Key statistics for osteoporosis in Asia

ACCORDING to the International Osteoporosis Foundation, it it projected that more than about 50 per cent of all osteoporotic hip fractures will occur in Asia by the year 2050.

Osteoporosis is greatly underdiagnosed and undertreated in Asia, even in the most high risk patients who have already fractured.

The problem is particularly acute in rural areas.

In the most populous countries like China and India, the majority of the population lives in rural areas (60 per cent in China), where hip fractures are often treated conservatively at home instead of by surgical treatment in hospitals.

Dual Energy X-Ray Absorptiometry (DXA) technology is relatively expensive and is not widely available in most developing Asian countries, especially in rural areas.

For example, in 2008 Indonesia had a total of only 34 DXA machines, half of them in Jakarta, for a population of about 237 million (0.001 per 10,000 population).

Like in many Asian countries, this falls far below the recommended number for Europe, of 0.11 per 10,000.

Nearly all Asian countries fall far below the Food and Agricultural Orghanisation/World Health Organisation (FAO/WHO) recommendations for calcium intake of between 1,000 and 1,300 mg/day.

The median dietary calcium intake for the adult Asian population is approximately 450 mg/day, with a potential detrimental impact on bone health in the region.

Studies carried out across different countries in South and Southeast Asia showed, with few exceptions, widespread prevalence of vitaminosis D (vitamin D deficiency/insufficiency), in both sexes and all age groups of the population In China, osteoporosis affects almost 70 million Chinese over the age of 50 and causes some 687,000 hip fractures in China each year.

From 1988 to 1992, the incidence of hip fractures in Beijing increased by 34 per cent in women and 33 per cent in men.

There is also a higher incidence of hip fractures in men than women in China.

The average direct cost of a hip fracture in 2007 was US$3,603 and statistics from different cities indicate that the cost of hip fracture has been increasing at a rate of 6 per cent per year. In 2006 China spent around US$1.5 billion treating hip fracture.

It is estimated that this will rise to US$12.5 billion in 2020 and by 2050 to more than US$264.7 billion.

In China, osteoporosis prevention and awareness is largely restricted to urban areas of China and DXA machines are only available in the urban centers.

In 2008 there were only 450 DXA machines in China for a population of around 1.3 billion.

The average length of hospital stay (19 to 24 nights) for a hip fracture exceeds that for treating breast cancer, ovarian cancer, prostate cancer or heart disease.

In Hong Kong, China, epidemiological studies showed that hip fracture incidence had increased by 300 per cent from the 1960s to 1990s, and has stabilised from 2001 to 2006. The reasons are not clear, but may possibly be due to a number of factors including improved availability of medical intervention, increases in Body Mass Index (BMI), use of HRT, and improved falls prevention strategies.

Despite the stabilisation of hip fracture rates, fractures remain a major burden on health services and society.

The acute hospital care cost of hip fractures amounted to one per cent of the total annual hospital budget, or US$17 million for a population of six million.

The prevalence of vertebral fractures is estimated at 30 per cent in women and 17 per cent in men between the ages of 70 to 79 years of age.

These rates are comparable to those in American Caucasians.

In Taiwan, China, a study showed a high incidence rate of hip fractures, close to those of Western countries, and substantially higher than the rates in Beijing (three to five times) and Hong Kong (one to-two times), except after age 85.

In India, expert groups peg the number of osteoporosis patients at approximately 26 million (2003 figures) with the numbers projected to increase to 36 million by 2013.

In a study among Indian women aged between 30 and 60 years from low income groups, birth, marriage and death (BMD) at all the skeletal sites were much lower than values reported from developed countries, with a high prevalence of osteopenia (52 per cent) and osteoporosis (29 per cent) thought to be due to inadequate nutrition.

In Japan, the prevalence of osteporosis in the Japanese female population aged between 50 and 79 years has been estimated to be about 35 per cent at the spine and 9.5 per cent at the hip.

New hip fractures increased a dramatic 1.7-fold in the 10 years from 1987 to 1997.

The total number of hip fractures is forecast to be 153,000 per year in 2010 and 238,000 in 2030.

In Korea, the occurrence of hip fractures increased about 4-fold over 10 years (1991 to 2001).

The number of hip fractures after 75 years of age was 4.3 per 1,000 in women and 2.97 per thousand in men.

In Singapore, compared to the 1960's, hip fractures in women have gone up five times in women and 1.5 times in men.

IOF