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A hip fracture after sixty carries a mortality comparable to some cancers. The bone loss that causes it is painless, detectable and treatable years in advance.
Why it goes unnoticed
Bone loss produces no symptom until a fracture occurs. The first sign is often a wrist fracture from a minor fall, a vertebral compression fracture presenting as sudden back pain or gradual height loss and stooping, or — most seriously — a hip fracture.
Hip fracture in an older adult is a major event. A significant proportion never regain their previous mobility, and mortality in the year afterwards is substantial. Preventing it is far more achievable than treating it.
Who is at risk
- Women after menopause — oestrogen loss accelerates bone loss sharply
- Anyone over 65
- Low body weight and small frame
- Long-term steroid use
- Smoking and heavy alcohol use
- Family history of hip fracture
- Long-standing vitamin D and calcium deficiency
- Thyroid overactivity, chronic kidney disease and rheumatoid arthritis
- Early menopause or hysterectomy with ovary removal
Testing
A DEXA bone density scan is the standard test, giving a T-score. Above −1.0 is normal, −1.0 to −2.5 is osteopenia, and −2.5 or below is osteoporosis. It is painless, takes fifteen minutes and uses very little radiation.
Screening is advised for all women from 65 and men from 70, and earlier for anyone with the risk factors above or who has already had a fracture from a minor fall. Vitamin D and calcium levels should be checked alongside.
Prevention and treatment
- Calcium 1000–1200 mg daily, preferably from food: milk, curd, paneer, ragi, sesame, almonds, green leafy vegetables and small fish eaten with bones
- Vitamin D — deficiency is extremely common in India despite the sunshine, because of covering, indoor work and skin pigmentation. Supplementation is usually needed
- Weight-bearing exercise: walking, stair climbing, and resistance work with light weights
- Balance training such as standing on one leg — falls prevention matters as much as bone density
- Stop smoking and limit alcohol
- Prescription medication such as bisphosphonates where osteoporosis is established
Worth knowing
Preventing the fall matters as much as strengthening the bone. Remove loose mats, improve lighting on stairs, fix bathroom grab bars, treat cataracts, and review medicines that cause dizziness.
After a fracture
A fracture from a fall from standing height in an adult over fifty should always trigger an osteoporosis assessment, regardless of which bone broke. This is one of the biggest gaps in practice — the fracture is treated and the underlying bone disease is never addressed, leaving the patient at high risk of the next one.
If you or a family member has had such a fracture, ask specifically about bone density testing and osteoporosis treatment.
Key takeaways
- Osteoporosis is painless until a fracture occurs — screening is the only way to find it early.
- DEXA screening from 65 in women and 70 in men, earlier with risk factors.
- Vitamin D deficiency is very common in India despite abundant sunshine.
- Any fracture from a standing-height fall after fifty should trigger an osteoporosis assessment.
A note on medical advice
This article is general health education written and reviewed by the Department of Orthopaedics at SIMS. It is not a substitute for an examination, a diagnosis or the advice of your own treating doctor, and it cannot account for your history, medicines or reports. If a symptom is sudden or severe — chest pain, stroke symptoms, breathing difficulty, serious injury, seizures or heavy bleeding — call 9281862028 or come straight to the emergency department instead of reading further.
OsteoporosisFractureCalciumVitamin D