Osteoporosis – A neglected non-communicable disease

Noncommunicable diseases (NCDs) are the major cause of morbidity and mortality worldwide. There is a global epidemiological transition undergoing – a paradigm shift from communicable diseases to NCDs as the dominant causes of morbidity and mortality. This transformation, once confined to high-income countries, is now occurring in low-and middle-income countries as well. According to the Global Burden of Disease Study 2016, NCDs account for 50%–60% of the total disease burden in these settings.[1] While conditions like type 2 diabetes (T2DM), hypertension, cardiovascular diseases, chronic obstructive pulmonary disease, chronic liver disease, and cancer dominate NCD narratives, osteoporosis (OP) remains an often-overlooked contributor to chronic disability and fragility, particularly with improving life expectancy and progressive aging of the population. OP is frequently grouped under musculoskeletal disorders along with osteoarthritis, but it deserves distinct recognition due to its high burden of fragility fractures, especially hip and spine fractures in older adults. Fragility fractures are associated with high morbidity, mortality, and financial costs, yet attention remains disproportionately low compared to other NCDs. The most common site of fragility fracture is spine fracture, but hip fractures (HF) are the most visible and dramatic consequences of OP because of poor quality of life, increased mortality, and socioeconomic burden. In a prospective study by Dhibar et al., the mortality rate from hip fracture in 264 patients in the 1st year was 21.5%, 16.7% at 6 months, and 12.3% at 12 months.[2] However, the majority of mortality (25 out of 34) occurred at the end of the 3rd month. In a case-controlled, follow-up study by Varshney et al., 55% of cases as against 99% of controls walked independently, and 35/326 cases against 6/400 controls were dead at 1-year follow-up.[3] A retrospective study by Lee et al. showed that the 5-year relative survival rate of 93.9% (95% confidence interval 87.5%–99.7%) after osteoporotic hip fracture was below that of the general population and was comparable with some cancers, such as thyroid and breast cancer (99.8% and 91.0%, respectively). Therefore, osteoporotic HF should not be overlooked.[4] OP is more prevalent in females, especially postmenopausal women, due to hormonal changes. However, men still suffer poor health outcomes related to OP-related fractures. In addition, a lower proportion of men at high risk of fracture are treated than women at high risk.[5] Men also tend to have worse outcomes after fracture than women; they are twice as likely to die after hip fracture as women.[6] Hence, improvement in treatment and prevention rates of those at risk, regardless of gender, is an important goal in OP management. However, awareness and screening programs are often inadequate. Data from India is particularly sparse, and estimates suggest poor detection and undertreatment rates. Fractures are commonly attributed to falls or accidents, but underlying bone fragility is rarely evaluated or treated. Multiple factors contribute to the neglect of OP: Lack of awareness Prevalence in the elderly Limited symptoms until fractures occur Poor nutritional status (especially calcium and vitamin D) Inadequate screening infrastructure No structured fracture liaison services (FLS). To address these gaps, we need a paradigm shift from intervention-based approaches to preventive strategies starting from the intrauterine phase. This includes: Public awareness campaigns Nutritional supplementation (calcium, vitamin D) Weight-bearing exercises across the lifespan Fall-prevention strategies in elderly populations Integration of FLS in secondary care hospitals. India lacks comprehensive data on OP burden and fracture incidence. Multicentric studies are needed, combining the efforts of orthopedists, endocrinologists, obstetricians, and community health programs. Given that OP-related fractures can lead to loss of independence, reduced quality of life, and increased mortality, especially after HF, it is imperative that we recognize OP as a critical NCD and prioritize its prevention in the national health agenda. Doing so aligns with the objectives of the World NCD Federation and the global goal of reducing preventable chronic disease burden by 2030.