Osteoporosis

Osteoporosis means your bones have become thinner and weaker, but it is common, easy to check for and very treatable. Most people feel nothing, so a simple bone scan is how it is usually found. With the right medicines, calcium, vitamin D, exercise and fall prevention, you can strengthen your bones and lower your chance of a fracture.

Reviewed by Dr. Kshitij Chaudhary — Last reviewed October 2026

What is osteoporosis?

Bone is living tissue. It is always being broken down and rebuilt. In osteoporosis, you lose more bone than you make, or you never built enough to begin with. The bones get thinner and more porous, so they break more easily.

A bone with osteoporosis can crack after a fall from standing height. Sometimes it cracks from a cough, a bend or lifting something light. Doctors call this a fragility fracture.

What causes it?

Your bones grow denser through childhood and your teens. They reach their peak bone mass in your mid to late 20s. After that, everyone loses a little bone each year. Osteoporosis happens when you start with less bone, lose it faster, or both.

In women, bone loss speeds up after menopause, when oestrogen levels fall. It also speeds up if both ovaries are removed. Low calcium and low vitamin D make it worse, and both are common in India.

Who gets osteoporosis?

Anyone can, but some people are at higher risk. Here is what you cannot change:

• Being a woman, especially after menopause (early menopause, before 45, raises the risk further)
• Getting older
• A small, thin frame
• Asian ancestry
• A parent who broke a hip

And here is what you can change or treat:

• Too little calcium or vitamin D in your diet
• Little exercise
• Smoking (see 🚭Smoking and Low Back Pain) and heavy alcohol
• Long-term steroid tablets
• Long-term acid-reducing medicines, some epilepsy medicines, and hormone treatment for breast or prostate cancer
• An overactive thyroid, low testosterone, rheumatoid arthritis, kidney disease, or a gut problem that stops you absorbing nutrients

Men get osteoporosis too, especially after 70. Many men assume it only affects women.

How serious is it?

Osteoporosis itself does not hurt. It matters because of the fractures it can cause, most often in the hip, spine and wrist. A broken hip can take away your ability to walk on your own, and some people end up needing long-term care. A fracture from a mild fall also means a higher chance of breaking another bone, which is why treatment starts straight away.

Many people with osteoporosis never break a bone, and treatment lowers the chance further.

What are the symptoms?

Usually none. This is why it is called a silent disease. Most people find out after a scan, or after a bone breaks. Spine fractures can bring:

• Sudden back pain after a small fall, a cough or lifting
• Loss of height over the years, sometimes a few centimetres
• A stooped, hunched back

A new, sudden back pain in someone with thin bones is worth getting checked. A collapsed vertebra is called a ◾Vertebral Compression Fracture & Osteoporosis-Related Spine Fractures, and most heal well.

How is osteoporosis diagnosed?

The standard test is a DEXA scan. It measures the density of your hip and spine. It takes a few minutes, doesn't hurt, and uses a very low dose of X-rays. Your result is a T-score:

Low bone mass is not osteoporosis. With low bone mass, food, exercise and other lifestyle changes are often all you need. Your doctor decides about medicines by looking at your overall chance of a fracture.

A fragility fracture of the spine or hip can also confirm the diagnosis on its own.

Scans are usually advised for women from around 65, and earlier if you have risk factors. Men are tested when they have risk factors or a fracture. Your doctor may also check blood tests for calcium, vitamin D, thyroid and kidney function, to look for a cause that can be treated.

Will it get worse?

Left alone, bone loss carries on slowly as you age, and one fracture raises the chance of another. Treatment changes that. Medicines can slow or stop bone loss, and some build new bone.

How is osteoporosis treated?

Almost everyone is treated without surgery. The aim is to slow bone loss and prevent fractures. Treatment has five parts.

Calcium

Most adults need about 1,000 to 1,200 mg a day. Try to get it from food first:

• Vegetarian: milk, curd, paneer, ragi, sesame seeds (til), green leafy vegetables, tofu, rajma and other beans
• Non-vegetarian: small fish eaten with the bones, and sardines

If food falls short, your doctor may suggest a calcium supplement. Take it with meals.

Vitamin D

Vitamin D helps your body absorb calcium. Sunlight is the easiest source. Aim for about 15 to 20 minutes outdoors, 3 to 4 times a week, with arms and legs uncovered. Many people also need a supplement, and a blood test shows your level. Take only the dose your doctor advises. Extra doses don't help and can harm. ☀️Vitamin D deficiency: what it means for your bones explains this in detail.

Exercise

Weight-bearing exercise (walking, climbing stairs) and strength training help your bones and your balance. Aim for 30 minutes of activity on most days. Even a brisk walk counts, so choose something you enjoy. Add strength and balance exercises 2 to 3 days a week, because they lower your chance of falling.

Avoid high-impact exercise and sudden twisting or bending forward. Start with the 🏋️Exercise Program for Osteoporosis, and ask a physiotherapist to tailor it to you.

Preventing falls

Most fractures happen after a fall. Clear loose wires and rugs, keep floors dry, light your stairs and passages, and fit grab bars in the bathroom. Wear shoes with a firm grip. Have your eyes checked. Ask your doctor whether any of your medicines make you dizzy. 🤕Fall prevention in Osteoporosis has more.

Medicines

Your doctor may advise a bone-strengthening medicine. The main types are:

• Bisphosphonates such as alendronate (tablets) or zoledronic acid (a yearly drip). These slow bone loss and lower fracture risk.
• Teriparatide, a daily injection that helps build new bone
• Denosumab, an injection every six months that slows bone loss
• Romosozumab, a monthly injection that builds new bone while slowing bone loss. It is used for a limited period.
• Raloxifene, for some women after menopause

Doctors usually try a bisphosphonate first. If it doesn't do enough, or the side effects bother you, there are other options. Your doctor chooses based on your age, your scan, your kidneys and your other medicines. Don't stop any of these on your own. Stopping some of them suddenly can cause bone loss to speed up.

A repeat DEXA scan every year or two shows whether treatment is working. Sometimes a blood or urine test is added.

When is surgery needed?

Osteoporosis itself is treated with medicines, not surgery. Surgery comes into the picture when it causes a fracture.

• Spine: most compression fractures heal in about 6 to 12 weeks with pain relief, a brace if needed, and treatment of the bone. If pain stays severe, a small procedure can help (see below). Rarely, a fracture presses on the nerves or makes the spine unstable and needs fixation.
• Hip: most hip fractures need surgery.

If you need spine surgery for another reason and also have osteoporosis, the plan changes. Screws hold less well in thin bone, so we plan the operation and the bone treatment together.

Been advised surgery for a spine fracture and unsure? You can send your MRI for a second opinion.

What does surgery for a spine fracture involve?

Vertebroplasty and kyphoplasty are keyhole procedures. Through a small needle, bone cement is placed into the broken vertebra. In kyphoplasty, a small balloon first lifts the collapsed bone. Both can bring quick pain relief and help you get moving again.

What is recovery like?

After a spine fracture, keep moving as much as pain allows. Walk daily and avoid heavy lifting while it heals. Most people settle over 6 to 12 weeks. The medicines continue afterwards, because treating the bone protects you from the next fracture as much as healing this one does. More in ◾Vertebral Compression Fracture & Osteoporosis-Related Spine Fractures.

Can osteoporosis be prevented?

Largely, yes, and it is never too late to start. Eat enough calcium, get your vitamin D checked, stay active, don't smoke and keep alcohol low. If you have risk factors, ask about a bone scan early. If back pain is already bothering you, 📕The Back Pain Guide is a good place to start.

When should I call my doctor?

Call if you:

• Have osteoporosis and fall or get hurt
• Think you may have broken a bone
• Have new back pain
• Fall or lose your balance often

Questions to ask your doctor

• Do I need a bone density test? How often should I repeat it?
• Am I at risk, given my age, menopause or family history?
• How can I be sure I'm getting enough calcium and vitamin D?
• Is it safe for me to exercise? Which exercises should I do?
• What can I change at home to stop myself falling?
• Will I need medicine? Will it interact with the ones I already take?

Treatments we offer for this

Vertebroplasty and kyphoplasty for painful spine fractures, and spinal surgery when a fracture presses on the nerves.

This page is for general information and does not replace a medical consultation. Please see a doctor for advice about your own symptoms.