This Silent Bone-Disease Epidemic Is Secretly Affecting Indian Women
Believe it or not, sunlight alone may not provide enough vitamin D to keep your bones healthy.
She may be going to work every morning, looking after her family, walking to the market, and climbing stairs just as she always has. Nothing about her daily routine necessarily tells her that the strength of her bones is changing.
Then, one day, a relatively minor fall leads to a fracture. The doctor orders a few tests, asks about her medical history, and eventually gives the condition a name: osteoporosis.
For many people, this is the first time they have ever heard of it.
So, if you don’t want to end up with weaker and weaker bones, start cutting back on the sugar. It’s better to do something about it today than to regret it tomorrow.
That is what makes osteoporosis so concerning. It can develop without obvious warning signs, and the damage may go unnoticed until a bone breaks.
In India, the issue deserves serious attention, particularly among women as they grow older. Medical research has identified nutritional deficiencies, hormonal changes, and gaps in awareness and diagnosis as important concerns. The exact number of women affected varies between studies, so it would be misleading to claim that almost every Indian woman has osteoporosis.
But there is a much more important question to ask.
Why are so many women at risk of losing bone strength, and what can be done before it becomes a serious problem?
To answer that, we need to understand what happens inside the body, how everyday circumstances can affect bone health, and why the problem may begin long before a woman reaches old age.
What exactly is happening inside the bones?
Let’s begin with something most people rarely think about: your skeleton is not a finished structure.
Your bones are living tissue. They contain a protein framework strengthened by minerals, especially calcium and phosphorus. This combination gives them the ability to support your body, protect important organs, and withstand the forces created when you move.
Your bones are also constantly being renewed.
Specialised cells remove old bone tissue, while other cells build new tissue in its place. This ongoing process is known as bone remodelling. It helps the skeleton repair small areas of damage and adjust to the demands placed on it.
During childhood and adolescence, bone formation is especially important because the skeleton is growing. Bone mass generally reaches its highest level in early adulthood, although the exact timing differs from person to person.
After that, the body must continue maintaining the bone it has built.
Osteoporosis develops when too much bone is lost, the internal structure of bone deteriorates, or both occur. As the skeleton becomes weaker, certain bones become more likely to fracture.
The condition is different from a broken bone. A fracture is an injury; osteoporosis is a disease that can make such injuries more likely.
It is also different from arthritis. Arthritis affects joints, while osteoporosis affects the strength and structure of bones. The two conditions can occur in the same person, but one does not automatically mean the other is present.
The US National Institutes of Health’s National Institute of Arthritis and Musculoskeletal and Skin Diseases explains these changes in its medical guide to osteoporosis. It is a useful starting point for understanding the disease without getting lost in medical terminology.
Why can a person have osteoporosis without feeling ill?
One reason osteoporosis is often discovered late is that weakening bones do not necessarily hurt.
There are no reliable sensations that tell you your bone density has fallen. A person can feel perfectly well while bone loss is taking place.
This does not mean that bones never hurt in someone with osteoporosis. A fracture in the spine can cause back pain, and repeated spinal fractures may lead to a reduction in height or a more stooped posture. But these signs are not present in every case, and back pain has many possible causes.
The difficulty is that the disease itself may not produce a clear warning.
A healthy bone can usually withstand the ordinary forces of daily life. A severely weakened bone may break after a fall from standing height or another relatively minor incident that would be less likely to cause a fracture in a person with stronger bones.
That is why a fracture following a minor fall deserves medical attention, especially in an older adult.
It is not something that should automatically be dismissed as an unavoidable consequence of getting older.
The first problem: Many diets do not provide enough calcium
Calcium is one of the main building materials used in bone.
Your body needs it for several other jobs, too, including muscle contraction and nerve signalling. Because the amount of calcium in the blood must remain within a narrow range, the body carefully regulates how calcium is absorbed, retained, and released from its stores.
Bones are an important part of that storage system.
When a person’s diet repeatedly falls short of calcium requirements, the body has to manage that shortage. Over time, inadequate calcium intake can contribute to poor bone health, particularly when other risk factors are present.
This is where the Indian diet deserves a closer look, without unfairly blaming Indian food itself.
A meal of roti, rice, dal, vegetables, and seasonal produce can be nutritious. However, the calcium content depends on which foods are included, how much is eaten, and how frequently calcium-rich ingredients appear in the diet.
For example, someone who rarely consumes dairy products or suitable alternatives may need to pay closer attention to other calcium sources.
Milk, curd, paneer, ragi, sesame seeds, certain leafy vegetables, pulses, and calcium-fortified foods can all contribute calcium. Their calcium content and how much the body absorbs differ, so simply including one of these foods occasionally may not be enough.
A vegetarian diet can support strong bones. A non-vegetarian diet does not guarantee strong bones. What matters is whether the overall diet supplies the nutrients a person needs.
The 2026 consensus statement from the Endocrine Society of India identifies inadequate dietary calcium intake as an important concern in India. It recommends meeting calcium needs primarily through food, with supplements considered when food alone is insufficient or when a medical situation requires them.
There is a practical lesson here: eating enough food is not necessarily the same as getting enough of every nutrient.
And calcium is not a nutrient that should be ignored until old age. It matters during the years when bones are developing, as well as throughout adulthood.
The sunshine paradox: Why vitamin D can still be low in India
India has plenty of sunshine in many parts of the country. It might seem reasonable to assume that vitamin D deficiency should therefore be uncommon.
Unfortunately, sunlight availability and vitamin D levels are not the same thing.
The skin produces vitamin D when it receives suitable ultraviolet B radiation. The amount produced depends on several factors, including the time of day, season, location, skin pigmentation, clothing, and how much time a person spends outdoors.
Someone who spends most of the day inside a home, classroom, office, or other building may receive limited useful exposure even when the weather is bright.
Clothing that covers most of the skin can reduce the area exposed to sunlight. Air pollution and other environmental conditions can also influence exposure.
This is not an argument for abandoning sun protection or deliberately exposing the skin to damaging sunlight. It is a reminder that living in a sunny climate does not automatically mean a person has adequate vitamin D.
Why does this matter for bones?
Vitamin D helps the intestine absorb calcium from food. When vitamin D levels are inadequate, calcium absorption can be impaired, making it harder for the body to maintain healthy bone mineralisation.
Severe vitamin D deficiency can contribute to osteomalacia, a condition in which bones do not mineralise properly. Osteomalacia and osteoporosis are different conditions, although both can affect bone strength and may occur together.
Indian clinical guidance identifies vitamin D deficiency as a widespread concern, with estimates varying substantially between populations and studies. You can read more in the Indian Menopause Society’s 2026 clinical practice guidelines.
The answer is not for everyone to start taking high-dose vitamin D. The appropriate approach depends on dietary intake, individual risk, medical circumstances, and whether testing or supplementation is needed.
Too little vitamin D can be harmful, but excessive supplementation can also cause serious problems.
Why menopause changes the story for women
Here is one of the most important differences between women’s and men’s bone health.
The female body undergoes a major hormonal transition during menopause. As ovarian oestrogen production falls, the normal balance between bone breakdown and bone formation changes.
Oestrogen helps regulate the activity of cells responsible for removing old bone. When oestrogen levels decline, bone breakdown can accelerate, particularly around the menopausal transition and in the years that follow.
As a result, women can lose bone more quickly during this period.
Men can also develop osteoporosis, especially as they age or develop other risk factors. However, women generally have a greater risk because of the combination of menopause-related bone loss and differences in the amount of bone they build and retain.
This does not mean menopause inevitably leads to osteoporosis.
A woman’s risk depends on many factors, including her bone mass earlier in life, family history, nutrition, physical activity, medical conditions, and medicines.
Consider two women who reach menopause at roughly the same age. One may have adequate nutrition, a history of regular physical activity, and relatively strong bones. The other may have had years of inadequate nutrition, limited activity, or a medical condition affecting bone health.
Their risks may be very different.
That is why menopause is an important time to assess bone health, rather than a reason to assume that every woman will develop the disease.
The part we cannot explain with food alone: Women’s everyday circumstances
A discussion about osteoporosis in India is incomplete if it focuses only on nutrients and hormones.
Access to food, time for exercise, medical awareness, and the ability to seek healthcare can all influence a woman’s health.
In some families, women may prioritise feeding children or other family members while paying less attention to their own nutritional needs. Some may have limited control over household spending or the food purchased. Others may spend so much time on paid work and domestic responsibilities that regular physical activity and medical appointments become difficult.
These experiences do not apply to every Indian woman or every household. But where they occur, they can affect health over many years.
The effects may be especially difficult to recognise because inadequate nutrition does not necessarily cause an immediate, visible illness.
A girl who does not get sufficient nutrition during adolescence may continue attending school and carrying out her usual activities. A young woman who rarely exercises may feel no different from her friends. An adult who repeatedly puts her own health last may continue managing her responsibilities for decades.
None of these experiences proves that a person will develop osteoporosis. They can, however, contribute to a combination of risk factors that becomes more important with age.
This is why the problem cannot be solved by telling women to take better care of themselves without considering the circumstances in which they live.
Nutrition education matters. So do affordable, varied foods, opportunities for physical activity, access to healthcare, and the ability to make decisions about personal health.
Bone health is a medical issue, but the conditions that shape it are also part of everyday life.
The years that matter before a woman becomes a mother or grandmother
Osteoporosis is often discussed as though it begins when women become older.
The biological story starts much earlier.
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During childhood and adolescence, the skeleton is growing and accumulating bone mass. Adequate nutrition, normal hormonal development, physical activity, and general health all help support this process.
If a young person consistently eats too little, has a significant nutritional deficiency, or develops a medical condition that interferes with normal growth or hormones, bone development may be affected.
This does not mean that one missed meal or one period of inactivity will cause osteoporosis. Bone health reflects many influences over time, and genetics also plays a substantial role.
The important point is that the skeleton developed in youth helps determine the amount of bone a person has available later in life.
A person who builds a healthy amount of bone during growth has a different starting point from someone who does not. Both can lose bone as they age, but their eventual bone strength may differ.
That is one reason prevention should include children and teenagers, not only postmenopausal women.
Adequate food, regular movement, and medical attention to significant growth or hormonal problems are investments in health that may matter decades later.
Other factors that can quietly increase the risk
Nutrition and menopause are important, but they do not explain every case of osteoporosis.
Family history can influence a person’s risk. A history of hip fractures or osteoporosis in a parent is worth mentioning to a doctor.
Certain medical conditions can interfere with bone health, including some hormonal disorders, problems with nutrient absorption, and some chronic illnesses.
Long-term use of particular medicines can also contribute. Glucocorticoids, often prescribed for inflammatory and immune-related conditions, are a well-established example.
Smoking, heavy alcohol use, low body weight, and prolonged physical inactivity can add to the risk.
These factors do not affect everyone equally. A person may have several risk factors and retain relatively good bone density, while someone else develops osteoporosis with fewer obvious warning signs.
That is why it is unhelpful to assume that a woman’s diet or lifestyle must be the sole explanation for her condition.
A proper assessment considers her health history as a whole.
How can a doctor find a disease that produces so few symptoms?
Doctors can assess osteoporosis risk using a person’s age, medical history, fracture history, medication use, and other relevant information.
When a bone-density test is appropriate, one of the main methods is called DXA, short for dual-energy X-ray absorptiometry.
The test measures bone mineral density, commonly at the hip and lower spine. The person lies on a table while a scanner uses a low dose of X-rays to measure the bones. The procedure is generally quick and painless.
For postmenopausal women, a T-score of −2.5 or lower at an appropriate measurement site is a standard diagnostic criterion for osteoporosis. However, doctors also consider fragility fractures and the person’s overall clinical circumstances.
A related term is osteopenia. This describes bone density that is below the expected healthy reference level but does not meet the usual DXA threshold for osteoporosis. It does not mean that a fracture is inevitable.
Blood tests may also be used to investigate possible contributors, such as vitamin D deficiency, abnormal calcium levels, or certain hormonal and kidney problems.
An ordinary X-ray may reveal a fracture or other changes, but it is not the same as a DXA scan and cannot reliably exclude early osteoporosis.
The NIAMS guide to osteoporosis diagnosis explains the role of bone-density testing and how the results help doctors make treatment decisions.
Not every woman needs a DXA scan. Whether and when to test depends on age, fracture history, risk factors, and applicable clinical guidance.
A doctor is the right person to decide what assessment is appropriate.
Can osteoporosis actually be treated?
Yes. Osteoporosis can be treated, and treatment can lower the risk of future fractures.
But it is important to understand what treatment is trying to achieve.
There is no single tablet that instantly restores every weakened bone to its previous condition. Treatment aims to improve or preserve bone strength, reduce further bone loss where possible, and prevent fractures.
The plan depends on the severity of the disease, the person’s age, previous fractures, other health conditions, and individual fracture risk.
Calcium and vitamin D: Important, but not a complete treatment
Adequate calcium and vitamin D help the body maintain healthy bone tissue. If a person does not get enough from food or has a deficiency, a clinician may recommend supplementation.
But calcium tablets are not a universal cure for osteoporosis.
A person who has established osteoporosis and a high risk of fracture may need prescription treatment in addition to appropriate nutrition.
Taking unnecessary supplements can also be harmful, especially in people with certain kidney conditions or a history of kidney stones. More is not automatically better.
The Endocrine Society of India’s 2026 guidance recommends meeting calcium needs primarily through food and using supplements when dietary intake or clinical circumstances warrant them.
Medicines that protect bone or help build it
Several prescription treatments are available.
Bisphosphonates are medicines that slow bone breakdown. Denosumab acts on a different part of the process that causes bone loss. Certain medicines, including teriparatide and romosozumab, can help build bone in selected patients with very high fracture risk.
These treatments are not suitable for everyone, and the choice depends on individual medical circumstances. Some require specific precautions, monitoring, or a carefully planned transition when treatment changes.
For example, denosumab should not simply be stopped or delayed without a clinician’s plan because doing so can lead to rapid bone loss and increased fracture risk.
These are reasons to seek professional medical advice, not to choose a medicine independently.
What about hormone treatment after menopause?
Because falling oestrogen levels contribute to bone loss, menopausal hormone therapy may help protect bone in some women.
However, it is not appropriate for everyone. The decision depends on factors such as age, time since menopause, menopausal symptoms, medical history, and the potential benefits and risks.
It should be discussed with a qualified clinician rather than started solely out of fear of osteoporosis.
Exercise and fall prevention
Physical activity supports bone and muscle health. Walking and suitable resistance exercises can help maintain strength, while balance training may reduce the likelihood of falls.
People who already have osteoporosis or spinal fractures may need to modify certain movements. A physiotherapist can help identify safe activities and exercises.
Preventing falls is particularly important for older people with fragile bones. Better lighting, secure handrails, appropriate footwear, and attention to eyesight or medicines that cause dizziness may help reduce risk.
The right treatment is not the same for everyone. Some people need medication; others may need assessment and monitoring, nutritional changes, exercise, or a combination of approaches.
Where can Indian women seek help?
A woman who is concerned about her bone health can begin by consulting a general physician at a primary health centre, community health centre, or other healthcare facility.
The doctor can review her history, assess risk factors, and decide whether a bone-density scan or blood tests are needed.
Depending on the findings, she may be referred to an endocrinologist, orthopaedic specialist, gynaecologist, or another clinician with experience in bone disorders.
Public and private facilities differ in the tests and treatments they provide, so local availability and cost should be checked.
It is especially important to seek medical assessment after a fracture caused by a relatively minor fall, or if there is significant height loss, new spinal curvature, or persistent back pain that needs investigation.
A person should not wait for several warning signs to appear. Osteoporosis may have no obvious symptoms, and the absence of pain does not establish that bone density is normal.
Nor should everyone begin high-dose calcium or vitamin D supplements without advice. The appropriate amount depends on dietary intake, health conditions, and other medicines.
Five practical ways to support bone health
The aim is not to live in fear of a disease that may never develop. It is to give the body the conditions it needs to maintain healthy bones.
1. Pay attention to what meals provide. Include calcium-rich foods regularly, alongside adequate protein and a varied diet. If dairy products are not part of the diet, suitable alternatives and other calcium sources can help.
2. Make movement part of the week. Walking, appropriate muscle-strengthening activity, and balance exercises can support bone and muscle health. Children and teenagers benefit from regular physical activity as well.
3. Do not assume that sunshine guarantees enough vitamin D. Discuss testing or supplementation with a healthcare professional if there are reasons for concern. Avoid excessive doses.
4. Take medical risk factors seriously. Early menopause, certain long-term medicines, significant hormonal disorders, and previous fragility fractures may change when bone-health assessment is needed.
5. Discuss bone health before a fracture happens. Women approaching or past menopause can ask a clinician whether their personal risk warrants a bone-density assessment.
These measures cannot eliminate every risk. Genetics, ageing, and medical conditions remain important. But appropriate prevention and treatment can make a meaningful difference.
A problem that deserves attention long before old age
Osteoporosis is not simply a story about ageing bones. It is the result of several processes that may build on one another over a person’s lifetime.
A girl may have difficulty getting enough nutrients during her growing years. An adult woman may spend most of her day indoors and have little opportunity for physical activity. Later, menopause may accelerate bone loss. If she also has a medical condition or takes a medicine that affects bone strength, the combined risks may become more serious.
None of these experiences guarantees that osteoporosis will develop. But together, they help explain why prevention needs to start early and why medical assessment matters when risk increases.
For Indian women, improving bone health means more than recommending calcium tablets. It means better nutrition, appropriate physical activity, awareness of vitamin D deficiency, recognition of menopause-related changes, and access to diagnosis and effective treatment.
It also means treating women as people whose health deserves attention at every stage of life, not only when a problem becomes impossible to ignore.
The important question is not whether every Indian woman will develop osteoporosis. She will not. The important question is how many women could avoid a fracture, or receive treatment earlier, if their bone health were taken seriously before the first break.
That is where greater awareness can make a real difference.
Sources used
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), US National Institutes of Health. Osteoporosis: Causes, Risk Factors, Symptoms, Diagnosis and Treatment.
https://www.niams.nih.gov/health-topics/osteoporosis - Indian Menopause Society, 2026. Clinical Practice Guidelines for Menopause: An Executive Summary and Recommendations.
https://pmc.ncbi.nlm.nih.gov/articles/PMC12948155/ - Endocrine Society of India Skeletal Health Taskforce, 2026. Calcium Supplementation in the Indian Context: A Consensus Statement.
https://pmc.ncbi.nlm.nih.gov/articles/PMC13427011/ - Khadilkar AV and Mandlik RM, 2015. Epidemiology and treatment of osteoporosis in women: an Indian perspective. International Journal of Women’s Health.
https://pubmed.ncbi.nlm.nih.gov/26527900/
