Screening for Osteoporosis

Osteoporosis is a condition where there is weakening of the bones. It is a silent disease that manifests only when we fracture. As we age, our bones tend to lose strength and when we fall, we fracture more easily than those younger than us or those with stronger bones. Not falling and not fracturing are extremely important in our atmasvasth quest to live long healthy.

It stands to reason then that if we can pick up osteoporosis in time, we can then institute measures to improve bone strength and reduce the likelihood of fractures.

It is therefore important to screen for osteoporosis and if osteoporosis is found, to take measures to improve bone density.

The USPSTF [1] recommends one bone density measurement (which is usually best done by DXA - dual X-ray absorptiometry) in women above the age of 65. However, it is recommended in women under the age of 65 and in men of all ages, only if they have other risk factors that increase the likelihood of osteoporosis.

The Indian Society for Bone and Mineral Research (ISBMR) [2] argues that since menopause and fractures occur earlier in Indian women, a bone density measurement by DXA should be done after the age of 60 and not 65, which is fine.

What does one do if osteoporosis is detected? One common misconception is to start people on calcium and vitamin D, which may be acceptable in a nutritionally deprived population, but is superfluous in those who have adequate nutrition, albeit with the potential to cause harm, as I have mentioned earlier. There is no data to suggest that calcium and vitamin D supplementation makes any difference in those with adequate nutrition [3].

What does this mean for you and I?

If you are a woman above the age of 60 in India, you should get one screening bone density measurement by DXA to diagnose osteoporosis. Below the age of 60 or if you are male, you should get the test done only if you or your physician find that you have specific risk factors for osteoporosis. If you are found to be osteoporotic, you may be prescribed long term medication (bisphosphonates, etc). Physical activity and strength training and taking steps to prevent falls are equally important measures that help reduce the risk of fractures and in turn help you live long, healthy.

Footnotes

1. US Preventive Services Task Force, Curry SJ et al. Screening for Osteoporosis to Prevent Fractures: US Preventive Services Task Force Recommendation Statement. JAMA. 2018 Jun 26;319(24):2521-2531.
2. Bhadada SK et al. The Indian Society for Bone and Mineral Research (ISBMR) position statement for the diagnosis and treatment of osteoporosis in adults. Arch Osteoporos. 2021 Jun 26;16(1):102.
3. US Preventive Services Task Force, Grossman DC et al. Vitamin D, Calcium, or Combined Supplementation for the Primary Prevention of Fractures in Community-Dwelling Adults: US Preventive Services Task Force Recommendation Statement. JAMA. 2018 Apr 17;319(15):1592-1599.