One in three Indian women aged 50 and above is at risk of osteoporosis — a condition where bones lose density and become brittle — while around 1.4 million osteoporosis-related fractures occur among Indian women every year, according to figures cited by the International Osteoporosis Foundation (IOF) from 2021.Osteoporosis is often described as a silent condition because it can weaken bones without causing obvious symptoms until a fracture occurs. The risk increases with age, particularly among postmenopausal women, as declining oestrogen levels accelerate bone loss. Fractures can compromise mobility and independence, while hip fractures can have particularly serious consequences for older adults.According to the Osteoporosis Society of India (OSI), osteoporosis affects an estimated 22.9% of Indian adults, equivalent to around 33 crore people. Osteoporotic fractures also impose an estimated annual economic burden of ₹14,000–20,000 crore in India. The figures underscore the challenge of identifying people at risk before a fracture occurs.Against this backdrop, the OSI, in association with Sun Pharma, has launched a Bone Health Score Card as part of its year-long Why Wait? Till It Breaks initiative. The tool is designed to help healthcare professionals assess osteoporosis risk and identify people who may need further investigation.Dr Sushrut Babhulkar, president of OSI, said the need for a screening tool arose partly because doctors across specialties—including orthopaedics, gynaecology, endocrinology, rheumatology and nephrology—may follow different guidelines when managing osteoporosis. This can result in inconsistencies in how patients are assessed, he said. The concern, Dr Babhulkar explained, extends beyond osteoporosis alone. “Osteomalacia, a condition involving defective bone mineralisation that is often associated with calcium or vitamin D deficiency, and sarcopenia, which involves the loss of muscle mass and strength, can coexist with osteoporosis. The combination can complicate treatment and recovery following a fracture,” he said.He cited a World Health Organization (WHO) figure suggesting that 25–30% of patients who sustain an osteoporosis-related hip fracture die within a year, despite receiving treatment. The figure highlights the potentially serious consequences of such fractures, particularly among vulnerable older adults.How does the Bone Health Score Card work?The Bone Health Scorecard is a rotating cardboard wheel that assesses osteoporosis risk using eight parameters. According to Dr Babhulkar, these include age, body mass index (BMI), family history, co-existing medical conditions, smoking, systemic steroid use and certain cancer treatments, including therapies used for breast cancer. For each parameter, the user selects the applicable response and rotates the corresponding ring to align it with a red marker. The marker indicates the score for that factor. The scores across all eight parameters are then added to calculate the total.Story continues below this ad“For instance, a smoker receives two points for the smoking parameter, while a non-smoker receives zero. The final score is used to place the person in a risk category. A total score of zero to three indicates lower risk, while a score above 12 indicates very high risk,” Dr Babhulkar explained.A history of a fragility fracture after the age of 40 automatically places a person in the very-high-risk category, irrespective of the total score. A fragility fracture is one that occurs after a fall or impact that would not ordinarily fracture a healthy bone. The score card is intended for initial screening, not diagnosis.People identified as being at high or very high risk may require further evaluation, depending on a doctor’s assessment. This could include a dual-energy X-ray absorptiometry (DXA or DEXA) scan or quantitative computed tomography (QCT), both of which can be used to assess bone density. Blood tests to measure calcium, vitamin D and parathyroid hormone levels may also be considered when clinically indicated.Dr Babhulkar said these investigations can be expensive and may be difficult to access, particularly in rural areas. The score card is intended to help identify people who may benefit from further testing, rather than requiring everyone to undergo scans.Story continues below this adHow will the tool reach doctors and the public?The rollout is planned in phases, beginning with efforts to familiarise doctors—including general practitioners and private practitioners—with the tool. Subsequent stages are expected to focus on making it available to the public and providing an online or downloadable version.Dr Babhulkar said the initial target was to reach doctors across 800 districts. Joseph Gerald, CEO, Super Cluster-II, India Business, Sun Pharma, said the score card would also be made available digitally and free of cost to healthcare professionals and the public by the first week of December 2026. The digital version was not yet available at the time of the statement.The physical version is designed as a cardboard wheel, with a minimum size of A4 to ensure that the information remains readable.What should patients know about the score?According to the doctors, the screening tool has sensitivity and specificity of more than 95%. Sensitivity refers to a test’s ability to correctly identify people who have the condition being assessed, while specificity refers to its ability to correctly identify those who do not.Story continues below this adThe material accompanying the wheel cites references including the US Preventive Services Task Force’s 2025 osteoporosis screening recommendation, a 2021 review of osteoporosis screening tools in India by Paul TV and colleagues, and the FRAX fracture-risk assessment resource.The scorecard aims to make risk assessment more accessible and encourage people to seek timely medical advice. However, a low score does not rule out osteoporosis, and a high score does not confirm the condition. A clinical assessment and, where appropriate, further investigations remain necessary to establish the diagnosis and guide treatment.