Osteoporosis risk: who should be tested?

Osteoporosis has no symptoms. There is no ache that warns you, no stiffness that builds. Bone density falls quietly for years and the first sign, for most people, is a fracture.

That makes it a condition where testing matters more than listening to your body, because your body will not tell you.

This is information, not medical advice. Testing decisions and treatment belong with your doctor. If you have broken a bone from a minor fall, read the section on fragility fractures below and raise it with them.

What it is, briefly

Bone is living tissue, continuously broken down and rebuilt. Up to roughly the late twenties, building outpaces breakdown and bone mass accumulates to a peak. After that the balance gradually reverses.

Osteoporosis is when bone mass and quality have fallen enough that bones break under forces that would not normally break them. Osteopenia is the intermediate stage, lower than normal, not yet osteoporosis.

The clinically important point: the fractures that matter, hip, spine, wrist, are not merely painful. A hip fracture in an older adult carries substantial mortality in the following year and frequently results in permanent loss of independence. This is why the condition is taken seriously despite being silent.

The one event that should always trigger testing

A fragility fracture.

That means a bone broken by a force that should not have broken it, a fall from standing height, a minor stumble, a knock against furniture, or in the spine, sometimes no identifiable event at all.

If you are over about fifty and you break a bone from a minor fall, that is a diagnostic event. It should prompt a bone density assessment regardless of anything else on this page.

And this is where the system most often fails people. A wrist fracture gets plastered, heals, and nobody asks why it broke. That wrist was telling you something about your hip. A fragility fracture roughly doubles the risk of a further fracture, and the period immediately after one is the highest-risk window.

So if this has happened to you or a family member: ask about a bone density scan and about treatment. It is the single most valuable question in this article.

Who should be tested

Guidelines vary by country, and your doctor will apply the local one. Broadly, testing is considered for:

By age and sex:

• Women aged 65 and over
• Men aged 70 and over
• Post-menopausal women under 65 with additional risk factors
• Men aged 50–69 with risk factors

After a fragility fracture, at any age over 50.

Because of medication:

• Long-term oral steroids, this is a major and often overlooked cause. Prednisolone for asthma, rheumatoid arthritis, lupus, or inflammatory bowel disease causes bone loss, and anyone on sustained treatment should have bone health addressed proactively
• Aromatase inhibitors for breast cancer
• Androgen deprivation therapy for prostate cancer
• Long-term proton pump inhibitors
• Some anticonvulsants
• Long-term heparin
• Thyroid hormone over-replacement, a suppressed TSH on levothyroxine affects bone over time, and this is worth raising if you have been on the same dose for years without review

Because of a medical condition:

• Early menopause, before 45, or premature ovarian insufficiency
• Hyperparathyroidism
• Hyperthyroidism
• Coeliac disease and other malabsorption, including after bariatric surgery
• Chronic kidney disease
• Rheumatoid arthritis
• Type 1 diabetes
• Inflammatory bowel disease
• Chronic liver disease
• Hypogonadism in men, low testosterone is a genuine and under-recognised cause of male osteoporosis
• Anorexia nervosa or long-standing low body weight

Because of other risk factors:

• Parental history of hip fracture, a strong independent predictor
• Smoking
• Significant alcohol intake
• Low body weight, a BMI under about 19 is a meaningful risk factor
• Loss of height, or a developing stoop
• Recurrent falls
• Prolonged immobility
• Very low physical activity

The Indian context

Two factors make this more pressing here than the general guidance suggests.

Vitamin D deficiency is extremely common, and vitamin D governs calcium absorption. The combination of low vitamin D and a low-dairy diet is a direct route to poor bone health, and it is widespread.

Calcium intake is frequently low, particularly in people who do not consume dairy, and plant calcium sources are less bioavailable.

Menopause also tends to occur somewhat earlier in Indian women than in Western populations, which extends the post-menopausal years during which bone loss is accelerated.

And a practical problem: DXA scanners are concentrated in cities, so access is uneven. Where a scan is not available, clinical risk assessment tools such as FRAX can estimate fracture risk from history alone, and your doctor can use one.

What the test is

DXA, dual-energy X-ray absorptiometry. A scan of the hip and lumbar spine, usually taking a few minutes, with a very low radiation dose. Painless, nothing injected, no preparation beyond avoiding calcium supplements on the day.

The result is a T-score, comparing your bone density to a young adult reference:

T-score	Interpretation
−1.0 and above	Normal
−1.0 to −2.5	Osteopenia
−2.5 and below	Osteoporosis
−2.5 or below with a fracture	Severe osteoporosis

A Z-score compares you to others of your own age and sex, and is used instead of the T-score in younger adults, in children, and in pre-menopausal women.

One caution worth knowing: a heel ultrasound scan at a health camp or pharmacy is not a DXA and is not diagnostic. It is a screening prompt at best. If it flags something, the next step is a proper DXA, not a supplement.

And the spine reading can read falsely high in people with significant spinal arthritis or previous vertebral fractures, because the degenerative changes add density. Your doctor will account for this.

What accompanies the scan

A diagnosis of low bone density is usually followed by tests to look for a cause, because treatable secondary causes are common:

• Calcium, phosphate, albumin
• Vitamin D (25-OH)
• Parathyroid hormone
• Kidney function
• Liver function and alkaline phosphatase
• TSH
• Full blood count and ESR
• Coeliac screening, where indicated
• Testosterone in men
• Occasionally tests for myeloma or other conditions

This matters because osteoporosis secondary to hyperparathyroidism, coeliac disease or hypogonadism is managed by treating the cause as well as the bone.

Treatment exists, and it works

This section is here because many people treat an osteoporosis diagnosis as something to manage with diet and a calcium tablet. For established osteoporosis, that is not sufficient.

Bisphosphonates, alendronate, risedronate, zoledronic acid, are the usual first-line treatment and reduce fracture risk substantially in appropriate patients. Oral forms have specific dosing requirements (taken on an empty stomach with a full glass of water, remaining upright afterwards) which exist to prevent oesophageal irritation, and following them matters.

Other options include denosumab, teriparatide and romosozumab for higher-risk cases, and hormone therapy in appropriate post-menopausal women.

Calcium and vitamin D are supportive, necessary alongside treatment, and not a substitute for it.

A note on side effects: osteonecrosis of the jaw and atypical femoral fractures are the two side effects that generate most anxiety about bisphosphonates. Both are rare, and the fracture risk reduction for someone with genuine osteoporosis generally outweighs them considerably. Dental work is usually best completed before starting, which your doctor will advise on. This is a risk-benefit discussion worth having properly rather than avoiding treatment because of a headline.

What you can do regardless

Weight-bearing and resistance exercise. The most effective non-pharmaceutical measure. Bone responds to load, that is the mechanism.

Walking, stair climbing, and particularly resistance training. Swimming and cycling are excellent exercise and do relatively little for bone density, because they do not load the skeleton.

And for women specifically: the belief that weight training makes women bulky keeps them away from precisely the exercise they most need after menopause. It is a myth with a real cost.

Adequate protein. Bone matrix is largely protein. Low protein intake is associated with poorer bone health, and intake is often low in older Indian adults.

Calcium from food first, supplements to fill the gap. Non-dairy sources include ragi, sesame, almonds, methi, moringa, and calcium-set tofu. Note that spinach is an unreliable source because of its oxalate content.

Vitamin D, tested and dosed by your doctor. This comes before calcium supplementation in priority, because without it much of the calcium is not absorbed.

Stop smoking. A direct, well-documented effect on bone density.

Limit alcohol.

Reduce excess salt, which increases urinary calcium loss.

Prevent falls, and this is as important as the bone itself, because a fracture needs both weak bone and a fall. Check vision, review medications that cause dizziness or drowsiness, improve lighting, remove loose rugs, fit bathroom grab rails, and work on balance. Tai chi and similar balance training have reasonable evidence for fall reduction.

What products can and cannot claim

We manufacture in this category, so the line matters.

Sayable: the recognised roles of calcium in maintaining normal bones, of vitamin D in calcium absorption and normal bone maintenance, of vitamin K2, magnesium and protein in bone and muscle health.

Not sayable: prevents osteoporosis, treats osteoporosis, prevents fractures, increases bone density. These are medicinal claims, and we decline artwork that makes them.

And the position we hold: a calcium and vitamin D supplement is a reasonable, useful product for someone whose intake is low. It is not a treatment for diagnosed osteoporosis, and the person who takes it instead of starting prescribed treatment is accepting a fracture risk they do not need to accept.

If you sell into the senior segment, put the testing prompt on your material. The most useful thing a bone health brand can tell a customer is that a fragility fracture warrants a scan.

The short version

1. Osteoporosis is silent. There are no symptoms until a fracture.
2. A bone broken by a minor fall after 50 is a diagnostic event, it warrants a scan and a treatment discussion. This is the most commonly missed opportunity in the condition.
3. A fracture roughly doubles the risk of the next one, and the following months are the highest-risk window.
4. Get tested if: woman 65+, man 70+, post-menopausal with risk factors, after a fragility fracture, on long-term steroids, early menopause, or with any of the listed conditions.
5. Long-term steroids and over-replaced thyroid hormone are two commonly overlooked causes.
6. DXA gives a T-score. Below −2.5 is osteoporosis. A heel ultrasound at a camp is not a DXA.
7. Look for secondary causes, vitamin D, parathyroid, coeliac, thyroid, testosterone in men.
8. Treatment works and reduces fracture risk substantially. Calcium and vitamin D support it; they do not replace it.
9. Resistance and weight-bearing exercise is the most effective thing you can do yourself. Swimming and cycling do little for bone.
10. Preventing falls matters as much as the bone, vision, medication review, home safety, balance.

Product detail: calcium with D3 and K2 and vitamin D3 drops. Related: how calcium, D3 and K2 work together and the Hindi piece हड्डियों को मज़बूत करने के उपाय.