Older Indians may have undiagnosed spinal fractures, neurosurgeon warns

On World Osteoporosis Day, Guntur neurosurgeon Dr. Mohana Rao Patibandla warned that osteoporosis often shows up first in the spine and is frequently missed. He pointed to Indian study data suggesting many older adults may already have vertebral fractures without knowing it, with implications for screening, diagnosis and treatment.

Why it matters: - Vertebral fractures can be the first sign of osteoporosis, but they are often overlooked until pain, height loss or a more serious break appears. - Missed spinal fractures can delay treatment and raise the risk of another fracture. - The warning is especially relevant in India, where low bone density and vitamin D deficiency add to the burden.

What happened: - On World Osteoporosis Day, Guntur neurosurgeon Dr. Mohana Rao Patibandla called for spinal health to become a central part of India’s bone-health conversation. - Dr. Rao is Chief Neurosurgeon at Dr. Rao’s Hospital – International Institute of Neurosciences (IIN), Guntur. - The message focused on older Indians who may be living with undiagnosed spinal fractures.

The details: - The Delhi Vertebral Osteoporosis Study found vertebral fractures in 17.9% of 808 residents older than 50. - That equals about 1 in 6 older adults in the study. - Roughly two-thirds of spinal fractures worldwide are estimated to go undiagnosed. - Applied to the Delhi result, that suggests about 1 in 8 older adults could be living with a spinal fracture that has not been identified. This is an illustrative extrapolation, not a measured Indian figure. - In a rural study of postmenopausal women from Tirupattur in southern India, osteoporosis at the spine was found in 45%, compared with 32.6% at the femoral neck. - In Delhi women older than 50, 35.7% met the definition for osteoporosis by bone density alone. - When spinal fractures were included, the share needing treatment rose to 46.5%. - Bone density was not lower in women with fractures than in those without, showing that a “borderline” scan can miss a collapsed vertebra. - The Delhi study found fracture prevalence of 18.8% in men and 17.1% in women. - In women, fracture prevalence rose with age, from 14.7% at ages 50-59 to 22.4% at age 70 and older. - A vertebral fracture is linked to a fivefold higher risk of another fracture. - In one study of patients admitted with a recent non-spine fracture, 51% had a previously undiagnosed vertebral fracture, even when bone density was normal. - An estimated 50 million people in India had low bone density by 2013. - Widespread vitamin D deficiency across age groups adds to fracture risk.

Between the lines: - The core message is that osteoporosis is not just a hip-fracture problem. - Spine fractures can happen during ordinary activities, including coughing or stepping out of a bathtub in advanced osteoporosis. - Back pain and height loss in older adults are often dismissed as aging or arthritis, which can delay diagnosis. - The data suggest that looking only at bone density numbers can understate fracture risk.

What's next: - Dr. Rao advised anyone over 50 with warning signs, or younger people with risk factors, to ask for a DEXA scan and imaging of the spine. - Vertebral fracture assessment, X-ray or MRI can detect collapsed vertebrae that a density scan may miss. - Risk factors listed in the release include early menopause, long-term steroid use, diabetes, thyroid disorders, smoking, alcohol, low body weight, family history and vitamin D deficiency. - Prevention steps include calcium, protein and vitamin D, weight-bearing exercise, less smoking and alcohol, home fall-proofing, and screening after menopause or after age 50 in men with risk factors. - Dr. Rao said osteoporosis is treatable and that a fracture is the strongest reason to start treatment. - He said most spinal fractures heal with pain control, bracing and rehabilitation, while minimally invasive surgery may be considered for deformity, severe pain or pressure on nerves or the spinal cord. - Dr. Rao urged families and doctors to treat persistent back pain in older people as a signal that needs evaluation, not as a nuisance.

The bottom line: - The release argues that India is missing too many spinal fractures and should look at the spine earlier, not after a hip fracture or major collapse forces the issue.