Bone Health & Osteoporosis

Osteoporosis is a disease where bones become porous and fragile enough to break from minor trauma — a fall from standing height, sometimes even a cough or a bend. It progresses silently for years — you feel nothing until a fracture happens. In India, roughly 1 in 3 women over 50 has osteoporosis; the number is lower but still significant in men. The condition matters because hip fractures in older adults have a 20-30% one-year mortality and permanently reduce independence for most survivors.

DEXA (dual-energy X-ray absorptiometry) is the standard bone-density test. In India, ₹1,500-3,500 at good diagnostic centers. Recommended for: women 65+ and men 70+ routinely; younger postmenopausal women with risk factors (family history, thin build, steroid use, early menopause, previous fragility fracture); anyone who has broken a bone from a minor fall. Results come as a T-score: above -1 is normal, -1 to -2.5 is osteopenia (mild thinning), below -2.5 is osteoporosis.

Vitamin D deficiency is close to universal in India — despite abundant sunshine — because most adults spend the sunny hours indoors, cover skin due to modesty or climate, or use sunscreen. Deficiency weakens bones, worsens muscle strength (increasing fall risk), and drives osteoporosis. Adults typically need 1,000-2,000 IU/day of vitamin D3 for maintenance, higher doses for correction of documented deficiency (get a 25-OH vitamin D blood test first). Add 800-1,000 mg/day of dietary or supplemental calcium — Indian diets often fall short of this.

Osteopenia is bone density below normal but not yet in the osteoporosis range (T-score between -1 and -2.5). Most osteopenia is managed with lifestyle: adequate vitamin D and calcium, weight-bearing exercise (walking, resistance training), no smoking, moderate alcohol. Medication (bisphosphonates like alendronate, denosumab) is reserved for high-risk osteopenia (prior fragility fracture, high FRAX fracture risk score, corticosteroid use). Not everyone with osteopenia needs pills — evidence-based practice targets those at genuine fracture risk.

Weight-bearing exercise is best — walking, jogging, stair-climbing, dancing, resistance training. Swimming and cycling are excellent for cardiovascular health but do little for bone density because they don't load bone. Aim for 30-45 minutes of weight-bearing activity 4-5 days a week, plus 2 sessions of resistance training. In older adults, balance work (tai chi, targeted physio) prevents the falls that lead to fractures — often more valuable than trying to add bone at that stage.