Reimagining osteoporosis care: from preventing loss to rebuilding strength

Osteoporosis, often described as a “silent disease,” affects millions across India, predominantly postmenopausal women and the elderly. It is silent not only because it progresses without obvious symptoms, but also because it remains largely underdiagnosed and undertreated until a fracture occurs. For years, the emphasis in medical practice has been on slowing the pace of bone loss. Today, however, with evolving science and therapeutic innovation, the paradigm is shifting—towards rebuilding bone, restoring strength, and rethinking what osteoporosis care can truly achieve.

A shift in scientific thinking

At the heart of osteoporosis is an imbalance between bone formation and bone resorption. While the body continually breaks down and builds bone, in osteoporosis, bone resorption exceeds formation. The result is a reduction in bone mass and deterioration in bone architecture, which significantly increases the risk of fractures.

Traditionally, treatment has focused on antiresorptive agents such as bisphosphonates, which slow the rate at which bone is broken down. While these medications have undoubtedly prevented many fractures, they do not restore bone that has already been lost.

In recent years, the focus has expanded to include anabolic therapies that actively promote bone formation. This marks a significant turning point in the clinical management of osteoporosis—particularly for patients at high risk of fracture or those who have already suffered one or more fragility fractures.

The promise of bone-building therapies

A multimodal and individualised approach is taken in deciding the appropriate drug of choice for the patient. This involves investigations to assess bone density and metabolic state of the patient, followed by a consultation with the orthopaedic surgeon and endocrinologist.

Several new therapies such as anabolic, or bone-forming, therapies as well as monoclonal antibody medications are now available.

Towards a holistic view of bone health

Managing osteoporosis is not solely about prescribing medication. It requires a multi-dimensional strategy. Nutritional support, particularly adequate calcium and vitamin D intake, weight-bearing exercise, fall prevention, and regular monitoring of bone mineral density are all essential components of comprehensive care.

Public awareness remains a key challenge. Symptoms such as chronic back pain, reduced height or a stooped posture are often dismissed as signs of ageing. Greater public education and proactive screening, especially among postmenopausal women and older adults, can help reverse this trend.

Rebuilding more than bone

At its core, osteoporosis is not only a disease of the skeleton but one that affects confidence, mobility and quality of life. Advances in bone-building therapies bring with them more than just improvements in bone mass. They offer individuals a chance to regain independence and lead fuller lives.

The future of osteoporosis care lies not in merely preserving what is left, but in restoring what has been lost—with science, empathy and precision. As we embrace this new chapter in care, we must ensure that no fracture becomes a missed opportunity for intervention.

(Dr Sameer Chaudhari is a consultant in orthopaedics, Apollo Hospitals, Navi Mumbai. drsameer_c@apollohospitals.com)