Can a cardboard scorecard flag Indian women at fracture risk before it's too late?

A rotating cardboard wheel, at least A4 in size, is now being handed to Indian doctors as a way to decide who should get a bone scan and who probably doesn't need one yet. It is called the Bone Health Score Card. The OSI launched it with Sun Pharma as part of a year-long campaign titled Why Wait? Till It Breaks.

The numbers behind it are large. Osteoporosis is estimated to affect 22.9% of Indian adults, and the annual economic burden is put at ₹14,000 to ₹20,000 crore. Dr Sushrut Babhulkar, president of the OSI, also cited a World Health Organization figure: 25 to 30% of patients who suffer an osteoporosis-related hip fracture die within a year, even with treatment.

Babhulkar said part of the reason for the tool is that doctors in different specialties, including orthopaedics, gynaecology, endocrinology, rheumatology and nephrology, may follow different guidelines for osteoporosis, so patients can be assessed inconsistently. He also pointed to conditions that can sit alongside it. Osteomalacia is defective bone mineralisation, often linked to calcium or vitamin D deficiency. Sarcopenia is the loss of muscle mass and strength. Together with osteoporosis, he said, they can complicate treatment and recovery after a fracture.

The wheel scores eight parameters. According to Babhulkar, these include age, body mass index, family history, co-existing medical conditions, smoking, systemic steroid use and certain cancer treatments, including therapies for breast cancer. For each factor, the user picks the applicable answer and turns the matching ring until it lines up with a red marker, which shows that factor's score. The eight scores are added together. A smoker, for example, gets two points for smoking, a non-smoker none.

The total places a person in a risk band. A score of zero to three means lower risk; above 12 means very high risk. One rule overrides the arithmetic: anyone with a fragility fracture after age 40 goes straight into the very-high-risk category. A fragility fracture is one caused by a fall or impact that would not normally break a healthy bone.

The card is for initial screening, not diagnosis. People in the high or very-high bands may need further evaluation, depending on their doctor's judgment. That could mean a DXA scan or quantitative computed tomography to measure bone density, and possibly blood tests for calcium, vitamin D and parathyroid hormone. Babhulkar noted these investigations can be expensive and hard to reach, especially in rural areas. The aim is to point scans at those who may benefit rather than send everyone for one.

The rollout is phased. First comes familiarising doctors, including general and private practitioners, with the tool; Babhulkar said the initial target is doctors across 800 districts. Later stages are meant to put it in public hands. Joseph Gerald, CEO of Super Cluster-II, India Business, at Sun Pharma, said a digital version will be free to healthcare professionals and the public by the first week of December 2026. It was not yet available when the statement was made.

The doctors say the tool has sensitivity and specificity above 95%, meaning it is good at both catching people with the condition and clearing those without it. The accompanying material cites the US Preventive Services Task Force's 2025 osteoporosis screening recommendation, a 2021 review of screening tools in India by Paul TV and colleagues, and the FRAX fracture-risk resource.

The caveats are plain. A low score does not rule out osteoporosis, and a high score does not confirm it. Diagnosis and treatment still depend on clinical assessment and, where appropriate, further tests. The next markers to watch are the doctor outreach and whether the free digital version appears in December.