risk and a prevention plan.