Osteoporosis is no longer a disease of "old age"; more women in their 30s and 40s are now presenting with fragile bones and unexpected fractures. Keeping bones healthy at every age is vital for women to stay active, mobile, and independent as they grow older. Just last week, a 38-year-old woman came to the clinic with very bad back pain after what she described as a small slip at home. Her X-rays showed that one of the bones in her spine had broken, and a DEXA scan (a bone strength test) confirmed that she had generalised osteoporosis. She had been taking steroid tablets for several years for an autoimmune disease, and during this time her bones had been slowly getting weaker without her knowing it. This was not an isolated incident but a reminder that fragile bones are no longer a problem limited to the elderly.
Bone strength depends on both bone density and bone architecture, and the most reliable way to assess it is through a Bone Mineral Density test using a DEXA scan. Most women are unaware that their bones reach their maximum strength by about thirty years of age. From then on, bone loss begins quietly, and in many women, it progresses rapidly because of medical conditions and lifestyle patterns that often go unnoticed. Steroid medications remain one of the most powerful triggers for early bone loss, as they interfere with calcium absorption, suppress new bone formation, and accelerate bone breakdown. Hormonal disorders further complicate the picture.
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In Polycystic Ovary Syndrome, oestrogen levels may appear adequate, yet the absence of regular ovulation leads to chronic progesterone deficiency, insulin resistance, and low-grade inflammation, all of which gradually weaken bone structure. Overactive thyroid, whether from disease or over-treatment, causes excessive bone turnover so that bones are broken down faster than they can be rebuilt. Women with irregular or infrequent menstrual cycles are also at risk because inconsistent hormonal signals can reduce the activity of cells that build bone. Several other factors contribute to the ideal conditions for silent bone loss, including modern city life, limited sun exposure, a diet low in calcium, a lack of physical activity, and irregular eating habits.
Menopause is another major phase that marks bone decline. Estrogen levels takes a major dip after menopause, leading to a surge in bone resorption. Women experience a loss up to 20% of their bone mass in the first 5 to 7 years after their last period. This is why fractures become common in the early postmenopausal period. For carefully selected women, hormone replacement therapy started around the time of menopause can significantly slow bone loss, preserve bone density, and reduce fracture risk, in addition to relieving menopausal symptoms.
Bone health, however, is largely determined much earlier in life. Adolescence is the window during which lifelong skeletal strength is built. During these years, it is important to carry on with regular weight-bearing activities, take enough calcium and protein-rich foods, and regular sun exposure to help produce vitamin D. Restrictive dieting, junk food dependence, and untreated menstrual problems can permanently compromise peak bone mass.
When osteoporosis is identified, treatment can truly change your life for the better. Simple steps like a better diet, more exercise, and calcium and vitamin D supplements work alongside medicines like bisphosphonates to slow bone thinning; injections like denosumab if pills don't suit you; and stronger options like teriparatide shots for severe cases - all to cut down fracture chances and help you stay active longer.
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Osteoporosis isn't just an old-age problem anymore-it's hitting younger women too. Early awareness, proactive screening, and timely treatment can prevent fractures and protect mobility for years to come. Strong bones aren't built when you're old; they're made strong in childhood, kept strong as a young adult, and protected every day - start today to stay on your feet and active for years ahead.
Talk to your doctor about a quick DEXA bone scan if you have risk factors like fractures after a minor fall or you are on long-term steroids. Add easy daily steps like walking, milk or curd for calcium, and 15 minutes of sunlight to build and protect strong bones right now.
(By Dr. Radha S Rao, Senior Consultant & Lead - Obstetrics & Gynaecology, Manipal Hospital Kanakapura Road, Bengaluru)
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