Only 1 in 500 post-menopausal women tested for osteoporosis – an alarming real-world analysis

Akansh Khurana, CEO and Co-Founder, Technology Healthcare Big Data Analytics elucidates on the importance of preventing the onset of osteoporosis

We are all (sub) consciously worried about the older ones in our families getting fractures even through minor falls. But there is seldom any action to assess the risk and prevent these preventable fractures – just because we are unaware about the existence and intensity of one of the widely prevalent silent diseases that without visible symptoms can lead to permanent damages –  osteoporosis.

The case in India

De-identified datasets from a sample of patients were analysed to assess the osteoporosis epidemiology in Indian women for pre-menopausal (30-45 years), and post-menopausal (>45 years) age groups to understand the extent of risk, and the degree of under-diagnosis. Refer fig below:

The analysis above indicates that 1 in 500 (0.2 per cent)post-menopausal women monitor bone mineral density (that helps diagnose osteoporosis), highlighting the magnitude of under-diagnosis for bone health in this age-group. Even bigger worry – that among those who monitor, around ~65 per cent are found to have osteoporosis or osteopenia.

Even among pre-menopausal women, more than 20 per cent of those who monitor have osteopenia, which if uncorrected puts them at a higher risk of progressing to osteoporosis as the age increases and menopause sets in.

Precautionary steps ahead

Measurement of BMD is the gold standard test for the diagnostic evaluation of osteoporosis. BMD is an important diagnostic tool that not only measures the amount of calcium in certain bones but can also be used to estimate the risk of fractures. The test is easy, fast, painless and non-invasive. WHO definition of osteoporosis is based on BMD and T-scores of the proximal femur and spine.

The above real world evidence (RWE) findings, analysed on the basis of BMD and T-scores- highlight a significant deficit in the awareness level of Indian women regarding bone health and osteoporosis – and since lack of awareness leads to lack of means to prevent it, clearly we are headed towards unwanted and preventable fractures. The magnitude of the problem, ranging from lack of importance of bone health supplements (lower odds ratio of vitamin / mineral replacement) to lack of importance of early diagnosis has left us with a lot of ground to cover before winning the actual battle.

Deficiency of calcium and vitamin D, early menopause and poor knowledge of bone health and lack of nutritional food, poor lifestyle and hormonal imbalance are some of the main reasons leading to osteoporosis in India. According to the International Journal of Bone Health, India falls far below the WHO recommendations of daily calcium intake, highlighting the magnitude of unawareness for bone health in a population of all age groups. The worldwide incidence of osteoporosis is rising because of increase in the ageing population and sedentary lifestyle. A study from International Women Health Research, 2015 says that of the 230 million Indians over the age of 50years, 20 per cent which is approximately 46 million, were women with osteoporosis. A more recent, UNI 2018 report says that four out of five women have osteoporosis in India.

Doesn’t this ring an alarm for the need for immediate action?

There is a severe need of work to be done towards timely diagnosing. We need dedicated efforts in bringing more women for diagnosis in all age groups.

Osteoporosis was previously considered a normal part of ageing, but it is now understood to be preventable and treatable. Many interventions reduce fracture risk in the general population and can be used for primary and secondary prevention – e.g. adequate combined calcium and vitamin D intake (calcium alone has not been shown to reduce fractures), anti resorptive therapy, weight-bearing exercise, tobacco avoidance, moderate alcohol intake, and avoidance of trip or fall hazards and most importantly an immediate need for an increase in awareness and timely testing for early diagnosis- an immediate need of awareness of bone mineral density tests for osteoporosis to prevent the preventable fractures.