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Addressing the growing fracture burden
This article is authored by Dr Ankit Rai, associate director, medical affairs, Abbott India.
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A significant demographic shift is underway. By 2050, the world’s population of people aged 60 years and older will double to 2.1 billion; 80% of the world's older population will reside in emerging countries, bringing a greater prevalence of age-related health conditions.
Among the most impactful is osteoporosis, a condition that silently weakens bones over time, making them more fragile and prone to breaking. It is often called a “silent disease” because it can weaken bones for years without any noticeable symptoms. Many people only realise they have the condition after experiencing a fracture. These fractures can have a significant impact on mobility, independence, and quality of life. In fact, only about one in three people who suffer a hip fracture regain their previous level of function, making early diagnosis and fracture prevention critical.
As people live longer, there is a growing need to focus on protecting bone health before fractures occur. This means recognising risks early, promoting awareness, and ensuring timely access to appropriate care that can help people stay active, independent, and health.
Protecting bone health begins well before osteoporosis treatment is needed. Adequate nutrition, including calcium and vitamin D, regular physical activity and attention to modifiable risk factors are important foundations. Where dietary intake is insufficient, supplementation may also have a role based on individual needs and appropriate medical guidance.
Effective bone health management also requires timely diagnosis and appropriate medical treatment. The greater challenge is shifting from reacting to fractures after they occur to proactively identifying risk early and ensuring access to therapies that can help prevent them.
The scale of the bone health challenge in India is substantial. According to the Osteoporosis Society of India (OSI), India has one of the highest prevalences of osteopenia globally, with approximately 230 million people aged 50 years and above. Studies cited by OSI suggest that osteoporosis affects between 8.5% and 24.6% of Indian men over 50, and 8% to 62% of women across different age groups. An estimated 61 million Indians are living with osteoporosis, with women accounting for nearly 80% of cases. Compounding the challenge, osteoporosis is believed to develop 10 to 20 years earlier in Indians than in western populations. The impact is reflected in the country's fracture burden, with more than 250,000 hip fractures occurring each year and over 4.5 million women above the age of 60 affected by vertebral (spinal) fractures.
A key reason osteoporosis remains undertreated is the challenge involving both established and innovative therapies. On one hand, older treatments often come with strict dosing requirements and potential side effects. This can make them difficult for patients to stick with, leading to high discontinuation rates – with some studies reporting discontinuation rates of up to 50–70% within the first year. This can potentially compromise treatment continuity, increasing the risk of future fractures.
On the other hand, biologic therapies have expanded treatment options for people living with osteoporosis, with some treatments offering the convenience of less frequent dosing. However, the availability of effective therapies does not always translate into access for everyone who may benefit. This is where biosimilars can play an important role.
Biosimilars are medicines that are highly similar to already approved biologic therapies, with no clinically meaningful differences in safety, effectiveness, or quality. By offering more affordable treatment options, biosimilars have the potential to improve access to osteoporosis care and help more people receive the therapies they need to protect their bone health and reduce fracture risk.
By improving affordability and expanding access, they have the potential to help health care systems provide appropriate treatment to more eligible patients while making more efficient use of health care resources.
Equally important is building confidence in their use. Ongoing scientific exchange and health care professional education can support informed treatment decisions and greater understanding of the role biosimilars can play in osteoporosis care. At the same time, biosimilars should be viewed as one component of a comprehensive approach to bone health that includes good nutrition, regular physical activity, early risk assessment, timely diagnosis, and individualised treatment plans.
Ultimately, improving osteoporosis care is about preventing the life-changing consequences of fractures. Greater awareness can help people recognise their risk earlier, timely diagnosis can identify those who may benefit from intervention, and access to appropriate treatment can help reduce fracture risk. As the burden of osteoporosis continues to grow, strengthening every step of the care pathway will be essential to helping more people maintain mobility, independence, and quality of life.
Bone health should not begin with a fracture. As the burden of osteoporosis continues to grow, the opportunity lies in identifying risk earlier, intervening sooner, and ensuring that people can access the care they need. By combining greater awareness, timely diagnosis, and access to effective treatments, we can help more people stay active, independent, and resilient throughout their later years.
(The views expressed are personal)
This article is authored by Dr Ankit Rai, associate director, medical affairs, Abbott India.
