New Delhi: Bone health in India is at a critical inflection point, with experts warning that fractures—often dismissed as an inevitable consequence of ageing are emerging as a major public health challenge. At the 2nd edition of ETHealthworld NutriWell Conclave, clinicians from endocrinology, orthopaedics, pediatrics, fertility medicine and trauma care came together to examine “The Indian Bone Health Landscape: Challenges, Innovations, and the Road Ahead.”
The discussion delivered a clear message: osteoporosis and fractures are not confined to women, nor are they unavoidable. With early screening, better nutrition, adequate physical activity and timely treatment, a significant proportion of fractures can be prevented.
Fractures: More Than Just Broken Bones
Opening the discussion, Dr. Lakshmi Nagendra, Director at Magna Centres for Obesity, Diabetes and Endocrinology, highlighted a lesser-known but alarming reality—men face higher mortality following fractures than women.
“Fractures are more common in women, but when men sustain fractures, outcomes are often poorer,” she said, noting that India’s rapidly ageing population is driving a sharp rise in fracture incidence.
Beyond physical injury, fractures severely compromise quality of life, independence and survival, particularly among older adults. Importantly, she stressed, fractures are largely preventable when bone health is addressed proactively rather than after injury.
Building Strong Bones Starts Early
Taking a lifecycle view, Dr. Nitin Kapoor, Professor and Head, Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, explained that peak bone mass is typically achieved by around 30 years of age.
“We gain bone till about 30 years and spend the rest of our lives losing it,” he said. Achieving a high peak bone mass during childhood and adolescence—through adequate calcium intake, sufficient vitamin D and regular physical activity—can significantly reduce the risk of osteoporosis later in life.
Men, he noted, usually experience bone loss about a decade later than women, but lifestyle choices during early years play a decisive role for both sexes.
The Missed Opportunity After Fractures
From an orthopaedic standpoint, Dr. Sunil Marwah, Director of Marwah Clinic, pointed to a critical gap in routine care.
“Nearly 80 percent of patients who present with fractures are treated only for the fracture, not the underlying bone weakness,” he said. This oversight significantly increases the risk of repeat fractures, particularly hip fractures, which are associated with high mortality.
Modern treatment options—including hormone replacement therapy for eligible women and advanced anti-resorptive therapies such as denosumab—can halt bone loss when initiated at the right time, he noted. “The solutions exist. What’s missing is awareness—among both patients and doctors.”
Dr. Nagendra added that one in five patients experiences a refracture within six months if osteoporosis is left untreated, often with life-altering consequences. This, she emphasised, makes post-fracture bone health assessment and treatment essential.
Childhood, Screens and the ‘Use It or Lose It’ Rule
Shifting focus to prevention, Dr. Chetan Pradhan, Assistant Medical Director and Head of Trauma at Sancheti Institute for Orthopaedics and Rehabilitation, warned that modern lifestyles are quietly undermining bone health in children.
“Swimming and yoga are beneficial, but they don’t build bone mass as effectively as weight-bearing and impact activities,” he explained. Running, jumping and outdoor sports between the ages of 10 and 15—when bones are most responsive—are crucial for long-term skeletal strength.
Rising screen time and declining outdoor play, he cautioned, could fuel a future osteoporosis epidemic.
The Overlooked Risk in Preterm and Adolescent Populations
Adding a pediatric perspective, Dr. Neelam Mohan, Senior Director, Department of Pediatric Gastroenterology, Hepatology and Liver Transplantation at Medanta – The Medicity, highlighted a significant evidence gap in India: the absence of structured bone health guidelines for preterm and low birth-weight infants, who account for nearly a quarter of births in the country.
Equally concerning is widespread calcium and vitamin D deficiency among adolescent girls—future mothers—especially those following vegetarian diets or avoiding dairy.
“One or two cups of milk alone are insufficient,” she said, advocating for greater dietary diversity, millet-based nutrition and dietitian-led interventions.
Menopause, Diabetes and the Hidden Bone Threat
From women’s health and endocrinology perspectives, Dr. Basab Mukherjee, Director of Ankuran Fertility and Fetal Medicine Centre, highlighted how menopause and diabetes silently accelerate bone loss.
“One in two postmenopausal women and nearly 20 percent of men by the age of 60 will develop osteoporosis,” he noted. Diabetes further compounds fracture risk by impairing bone quality, increasing the likelihood of falls and complicating treatment decisions.
Bone density tests alone may underestimate fracture risk in people with diabetes, making tools such as trabecular bone score and FRAX-based risk assessments increasingly relevant.
The Road Ahead: Screen, Educate, Prevent
The panel concluded with a strong call for routine fracture risk assessment. Individuals over 60 years of age—or those over 50 with diabetes—should undergo periodic evaluation using DEXA scans and validated risk calculators, experts said.
“Bone health is a lifelong continuum—from the womb to old age,” Dr. Nagendra concluded. “If India wants to avert a looming fracture epidemic, awareness, early intervention and integrated care must become the norm—not the exception.”
