Bone loss is silent until a fracture occurs. Because the first fracture substantially raises the risk of the next, identifying and treating osteoporosis early is one of the more clearly worthwhile interventions in endocrinology.
Assessment
Evaluation includes a DEXA bone density scan, vitamin D and calcium levels, parathyroid hormone, kidney function, and where relevant a search for secondary causes such as hyperparathyroidism, thyroid excess, coeliac disease or long-term steroid use.
Treatment
Treatment combines correction of vitamin D and calcium, weight-bearing activity, fall prevention, and bone-specific medication where the fracture risk justifies it. The choice and duration of medication depends on severity, age and kidney function, and is reviewed periodically.
Vitamin D deficiency
Vitamin D deficiency is extremely common in urban India and is often over-treated with high-dose sachets without follow-up testing. Correct repletion followed by a sensible maintenance dose is more effective than repeated large doses.