India’s bone health crisis: Why osteoporosis remains ignored

A 70-year-old suffers a minor fall while getting out of bed, while a 60-year-old develops chronic back pain after lifting a bucket of water. Such seemingly minor incidents can have life-altering consequences, triggering a chain of events that changes the course of a person’s life.

Osteoporosis, a condition in which the bones become vulnerable to breaking progresses silently—sometimes even without any symptom. While there are broad ranging discussions on diabetes, cancer and heart disease, bone health and osteoporosis are relatively under recognised. Most people do not even know that they have the disease till they have a fracture. An ageing population, restricted physical activity and lack of awareness on bone health has built a public health challenge.

And what is more important is that the consequences extend beyond just a broken bone. It can mean several months of rehabilitation, loss of self-confidence and in some cases even premature death. Yet, because bone loss is not visible, preventive action gets delayed causing further damage.

The challenge is that bone loss happens without any symptoms. There could be no pain or stiffness. For some women everything seems fine till a fracture happens. The disease is mostly diagnosed after a fracture, and this is the main reason why it remains undiagnosed in India.

Burgeoning burden

Research from India has repeatedly drawn attention to the burden of osteoporosis, particularly among postmenopausal women and older adults. In India, osteoporosis has been a major public health problem. But in the absence of any guidelines, the screening and follow up of patients are lagging. Various studies have revealed an osteoporosis prevalence in Indian women ranging from 8% to 62%. Poor dietary calcium intake, low vitamin D, and lifestyle changes contribute to osteoporosis, according to a review article published in Pub Med.

According to a study done by the Indian Society for Bone and Mineral Research (ISBMR) diagnosis of osteoporosis can be made in a patient with minimal trauma fracture without the aid of any other diagnostic tools. In others, bone mineral density measured by dual-energy X-ray absorptiometry remains the modality of choice. Data indicates that osteoporotic fractures occur at an earlier age in Indians than in the West; hence, screening for osteoporosis should begin at an earlier age.

Nutrition and screening gaps

Among other reasons for the prevalence of the disease in India is because the diets are low in calcium. Low vitamin D due to long hours indoors is another trigger. The Indian diet is healthy but low in calcium and protein both of which are needed for bone health.

Also, the testing facilities in India is scanty compared to the huge population. Most of the testing centers are in the cities and bone screening has not been made a part of the routine tests.

India must move beyond viewing osteoporosis because of ageing. There should be public campaigns on driving the message that early adulthoods are critical periods for bone health.

India needs to move beyond viewing osteoporosis as an inevitable consequence of ageing. Bone loss may be common with advancing age, but serious fractures are not an unavoidable price of growing older. The health workers in the rural areas should be equipped with tools to identify those at risk.

Even at the policy level, India needs to strengthen its data base on bone related health issues. Research should be extended to both rural and urban parts and should outline nutrition, socio economic conditions, access to diagnostic tools and preventive interventions.

Experts stress on the need to increase the awareness about preventive measures, the need for adequate calcium and vitamin D intake, exposure to sunlight, regular physical activity and reducing intake of alcohol.

The message is simple: bones deserve attention long before they break.

The first fracture may be the event that finally brings osteoporosis to medical attention. It should also be the moment that triggers a serious effort to prevent the next one.

India’s bone-health crisis is not only about weakening bones. It is about the years of independent living that can be lost when a preventable fracture is ignored.

—The author, Vanita Srivastava, is a science writer. The views are personal.