Life style

The silent killer: why we ignore Osteoporosis

Published

3 months ago

2026/01/25

Dr Aruna Caldera , Consultant Rheumatologist

Silent yet destructive, Osteoporosis often advances without warning until a simple fall results in a life altering fracture. In this interview Dr. Anura Caldera, Consultant Rheumatologist sheds light on a condition long misunderstood as an inevitable part of ageing. He explains why Osteoporosis is preventable, detectable, and treatable when addressed early and awareness especially among women and the elderly can mean the difference between independence and disability. Drawing from years of frontline experience, Dr. Caldera unpacks the myths, risks and lifesaving interventions surrounding one of the world’s most under diagnosed bone diseases.

Dr. Caldera is a product of Royal College with advanced foreign training that has shaped his professional expertise. This blend of strong local education and global training has been central to the perspective and standards he brings to his work today.

All of us may have seen the elderly woman in the neighbourhood who broke her hip, disappeared from the community, and passed away a few months later. We may also have seen another woman who gradually stoops forward and ends up needing a walking stick in no time. But many of us may never have realized that these are complications of a disease that could have been prevented.

What is Osteoporosis?

Osteoporosis is a systemic bone disease that reduces bone mineral density, making bones extremely weak and fragile. This reduction in bone density makes bones highly prone to fractures, often involving the hip, spine, forearm just above the wrist and upper arm, even following minor falls.

What happens in Osteoporosis?

Bones are dynamic structures, meaning they are constantly being built up and broken down within the body. Two main cell types are responsible for this process: osteoblasts, which form bone, and osteoclasts, which break down bone.

When we are young and healthy, these cells work in perfect harmony, maintaining strong and healthy bones. Ideally, we should not fracture a bone even if we fall from our own height.

In Osteoporosis, this balance is tipped towards bone breakdown. Over time, bone mineral density gradually decreases to dangerous levels. At this stage, even minor trauma—such as slipping while trying to sit on a chair and falling to the ground—can result in a fracture, particularly of the hip.

Why aren’t patients aware of it?

The major problem with Osteoporosis is that it has no symptoms until it causes a fracture. When you have diabetes, you may urinate frequently, feel excessive thirst, and lose weight. When your heart arteries are blocked, you may feel breathless climbing a few stairs. When your kidneys are failing, your feet may swell. But with Osteoporosis, you feel nothing.

By the time symptoms appear, the disease has already manifested its complications—fractures. Most patients in Sri Lanka discover they have Osteoporosis only after breaking a bone.

Some patients gradually lose height over time due to silent fractures of the spine, known as vertebral wedge fractures. Sometimes the pain is so minimal that the patient is unaware a fracture has occurred. Degeneration of spinal discs can also contribute to height loss. A stooped posture may develop for the same reasons. Lower back pain usually appears only once fractures have occurred.

What treatment options are available?

The mainstay of treatment is anti-resorptive therapy, which is available in tablet, injection, and infusion forms. The most commonly used medication is alendronate 70 mg, taken once weekly on an empty stomach with 200 ml of water. Patients must remain upright and avoid eating for at least 30 minutes after taking the tablet.

There are also monthly tablet formulations. If oral medications are poorly tolerated, treatment can be switched to an annual infusion such as zoledronic acid or six-monthly denosumab subcutaneous injections. Other treatment options are also available.

In addition, patients require calcium and vitamin D supplementation. The minimum recommended intake is 700 mg of calcium and 800 IU of vitamin D, obtained through a combination of diet and supplements. Combination tablets containing calcium and vitamin D in these ranges are generally safe.

How long should patients be treated?

The duration of treatment depends on the individual patient. A common misconception is that five years of treatment is sufficient for everyone. This is incorrect.

Decisions regarding treatment duration and drug holidays must be made carefully, based on multiple factors. Patients require regular DXA and FRAX assessments to monitor treatment response and identify new risk factors. If the response is inadequate, the physician may need to change the antiresorptive medication—for example, from oral therapy to infusion. Osteoporosis cannot be effectively managed by prescribing a single medication and assuming five years of treatment will resolve the condition.

Why is Osteoporosis called a “silent killer”?

Osteoporosis-related hip fractures significantly increase the risk of death within the following year, with up to 30% of patients dying within 12 months of a hip fracture. Death often results from complications such as pneumonia or blood clots due to prolonged immobility.

A significant number of survivors also lose their independent mobility after a hip fracture. Therefore, it is far better to be safe than sorry—get tested and treated when necessary. One of the greatest assets in old age is independent mobility, which allows a person to remain self-sufficient and maintain quality of life.

As a result, patients tend to attribute their pain to this condition. However, the real cause may be that one of the weakened vertebrae has already fractured and collapsed, and the next bone at risk of fracture could be the hip.

Which patients are most affected?

Peak bone mass is achieved in the early 30s, after which bone mineral density gradually declines. This loss is usually minimal and does not significantly increase fracture risk.

However, once women reach menopause, the lack of estrogen accelerates bone loss to a level where bone mineral density may reach Osteoporotic levels.

A study conducted in Sri Lanka in 2004 by Prof. Sisira Siribaddana and Prof. Sarath Lekamwasam revealed that 42.3% of women aged 50-59, 67.5% of women aged 6069, and 81.6% of women over 70 had Osteoporosis. According to similar studies, 94% of Sri Lankan patients with Osteoporosis are female. These figures are notably higher than those seen in many developed countries, where the prevalence is lower.

How can we diagnose this condition?

Any woman over the age of 50 should undergo a “fracture risk assessment”. Those with an intermediate or higher risk should then have a bone mineral density assessment using a DXA scan. This scan measures bone density in the spine, hip, and, in selected cases, the wrist.

The T-score is used to guide treatment decisions in most patients. However, a FRAX score—calculated using an online tool—is particularly useful for patients with borderline bone density (Osteopenia), as the DXA scan alone cannot reliably predict hip or major Osteoporotic fracture risk in all individuals.

There is one situation where treatment is initiated even without a DXA scan: when a patient has already suffered a fracture believed to be due to Osteoporosis. In such cases, treatment is started even if the DXA scan (Dual Energy Xray Absorptiometry scan) does not show established Osteoporosis.

Additional blood tests may be required, though not all are necessary for every patient. These commonly include serum calcium, vitamin D levels, parathyroid hormone levels (in selected patients), and routine kidney and liver function tests. Further investigations may be arranged on a patient-by-patient basis.

Are there other high-risk groups apart from post-menopausal women?

Yes. Other risk factors include advancing age, low Body Mass Index (BMI), previous fragility fractures, a parental history of hip fractures, long-term steroid therapy (more than three months), smoking, alcohol consumption exceeding three units per day, rheumatoid arthritis, type 1 diabetes, chronic liver disease, chronic kidney disease, sex hormone deficiency, and concurrent malignancy.

FRAX score is a fracture risk assessment tool that is particularly valuable for patients who do not meet treatment thresholds based on DXA results alone.

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Life style

Beauty of Sri Lanka in focus: Global showcase blends art, diplomacy and conservation

Published

3 days ago

2026/04/12

Thilina Walpola

Ambassador Jovita Neliupsiene, Head of the EU Delegation to the US, and Mahinda Samarasinghe, Ambassador of Sri Lanka to the US, joined a special viewing of the exhibition

By Ifham Nizam

The sixth edition of the “Beauty of Sri Lanka” Photography Exhibition is set to unfold across North America this April, transforming the power of visual storytelling into a compelling platform for cultural diplomacy, environmental advocacy and nation branding.

Organised by the America Sri Lanka Photographic Art Society in collaboration with key diplomatic and institutional partners, including the Embassy of Sri Lanka in Washington, D.C., the Permanent Mission of Sri Lanka to the United Nations, the Consulate General of Sri Lanka in Los Angeles and Toronto, and the Sri Lanka Tourism Promotion Bureau, the exhibition will run from April 22 to May 4 across Los Angeles, Toronto, New York and Washington, D.C.

Held in conjunction with Earth Day, the exhibition continues to evolve as a globally recognised initiative that brings together art, conservation and international engagement. What began as a photography showcase has now matured into a dynamic soft-power platform that tells Sri Lanka’s story to the world—through its landscapes, biodiversity, and deeply rooted cultural heritage.

Photographers from Sri Lanka at Nigara State Park

The 2026 tour will feature prestigious venues that reflect its growing international stature. These include the iconic Church of Scientology Celebrity Centre International, Metro Hall in Toronto—marking the exhibition’s debut in Canada—the Permanent Mission in New York, and the Sri Lankan Embassy in Washington, D.C., as part of the widely celebrated Passport D.C. event. Each venue represents not only a geographic expansion but also a widening of the exhibition’s global audience and influence.

Exhibition

At its heart, “Beauty of Sri Lanka” is a vivid narrative of a nation’s natural and cultural wealth. From the mist-covered central highlands and pristine coastal belts to dense rainforests teeming with endemic wildlife, the exhibition captures Sri Lanka’s ecological richness through the lenses of talented photographers. These images serve as both an invitation to explore and a reminder of the urgent need to protect fragile ecosystems.

This year’s programme takes a significant step further by integrating real-world environmental action. The “ReTree Los Angeles” initiative, launched in line with Earth Day, focuses on tree planting, urban restoration and community engagement. It also includes a children’s painting competition aimed at fostering environmental awareness among the younger generation. Organisers believe that nurturing creativity at an early age can instil a lifelong commitment to conservation.

Adding a scientific dimension to the event, Dr. Sarath Gunapala will deliver the keynote address on “The Journey of Infrared Photography,” exploring how advanced imaging techniques can reveal unseen dimensions of the natural world. His participation highlights the exhibition’s interdisciplinary approach, where art meets science to deepen understanding and appreciation.

The exhibition will also feature a vibrant cultural segment designed to immerse international audiences in Sri Lanka’s living traditions. A carefully curated lineup of performances—including the sacred Wes Pooja, the dramatic Naga Raksha mask dance, the rhythmic Thelme ritual dance and the light-hearted Salu Paliya—will bring to life the island’s folklore, rituals and performing arts heritage. These performances are expected to add colour, rhythm and emotional depth to the visual experience offered by the photographic displays.

ASPAS President Suria Perera emphasised that the exhibition is more than a display of images. “It is a celebration of Sri Lanka’s identity—its natural beauty, its cultural vibrancy, and its responsibility to future generations,” she said. “Through photography and community engagement, we aim to inspire a deeper connection between people and the environment.”

Over the years, the exhibition has drawn a diverse audience, including diplomats, policymakers, conservationists, art collectors and members of the Sri Lankan diaspora. Its ability to connect these varied groups underscores its role as a bridge between cultures, fostering dialogue and mutual understanding while strengthening Sri Lanka’s global presence.

The continued support of diplomatic missions, cultural institutions and tourism authorities has been instrumental in elevating the exhibition’s profile. Their collaboration reinforces the role of art as a powerful tool in shaping perceptions, building partnerships and promoting sustainable tourism.

As the 2026 edition prepares to open its doors, “Beauty of Sri Lanka” stands as a testament to the island nation’s enduring appeal and its commitment to conservation. It is not merely an exhibition, but a movement—one that celebrates beauty, inspires responsibility and connects Sri Lanka to the world through the universal language of art.

Life style

Vibrant celebration of tradition and togetherness

Published

3 days ago

2026/04/12

Thilina Walpola

This holiday season, City of Dreams Sri Lanka invites guests to step into the heart of a truly Sri Lankan celebration with Signature Avurudu—a four-day cultural experience taking place.

Blending time-honoured traditions with contemporary flair, the festivities promise to capture the spirit of the Aluth Avurudda (Sinhala and Tamil New Year) in all its colour, rhythm, and warmth. From the moment guests arrive, they will be welcomed into a space transformed with festive décor, echoing the charm of a village celebrations brought to life in the city.

At the centre of the celebration is the Pahan Pujava, a symbolic lamp lighting ceremony led by the management, setting a tone of unity, prosperity, and new beginnings. This meaningful ritual reflects the essence of the New Year—a time to pause, reflect, and step into the new year with hope and positivity.

Throughout the four days, guests can experience the rich cultural heritage of Sri Lanka through a series of traditional performances. The rhythmic beats of raban and drums, alongside vibrant dance acts, will fill the air, creating an atmosphere that is both nostalgic and celebratory. Adding to the experience are elegantly dressed Sri Lankan hostesses, offering a warm, authentic welcome that embodies the island’s renowned hospitality.

No Avurudu celebration is complete without its flavours, and City of Dreams Sri Lanka delivers a feast to remember. Guests can indulge in an array of traditional sweets and savouries, alongside curated Avurudu-themed buffets and creative beverages inspired by local ingredients. Passing canapés and festive treats ensure there is something to enjoy at every turn—whether you’re reminiscing over childhood favourites or discovering new twists on beloved classics.

Designed as a celebration for all, Signature Avurudu brings together families, friends, and visitors from around the world to share in the joy of the season. It is a reminder that Avurudu is more than a festival—it is a feeling of togetherness, renewal, and shared happiness.

This April, celebrate the sights, sounds, and tastes of Avurudu at City of Dreams Sri Lanka—where tradition meets modern celebration, and every moment feels like home.

Life style

Thomian sailors secure many medals in India

Published

3 days ago

2026/04/12

Thilina Walpola

Thomian sailors witj official

Students of S. Thomas’ College recently demonstrated commendable performance at two international sailing events held in India: the inaugural Indian Sailing Regatta and the 4th North-East Regatta. Both events featured participation from foreign teams, including Sri Lanka, Taiwan, Malaysia, Russia, Great Britain, South Korea, Singapore, and India.

The inaugural Indian Sailing League (ISL), held at Umiam Lake, Shillong, India, marked a significant milestone in the sport and was prominently featured in The Times of India. The ISL is a first-of-its-kind franchise-based sailing league, bringing together 14 teams, 182 sailors, and 58 international participants from eight countries.

The ISL follows a concept similar to the Cricket Indian Premier League, where top sailors are “bid” and selected into franchise teams representing different regions. The competition introduced an innovative team-based format in which the best sailor from each team in each category competed, combining multiple race formats such as fleet racing, team racing, marathon races, and rig-and-race challenges. This pioneering structure, widely regarded as a first in global sailing history, has significantly enhanced the spectator appeal and competitive depth of the sport, while promoting youth, women, and high-performance sailing on a single platform.

At the first Indian Sailing Regatta, in the Boys’ Optimist category, Haren Wickramatillake secured 3rd place and was also awarded a special medal for his courage during the rig and race event. Dhiren Perera achieved 3rd place in the rig and race event alongside his team member.

At the 4th North-East Regatta, performances continued to be noteworthy. In the Main Optimist Boys category, Haren Wickramatillake was placed 6th, while Shem Fernando secured 19th place out of 32 participants. In the Junior Green Fleet Optimist Boys category, Anuruth Tennakoon achieved 2nd place and Dhiren Perera was placed 4th out of 10 participants. In the ILCA 4 Boys category, Akaine Ubayasiri was placed 11th out of 22 participants.

These achievements highlight the high level of skill, determination, and sportsmanship demonstrated by the young sailors, while also reflecting Sri Lanka’s strong presence in an emerging and globally significant sailing platform.

Upcoming international sailing events, featuring students of S. Thomas’ College, include the Asian Beach Games 2026, to be held in China ,in April 2026, and the International Optimist Dinghy Association (IODA) competition, scheduled to take place at Port City, in Sri Lanka, in December 2026. These events will provide valuable international exposure and further opportunities for the young college sailors to compete at a high level.