The silent thief of bones: Why osteoporosis is diagnosed too late

India faces a significant osteoporosis burden, with over 61 million cases, 80% of them women, and the most striking finding may be the early onset of fractures, which occur a full 10–12 years earlier in Indian osteoporosis patients compared to those in the West. It has earned an apt nickname: "The Silent Thief." While many health conditions show signs of their arrival with aches and obvious symptoms, osteoporosis sneaks along silently, affecting our strength over decades of bone loss without ever once causing a symptom. It is only with a fragility fracture, a broken hip from a fall, a crushed vertebra from a friendly hug, or a fractured wrist, that the illness reveals its existence. It is essential to ponder: why is this widespread disease so late in being diagnosed, and how can we alter this narrative?


The root of the problem is the nature of the disease itself. As evident in laboratory observations by specialists, osteoporosis is a progressive bone disorder associated with reduced bone mass and the microscopic breakdown of bone tissue. This two-pronged attack results in increased bone fragility. But this process is painless until the structure fails. The bone density decreases quietly, and the thief escapes undetected.



Compounding this biological stealth is a significant gap in proactive screening. The diagnostic gold standard, the Dual Energy X-ray Absorptiometry (DEXA) scan, is only sought if a fracture has occurred or if major risk factors are already evident. Such risk factors, early menopause, family history, lack of exercise, long-term steroid exposure, and excessive caffeine or alcohol intake, are not usually sufficient to trigger early inquiry in regular clinical practice. By the time a DEXA scan is done, the T-score could already be at or below –2.5, the WHO criterion for osteoporosis, indicating that the disease is already advanced.


In addition, a very important and commonly underemphasized part of the puzzle is the widespread deficiency of vitamin D. Statistics from Indian testing labs show that well over 78% of the tested population is deficient or has inadequate vitamin D (less than 30 ng/mL). Close to half of these individuals have a severe deficiency (less than 10 ng/mL). Vitamin D is not just any vitamin; it is a pro-hormone required for calcium absorption. When levels are low, the body compensates by secreting extra parathyroid hormone (PTH), which resorbs calcium from bones to keep blood levels up. This chronic, asymptomatic process accelerates bone loss, but the patient remains entirely asymptomatic. The window of opportunity to intervene with easy vitamin D supplementation is lost because the deficiency itself is infrequently screened for until bones are severely compromised.

The delayed diagnosis has significant consequences. Osteoporosis causes millions of fractures per year, the most frequent being the lumbar vertebrae, hip, and wrist. Hip fractures especially are a major reason for death and long-term disability among the elderly, irreversibly altering an individual's independence and well-being.
The way ahead calls for a shift in paradigm from reactive to preventive. We need to start thinking about bone health as a lifelong investment. A holistic approach is called for. This entails:

• Proactive Screening: Individuals with key risk factors, especially post-menopausal women and men over 70, should undergo baseline DEXA scans.
• Essential Co-testing: Both vitamin D status and PTH should be evaluated to gain a deep insight into metabolic activity that contributes to bone loss. (An “Osteomon Profile” with bone turnover markers such as CTX and P1NP can provide an early assessment of treatment efficacy, well before the changes in BMD appear.)
• Lifestyle Integration: Ensuring adequate calcium intake, sun exposure, and regular weight-training must be encouraged from a young age to build peak bone mass.

By spreading awareness, campaigning for early testing, and realizing the importance of nutrients such as vitamin D, we can shift from diagnosing osteoporosis following a fracture to preventing the fracture itself.


Dr. Deepak Sanghavi, Senior Vice President Operations, Chief of Mumbai Reference lab, Agilus Diagnostics