Osteoporosis Screening for Indian Women: DEXA, T-Score, FRAX

• Osteoporosis has no symptoms until a fracture occurs, so screening before a fall is the whole point.
• ISBMR-aligned guidance: all women get a baseline DEXA scan at 65, and earlier (from 50, or even 40) if they have risk factors like early menopause, steroid use, low body weight, or a family history of hip fracture.
• Your DEXA T-score sets the diagnosis: above -1.0 is normal, -1.0 to -2.5 is osteopenia, and -2.5 or below is osteoporosis. The FRAX tool adds your 10-year fracture risk.
• Almost all Indian women are vitamin D deficient and most get far too little calcium, so correcting both is the foundation of any treatment.
• When medication is needed, oral bisphosphonates are usually first-line and inexpensive; HRT is a strong option for women in early menopause with symptoms.
• It is never too late to treat osteoporosis: even women in their 80s benefit, and treatment meaningfully cuts the risk of a life-altering hip fracture.

Osteoporosis means "porous bone" — the skeleton loses density and structure, making fractures likely from low-impact events like a stumble or a sudden bend. Studies from Indian centres including AIIMS Delhi, PGI Chandigarh, and CMC Vellore consistently find that bone loss and fragility fractures appear earlier in Indian women than in Western populations, sometimes by a decade.

Several factors stack up. Indian women tend to build less peak bone mass in their youth, partly due to lifelong low calcium intake — typical diets supply 400–500 mg a day against a need of around 1,000–1,200 mg. Vitamin D deficiency is near-universal because covered clothing, indoor lifestyles, and skin pigmentation all limit how much we make from sunlight; you can read more in our guide to vitamin D deficiency in women. South Asian women also tend to have smaller, lighter bones for their height, which Western risk calculators can underestimate.

The biggest accelerator is menopause. As oestrogen falls, bone loss speeds up to roughly 1–3% a year for the first five to seven years after the final period. Women who reach menopause early — naturally, after surgery to remove the ovaries, or through primary ovarian insufficiency — lose this protection sooner and are at higher risk. Smoking, heavy alcohol use, certain long-term medicines (especially steroids), an overactive thyroid, and conditions like coeliac, chronic kidney disease, or an underactive thyroid add further to the risk.

The stakes are high. A hip fracture in an older woman often means months of immobility, loss of independence, and a real risk to life in the year that follows. But none of this is inevitable — finding low bone density early and acting on it changes the trajectory.

Screening means checking bone density before a fracture happens. Indian Society for Bone and Mineral Research (ISBMR) guidance, adapted for our earlier risk profile, broadly recommends the following.

Everyone at 65. All women should have a baseline DEXA scan at age 65, regardless of how healthy they feel, and repeat it every couple of years depending on the result.

Earlier (from age 50) if you have risk factors. Talk to your doctor about screening sooner if any of these apply to you:

Some signs suggest a fracture or bone disease may already be present. See a doctor promptly — and ask about a DEXA scan and a fuller workup — if you have any of the following:

A DEXA (dual-energy X-ray absorptiometry) scan is the gold-standard test for bone density. It is quick, painless, and uses a very low dose of radiation — less than a chest X-ray. We cover the procedure in depth in our dedicated guide to the DEXA bone density scan in India; here is the short version.

There is no special preparation — you don't need to fast. You lie flat on a padded table in loose clothing without metal zips or buttons (or change into a gown), and a scanner arm passes over your hip and lower spine. The whole thing takes 10–30 minutes, and you walk out immediately. The scan measures the lumbar spine and hip because these sites best predict fracture risk.

Cost in India. A private DEXA scan typically costs around ₹1,500–4,500 depending on the city and centre. Government tertiary hospitals — AIIMS, PGI Chandigarh, JIPMER, CMC Vellore, KEM Mumbai, and most state medical colleges — offer it free or for a nominal ₹100–500, though waiting times are longer. Most health insurance plans cover DEXA when your doctor prescribes it for a clear medical reason, and Ayushman Bharat (PMJAY) covers it for eligible families.

DEXA is excellent but not perfect: severe spinal arthritis, a hip replacement, or a very large body frame can affect the reading, which is why your doctor interprets the number alongside your clinical risk factors.

Your DEXA report can look intimidating, but the key number for most women after menopause is the T-score.

T-score compares your bone density to that of a healthy young adult at peak bone mass:

When osteoporosis is diagnosed — and especially in younger women or anyone with a low Z-score — your doctor will look for treatable causes that may be driving the bone loss. Roughly one in four to five postmenopausal women with osteoporosis has a secondary cause, and treating it often improves bone density on its own.

A standard blood workup usually includes calcium, phosphate, kidney and liver function, vitamin D (25-OH-D), parathyroid hormone, and thyroid function (TSH). Together these cost around ₹3,000–6,500 privately and screen for the common culprits.

Depending on your history, your doctor may add tests for coeliac disease (which is under-diagnosed in India and a classic cause of unexplained bone loss), multiple myeloma in older women with spine fractures, or Cushing's syndrome. Conditions worth ruling out include an over-treated thyroid, chronic kidney disease, inflammatory bowel disease, and — in younger women — disordered eating or the low-energy patterns of the female athlete triad. Vitamin D deficiency is so common here that it should always be checked and corrected.

Whether you are preventing osteoporosis or being treated for it, the same foundations apply — and no medication works well without them.

Calcium. Postmenopausal women need about 1,200 mg a day from food and, if needed, supplements. Dairy is the easiest source (a glass of milk gives roughly 300 mg), but ragi, sesame (til), drumstick and amaranth leaves, tofu, and soya are excellent for vegetarians — see our list of calcium-rich Indian foods. If your diet falls short, a calcium supplement taken in divided doses with meals helps.

Vitamin D. Because deficiency is near-universal, most women need correction and ongoing maintenance. Sensible sun exposure helps — our guide on sunlight and vitamin D for Indian women explains how to do this safely. Your doctor may add a high-dose weekly sachet to correct a deficiency, then a daily or monthly maintenance dose.

Protein. Bone is a protein scaffold, not just minerals. Aim for adequate dal, paneer, eggs, soya, and curd — a particular gap for many vegetarians, covered in our guide to protein needs for Indian vegetarian women.

Exercise. Two types matter. Weight-bearing activity (brisk walking, stair-climbing, dancing) loads the skeleton, and resistance or strength training two to three times a week builds the muscle that protects bone and prevents falls. Swimming and cycling are great for the heart but don't load bone. Gentle, supported yoga for menopause and balance work add fall protection.

Cut the risks. Stopping smoking and limiting alcohol both slow bone loss directly.

Prevent falls. Most fractures need both fragile bone and a fall. Get your vision checked, review any medicines that cause drowsiness, improve lighting, remove loose rugs, and fit grab bars and a non-slip mat in the bathroom.

When your T-score is -2.5 or below, or you've had a fragility fracture, or your FRAX risk is high in the osteopenia range, medication is recommended alongside calcium, vitamin D, and exercise. Several effective options are available in India, and the choice depends on severity, your kidneys, your ability to take tablets, and cost.

Bisphosphonates (first-line). These slow the cells that break down bone. They cut spine fractures substantially and hip fractures by around 40–50% over three to five years. Oral options include weekly alendronate (₹200–500 a month) and risedronate (₹300–600 a month). They must be taken correctly — first thing in the morning with a full glass of plain water, staying upright and avoiding food, calcium, or other tablets for at least 30 minutes — to protect the food pipe. For women who can't manage the oral routine, annual intravenous zoledronic acid (₹8,000–15,000 per infusion) is a convenient alternative; a flu-like reaction for a day or two after the first dose is common and settles.

Side effects are usually mild. The much-feared problems — jaw osteonecrosis and atypical thigh fractures — are rare at osteoporosis doses, and the fracture-prevention benefit far outweighs them. After three to five years, your doctor reviews whether to continue or take a "drug holiday."

Other options for selected women:

Hormone replacement therapy (HRT) is genuinely effective for bones — oestrogen slows the bone loss that menopause triggers, reducing fractures by roughly 30–40%. It is most appropriate within the "window of opportunity": within 10 years of menopause and under age 60, where the benefit-to-risk balance is most favourable.

HRT shines when a woman has bothersome menopause symptoms as well, because she gets relief from hot flushes, night sweats, and vaginal dryness alongside the bone benefit. It can also suit women who can't tolerate bisphosphonates. It is generally avoided after a history of breast cancer, a recent clot, active liver disease, or unexplained vaginal bleeding, and is less favourable when started well after age 60.

For most women, HRT is continued for five to ten years and then reassessed; if osteoporosis risk remains high after stopping, a bisphosphonate can take over. The right choice is individual, so discuss it with a gynaecologist. Our guide on HRT cost and options in India goes deeper into brands, regimens, and how to weigh the decision.

Some women need a tailored approach.

Early or surgical menopause. Women who lose ovarian function young face faster bone loss and usually need oestrogen until the natural age of menopause, both for bones and overall health — see our guide on oophorectomy decisions.

Breast cancer survivors on aromatase inhibitors. These drugs accelerate bone loss, so baseline and yearly DEXA, mandatory calcium and vitamin D, and often a bisphosphonate are part of standard care.

Long-term steroid users. Steroids harm bone quickly, so screening should happen before or at the start of long-term treatment, with a lower threshold to begin a bone-protecting medicine.

Younger women with low bone density. Here a secondary cause is likely and should be found and treated first; standard osteoporosis drugs are used cautiously in this age group.

Older and frailer women. Treatment is worthwhile even in the 80s and beyond — it is never "too late." Preserving muscle matters too, because age-related muscle loss (sarcopenia) raises the risk of the falls that cause fractures.

• Indian Society for Bone and Mineral Research (ISBMR) — guidelines and resources
• ICMR-NIN Recommended Dietary Allowances and Estimated Average Requirements for Indians (2020)
• WHO — Assessment of fracture risk and its application to screening for postmenopausal osteoporosis
• FRAX Fracture Risk Assessment Tool
• NHS — Osteoporosis: overview, diagnosis and treatment
• Indian Menopause Society