As the global population grows and ages, the number of fractures worldwide is expected to rise, mainly due to fragile bones | Image used for representational purpose only
| Photo Credit: istock/magicmine
Low bone density, or osteopenia, refers to a condition where bone mineral density is lower than normal, indicating weakened bones that are more susceptible to fractures, though not as severe as osteoporosis. According to the International Osteoporosis Foundation, osteoporosis affects 1 in 3 women and 1 in 5 men over 50, causing up to 37 million fragility fractures annually, impacting around 500 million people worldwide. The global aging population is estimated to drive a significant surge in osteoporosis-related hip fractures, with annual cases projected to nearly double from 2018 to 2050.
How does low bone density occur?
Bones are living tissues that continuously break down and rebuild. However, as women age, especially after menopause, the process of bone loss outpaces bone formation due to a drop in estrogen levels, a hormone crucial for maintaining bone strength.
According to the World Health Organization (WHO), this accelerated bone loss in postmenopausal women increases their risk of fragility fractures, which result from minimal trauma like a fall from standing height or lower. Other factors contributing to bone density loss include poor nutrition, lack of physical activity, smoking, alcohol consumption, and certain medical conditions or medications, such as glucocorticoids or anticonvulsants.
What are the signs and symptoms?
Low bone density is often referred to as a “silent condition” because it typically has no symptoms until a fracture occurs. Women may not realise they have weakened bones until they experience a fracture, usually in the hip, spine, wrist, or upper arm, following a minor fall or injury. Spine fractures, in particular, can sometimes cause back pain, loss of height over time, and a hunched posture. The WHO stresses that most vertebral fractures go undiagnosed, further emphasising the importance of early screening for those at risk.
Who is at risk?
Certain groups of women are more vulnerable to developing low bone density and related fractures. Older women, particularly postmenopausal women, face the greatest risk due to hormonal changes that affect bone metabolism.
According to WHO, fractures are more likely to occur in older women as bone fragility increases with age. Non-modifiable risk factors include age, family history of fractures, early menopause, and ethnicity, with Caucasian and Asian women being at higher risk.
Modifiable risk factors also play a significant role. These include smoking, excessive alcohol consumption, physical inactivity, low body weight, and nutrient-poor diets lacking in calcium and vitamin D. Certain medications, like long-term steroid use, and underlying health conditions, such as diabetes or malabsorption disorders, further elevate the risk. The WHO stresses that while some risk factors cannot be changed, lifestyle modifications and medical interventions can help prevent fragility fractures.
What are the treatment options?
Treating low bone density involves a combination of lifestyle changes, medications, and fall prevention strategies. According to WHO’s Bone Health and Ageing initiative, the primary approach focuses on strengthening bones and minimising fracture risk. Consulting a healthcare professional for personalised care that will provide increasing calcium and vitamin D intake through diet or supplements is crucial, along with regular weight-bearing exercises like walking, jogging, and strength training to stimulate bone growth.
In more severe cases, doctors may prescribe medications such as bisphosphonates to slow bone loss or hormone replacement therapy (HRT) for postmenopausal women to maintain bone density. Fall prevention strategies, including home safety adjustments and balance exercises, are essential, as most fractures in older women result from low-energy trauma.
Early detection plays a key role in treatment. Tools for predicting fracture risk, which combine clinical risk factors and bone mineral density tests, help guide healthcare decisions.
Preventing future fractures, known as secondary prevention, also involves timely rehabilitation following a fracture. This can include physical therapy, assistive devices like walking aids, and lifestyle counseling. The WHO emphasises that effective management of fragility fractures not only reduces the risk of subsequent fractures but also improves the quality of life for older women. While some risk factors, like age and genetics, cannot be altered, proactive steps, from proper nutrition and exercise to early screening and medical treatment, can protect bone health.
Published – March 14, 2025 05:19 pm IST