Osteoporosis and Bone Health in Women

Osteoporosis is a condition in which bones become thin and weak, so they break more easily. It is more common in women, especially after menopause, and it usually causes no symptoms until a bone breaks. The good news is that exercise, good nutrition and early checks can protect your bones.

This guide explains who is at risk, what women in India should know, how bone density is checked, and what treatment involves.

What is osteoporosis?

The NHS explains that osteoporosis weakens bones so that even a minor fall or knock can cause a fracture, most often of the wrist, hip or spine. It usually develops slowly over years. NIAMS, a US National Institutes of Health institute, calls it a “silent” disease because there are often no warning signs before a break. When the spine is affected, people may notice severe back pain, loss of height or a stooped posture.

Why women are at higher risk

Women tend to have smaller, thinner bones to begin with, and oestrogen helps protect bone. When oestrogen falls at menopause, bone loss speeds up. The NHS says the risk is higher after menopause, if menopause starts early, or after the ovaries are removed. Read about this stage in our guide to menopause symptoms and management.

Other risk factors

• A parent who had osteoporosis or a hip fracture
• A slim build or low body weight
• Long-term use of steroid medicines, and some other medicines such as certain epilepsy and breast cancer drugs
• Conditions such as thyroid and other hormone disorders, rheumatoid arthritis, coeliac disease, inflammatory bowel disease and eating disorders
• Low vitamin D or low calcium in the diet
• Lack of physical activity
• Smoking and heavy alcohol use

Having risk factors does not mean you will develop osteoporosis, and some women with no obvious risk factors are still affected. Our guide to thyroid disorders in women explains one condition that can affect bones.

What do we know about India?

A study of 1,565 rural postmenopausal women in Vellore, Tamil Nadu, found osteoporosis in 22% at the hip (femoral neck) and 39% at the lower spine. Average calcium intake was about 420 mg a day, which the researchers called suboptimal, and about 54 to 55% of women had vitamin D deficiency. These findings come from one region and a volunteer group, so they cannot be applied to every Indian woman. They do show why calcium, vitamin D and bone checks deserve attention here.

The study authors also note that the average age of menopause in India is reported to be around 46 years. International guidelines often suggest bone screening from age 65, while a recent Indian guideline suggests screening all women five years after menopause. Guidelines vary, so ask your doctor when you should be tested.

Calcium, vitamin D and food

The NHS says adults aged 19 to 64 need about 700 mg of calcium a day, which most people can get from a varied diet. Requirements differ by country and age, and Indian recommendations may be different, so ask your doctor what suits you. Good sources include:

• Milk, curd, paneer and other dairy foods
• Leafy greens such as kale and okra (spinach contains calcium, but the body absorbs little of it)
• Calcium-fortified foods
• Fish eaten with the bones

Vitamin D helps the body use calcium. The NHS says sunlight on bare skin helps your body make it, and that few foods contain it, such as oily fish, egg yolks and fortified foods. Many people in India still run low, so a blood test may be worthwhile. NIAMS says supplements should be chosen and dosed by a provider. Too much calcium (above 1,500 mg a day according to the NHS) can cause stomach pain and diarrhoea, so avoid taking supplements on your own.

Tip: try to get calcium from food first. Add a glass of milk or curd, a handful of green leafy vegetables and ask your doctor before buying supplements.

Exercise for strong bones

Weight-bearing exercise, where your bones work against gravity, helps keep bones strong. The NHS and Cleveland Clinic suggest:

• Brisk walking, dancing or climbing stairs
• Strength exercises with light weights or resistance bands
• Balance activities such as yoga, tai chi or Pilates to lower the chance of falls

If you already have osteoporosis, a physiotherapist can help you choose safe movements, since twisting or bending forward heavily may not be suitable.

Screening and diagnosis

Osteoporosis is diagnosed with a bone density scan, called a DEXA or DXA scan. It is quick, painless and uses a low dose of X-rays. The NHS explains that the result is given as a T score: above -1 is normal, between -1 and -2.5 shows early bone loss (osteopenia), and below -2.5 means osteoporosis. Doctors may also use online tools to estimate your chance of a fracture. Cleveland Clinic suggests regular testing for people over 50, those with a family history, and postmenopausal women.

Treatment overview

Treatment aims to prevent fractures. Depending on your fracture risk, your doctor may prescribe bone-strengthening medicines, advise calcium and vitamin D, and suggest exercise. Cleveland Clinic lists several medicine types, some taken as tablets and some given by injection, and the choice depends on the person. Never start or stop a bone medicine without medical advice.

When to be cautious: a sudden back pain, loss of height or a fracture after a minor fall is a reason to ask about osteoporosis, not just to rest. Do not rely on painkillers or home remedies alone.

Preventing falls

• Keep floors dry and clear of loose mats and wires
• Use good lighting and night lights in corridors and bathrooms
• Wear sturdy, non-slip footwear
• Have your eyesight and hearing checked regularly
• Review medicines that cause dizziness with your doctor

Regular check-ups also help; see why regular gynecological checkups matter.

When to see a doctor

• You are past menopause, or entered it before age 45, and have never discussed bone health
• You have a family history of hip fracture or osteoporosis
• You break a bone after a minor fall or knock
• You notice you are getting shorter or your back is curving forward
• You have severe sudden back pain
• You take steroids or other long-term medicines that affect bones

A fall with severe pain, a deformed limb or inability to move needs emergency care; see our emergency page. For routine concerns, our gynecologist in Kadapa page explains how we support women’s health.

Talk to a doctor

Discussing your bone health early can help prevent painful fractures later. You can book an appointment or call +91 944 103 0587. This article is for general awareness and is not a substitute for a doctor's advice.