Osteoporosis Prevention: A Bone-Health Action Plan

Osteoporosis — the silent disease that quietly thins bones until a minor stumble produces a major fracture — is one of the most under-treated chronic conditions in adult medicine. Patients often only learn they have it after a fragility fracture, which by then has already happened. The good news is that bone health is highly modifiable across the entire adult lifespan. This article lays out a practical, evidence-based action plan for preventing osteoporosis and protecting bone health into older age.

The problem in numbers

Around one in three women and one in five men over 50 will sustain an osteoporotic fracture in their lifetime. Hip fracture in particular is associated with significant disability and a 20–30% one-year mortality. Yet the underlying disease is identifiable years in advance and treatable with safe, effective medications.

Build the bank: bone building in early adulthood

Peak bone mass is reached in the mid-20s and serves as the foundation for the rest of life. What helps build it:

• Weight-bearing exercise — running, jumping, brisk walking, racquet sports
• Strength training — progressive resistance work signals bone remodelling
• Adequate protein intake
• Sufficient calcium and vitamin D
• Avoiding extreme energy deficiency (relative energy deficiency in sport, RED-S)

Hold the bank: maintaining bone in middle age

From the mid-30s onwards bone mass starts to gradually decline; the loss accelerates around menopause in women and continues steadily in men. The same interventions that build bone also slow loss: weight-bearing exercise, strength training, adequate nutrition. Avoiding the major bone enemies matters: smoking, excessive alcohol, very low body weight, and chronic high-dose steroid use.

Screen the bank: who should have a DEXA scan?

A DEXA scan measures bone density and is the standard screening test. It is recommended for:

• Postmenopausal women — generally from age 65, earlier if risk factors are present
• Men over 70
• Any adult with a fragility fracture (low-energy fall from standing height)
• Patients on long-term steroids
• Patients with conditions or medications known to affect bone

Calcium and vitamin D

The recommended daily intake is 1000–1200 mg calcium and 800–1000 IU vitamin D for most adults over 50. Calcium is best obtained from food (dairy, leafy greens, sesame, tofu, fortified foods); supplements are useful when intake is inadequate. Vitamin D deficiency is endemic in India — many adults need supplementation regardless of sun exposure due to skin pigmentation, time indoors, and clothing patterns. A blood test guides the dose.

Medical treatment for established osteoporosis

For patients with confirmed osteoporosis on DEXA, or those with a fragility fracture, medical treatment is highly effective:

• Bisphosphonates (alendronate, risedronate, zoledronate) — the first-line treatment for most patients. Reduce fracture risk by 30–70%.
• Denosumab — a twice-yearly subcutaneous injection; well tolerated, highly effective.
• Teriparatide and abaloparatide — daily injections for severe osteoporosis; build new bone.
• Romosozumab — newer monthly injection with strong fracture reduction.

Fall prevention

For older patients, fracture prevention is half about bone density and half about not falling. Practical fall-prevention strategies include:

• Balance and strength exercises (tai chi, yoga, structured programmes)
• Annual vision check and updating glasses
• Reviewing medications that cause dizziness
• Home modifications: clear pathways, good lighting, removing rugs, grab rails in bathrooms, raised toilet seat
• Appropriate footwear

The action plan

1. From your 20s and 30s — exercise regularly with weight-bearing and strength components; eat adequate protein, calcium and vitamin D; avoid smoking and heavy alcohol.
2. From your 40s and 50s — continue all of the above; check vitamin D levels; address any risk factors with your doctor.
3. From your 60s — DEXA screening; start treatment if osteoporosis is confirmed; review fall-prevention strategies.
4. After any fragility fracture — DEXA scan and consideration of medical treatment regardless of age.