A Multidisciplinary Approach to Addressing Barriers in Osteoporosis Screening, Diagnosis, Therapy Sequencing, and Adherence in India.

Osteoporosis is a significant public health problem in India. In India, osteoporosis has unique characteristics; an earlier onset of disease is seen because of the inherently low peak bone mass in Indian subjects compared with that in Western populations. This leads to a higher burden of osteoporotic fractures. At the same time, other contributing factors include genetic predisposition, poor calcium diets, limited sun exposure, and an overall higher prevalence of metabolic loading factors such as diabetes. Despite this, awareness and screening remain inadequate. Diagnosis is delayed because access to dual-energy X-ray absorptiometry is limited, and poor long-term adherence to treatment compounds the difficulties of primary and secondary prevention. Early screening using validated tools such as the Fracture Risk Assessment Tool, the Osteoporosis Self-Assessment Tool for Asians, or the Simple Calculated Osteoporosis Risk Estimation is essential, particularly in high-risk populations. Risk stratification and imaging are key to guiding individualized treatment with antiresorptive agents such as denosumab and/or anabolic agents like teriparatide. Real-world barriers, including financial constraints, lack of awareness, and the absence of coordinated care models such as fracture liaison services, further limit effective management. With this background of special circumstances in Indian settings, a three-level care model is proposed, featuring community-level screening by primary care teams, diagnosis and initial treatment by specialists, and complex-case management centers with integrated support from allied healthcare professionals and community health workers. Implementing this stratified, multidisciplinary protocol has the potential to bridge existing gaps in osteoporosis care.