Asia
Although projections indicate that more than 50% of all osteoporotic hip fractures in the year 2050 will occur in Asia, there are many serious health issues in this region which will compete with osteoporosis for scarce health resources. IOF works closely with its member societies in Asia in order to bring osteoporosis awareness to the fore. With some 28 national societies in 14 Asian countries/territories, IOF is working with its members to develop the IOF Asia Program - a program of work and activities across all the IOF program areas.
Regional meetings of the IOF member societies in Asia have allowed members of the IOF family in Asia to discuss and give input into the creation of the IOF Asia Regional Program.
In Asia, as in many other parts of the world, there is a lack of key data needed to convince policymakers that osteoporosis is a serious burden on the population and that it makes sense to invest in prevention measures.
Asian Audit: Epidemiology, costs and burden of osteoporosis in Asia 2009
This new landmark report was launched on September 22 in Beijing, China in conjunction with the IOF Worldwide Conference of Osteoporosis Patient Societies. It is authored by Ambrish Mithal (Lead Author), Vibha Dhingra, and Edith Lau, in cooperation with IOF member societies in 14 Asian countries, regions and territories. This is the first time that information on epidemiology, burden and costs in individual countries, as well as collectively across Asia, has been collected in one document. IOF urges its use as a tool to both generate media and to support the call for improved fracture prevention and management in Asia.
In addition, three of Asia's largest, most economically-active countries have received IOF support to promote changes in health care policy for the benefit of people with osteoporosis. The IOF Targeted Support Program is aimed at the development of three-year programs in India, Indonesia and Vietnam - Asian countries which are, respectively, the world's second, fourth and 14th most populous countries. Each of these countries is experiencing dramatic economic growth, and the expanding and ageing population is putting increased pressure on government health care systems.
Key facts and statistics for this region
- Osteoporosis affects an estimated 75 million people in Europe, USA and Japan (1).
- 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% in China), where hip fractures are often treated conservatively at home instead of by surgical treatment in hospitals (221).
- 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 ca. 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 (221).
- Nearly all Asian countries fall far below the FAO/WHO recommendations for calcium intake of between 1000 and 1300 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 (221).
- Studies carried out across different countries in South and South East Asia showed, with few exceptions, widespread prevalence of vitaminosis D (vitamin D deficiency/insufficiency), in both sexes and all age groups of the population (222).
- China: Osteoporosis affects almost 70 million Chinese over the age of 50 and causes some 687,000 hip fractures in China each year (223). From 1988 to 1992, the incidence of hip fractures in Beijing increased by 34% in women and 33% in men (151). There is a higher incidence of hip fractures in men than in women in China (151,152,153).
- China: The overall prevalence of osteoporosis in mainland China might be approximately 7% among adults, 10-20% in urban areas, 22.5% among men aged 50 years or more, and 50.1% among women aged 50 years or more (231).
- China: The average direct cost of a hip fracture in 2007 was 3603 USD and statistics from different cities indicate that the cost of hip fracture has been increasing at a rate of 6% per year. In 2006 China spent ca. 1.5 billion USD treating hip fracture. It is estimated that this will rise to 12.5 billion USD in 2020 and by 2050 to more than 264.7 billion USD (224,225,226,227,228,229).
- 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 ca. 1.3 billion (223).
- China: The average length of hospital stay (19-24 nights) for a hip fracture exceeds that for treating breast cancer, ovarian cancer, prostate cancer or heart disease (223).
- Hong Kong, China: Epidemiological studies showed that hip fracture incidence had increased by 300% from the 1960s to 1990s, and has stabilized from 2001-2006. The reasons are not clear, but may possibly be due to a number of factors including improved availability of medical intervention, increases in BMI, use of HRT, and improved falls prevention strategies (155,221).
- Hong Kong, China: Despite the stabilization of hip fracture rates, fractures remain a major burden on health services and society. The acute hospital care cost of hip fractures amounted to 1% of the total annual hospital budget, or 17 million USD for a population of 6 million (154).
- Taiwan, China: The prevalence of osteoporosis in 1996-2001 among those ages 50 years and older was 1.6% in men and 11.4% in women (232). A study showed a high incidence rate of hip fractures, close to those of Western countries, and substantially higher than the rates in Beijing (3-5 times) and Hong Kong (1-2 times), except after age 85 (230). During 1996-2002, the incidence of hip fractures in the 65 years and older population increased by 30%, with rates greater in males (36%) than females (22%) (233).
- 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 (157).
- India: In a study among Indian women aged 30-60 years from low income groups, BMD at all the skeletal sites were much lower than values reported from developed countries, with a high prevalence of osteopenia (52%) and osteoporosis (29%) thought to be due to inadequate nutrition (193).
- Japan: The prevalence of osteporosis in the Japanese female population aged 50-79 years has been estimated to be about 35% at the spine and 9.5% at the hip (150).
- Japan: New hip fractures increased 1.7-fold during 1987-1997 (158).
- Japan: The total number of hip fractures is forecast to be 153,000 per year in 2010 and 238,000 in 2030 (202).
- Korea: The occurrence of hip fractures increased about 4-fold over 10 years (1991-2001) (159).
- Korea: The number of hip fractures after 75 years of age was 4.3 per 1000 in women and 2.97 per thousand in men (160).
Guidelines
To see list of guidelines for Asia click here.
http://www.iofbonehealth.org/health-professionals/national-regional-guidelines.html#asia
If you are a national or medical society and your country or region has evidence-based guidelines that you would like to include on the IOF website, please contact Prof. J. E. Compston at info@iofbonehealth.org
IOF does not officially endorse national or regional guidelines. This is because osteoporosis prevalence and some aspects of the prevention and treatment of fractures are country or region-specific. There may be multiple guidelines from any one country or region.
Listing of national and regional guidelines around the world, including references and links to full text.
