The Second Summit of CIS (Commonwealth of Independent States) Osteoporosis Societies met in St. Petersburg on September 23, 2012 to review the status of osteoporosis in the region since the landmark IOF Eastern European & Central Asian Regional Audit of 2010. The delegates’ signed Appeal outlines five clear areas in which action must be taken in order to reduce the enormous socio-economic burden of osteoporosis and related fractures.
The Meeting was held under the auspices of the International Osteoporosis Foundation (IOF) and with the participation of osteoporosis societies and medical doctors from the Russian Federation, Ukraine, Republic of Belarus, Republic of Moldova, Armenia, Kazakhstan, Azerbaijan, Uzbekistan, Tajikistan and Kyrgyzstan. Five of these societies– Russian Association on Osteoporosis, Ukraine Association on Osteoporosis, Armenian Osteoporosis Association, Belorussian Public Association “Overcome Osteoporosis Together” and Moldovan Anti-osteoporosis Association - are members of the IOF Committee of National Societies.
In 2010, representatives of these osteoporosis societies, together with colleagues from 11 other countries from the Eastern European and Central Asian Region, jointly prepared and issued the IOF Eastern European & Central Asian Regional Audit “Epidemiology, costs and burden of osteoporosis in 2010”. The document demonstrated that osteoporosis is one of the major health problems throughout the region. According to the data reported by the authors of the Audit, the situation might be called threatening. By 2050, the population of the majority of CIS countries will have substantially decreased while the proportion of patients with osteoporosis fractures will have increased among those who are 50 years and over.
A growing problem compounded by lack of awareness and scarcity of diagnostic facilities
At the Summit, Professor Olga Lesnyak, President of the Russian Osteoporosis Association, stated that even at that time every third woman and every fourth man over 50 years had osteoporosis. The problem of osteoporosis in the population is worsening steadily due to longer life spans. Professor Lesnyak stated that an estimated 34 million Russian people are at risk for fractures associated with osteoporosis. Meanwhile, in the Russian Federation a hip fracture occurs every five minutes. “We carried out research among people aged over 50 and came to the conclusion that vertebral fractures are very common. We diagnosed fractures even in those who didn’t suspect they had a problem,” said Lesnyak. “Overall, nearly 10% of the population of Russia had vertebral fractures with no awareness of the problem and registration in the statistics.”
The available data on osteoporosis points to an unfavorable prognosis: By 2035 the number of Russian people aged over 50 years suffering hip fracture will have increased almost two-fold, by 96% in women and 105% in men.
Ageing of the population and the low awareness of the problem of osteoporosis are distinguishing characteristics for other CIS countries as well. In Uzbekistan, it is predicted that by 2050, 40% (14 million) of the population will be 50 years and older, 12% (4.2 million) – 70 years and older along with increasing the population up to 35 million people. Given the population growth in the Republic, by 2020 the number of people suffering from osteoporosis is predicted to increase to up to 250,000 people. In Uzbekistan, the incidence of osteoporotic fractures is also growing. According to the Research Institute of Traumatology and Orthopedics of Uzbekistan, the main reason lies in lack of awareness of the problem among the population of the Republic. Furthermore, there are still difficulties in studying the problem of osteoporosis at a national level, including due to inadequate numbers of diagnostic equipment. In Uzbekistan, there are only 4 sonar and 5 DXA machines.
There is a lack of diagnostic equipment in many other countries throughout the region as well.
- Double X-ray absorptiometry is the most accurate modern method of diagnosis which is available only in big cities, although in one third of the reviewed countries 40% of the population lives in urban areas.
- In most of CIS, pharmacological treatment of people with high risk of fractures is not reimbursed, therefore citizens just can’t afford it themselves.
- Low levels of calcium and vitamin D intake pose a negative effect on bone health. Meanwhile, in almost all CIS countries the intakes for these nutrients fall far below FAO /WHO recommendations.
- The majority of the population suffer from obvious vitamin D deficiency. This not only increases fracture risk in seniors, but also leads to rickets. Over the last years the proportion of children affected with rickets has reached up to 54-66% in some Russian regions.
A few positive trends outweighed by inaction in most countries
The Summit participants reported that, since the publication of the 2010 Audit results, some positive changes had occurred in their countries.
- In Uzbekistan, the list of medications for treatment of osteoporosis was enlarged and diagnostics has been improved.
- In Kyrgyzstan, the Ministry of Health Care included an issue for the development and introduction of a National Programme on Osteoporosis in the order “of improvement of rheumatology service”, and bisphosphonates were included in the list of essential medications.
- • The Ministry of Health Care of Kazakhstan initiated a research programme “The development of integrated actions for osteoporosis prevention” which is being carried out from 2011-2013.
- • The Republic of Belarus is preparing normative documents to organize a Children Centre for Low Bone Density Prevention.
Unfortunately, despite these welcome, if modest, signs of progress, it is too early to declare that osteoporosis has been recognized as a priority for health care systems in CIS countries.
New epidemiological study underway
The governments of CIS and adjacent countries do not draw enough attention to the problem. Despite evidence that fractures resulting from osteoporosis pose a major public health burden, neither epidemiological nor health-economic studies that might encourage specialists to be engaged in prevention are being carried out.
In many countries there is still a complete lack of relevant statistics. That is why the Russian Association on Osteoporosis has initiated the multinational population-based study in the countries of the region “Epidemiological study of osteoporotic fractures in Eurasia (EVA)”. The goal is to obtain the data on incidence of main osteoporotic fractures.
Summit participants sign Appeal requesting action
Given the dire state of affairs, the participants of the Summit proposed that osteoporosis be recognized as a health priority at the state level, and that treatment and prevention strategies, as well as urgent surgical treatment for patients with hip fractures, be provided. An appeal with such proposals towards the governments and health ministries of CIS countries was signed by the summit participants presenting 10 countries.
The signed document calls for the following five measures to be taken:
- Recognize osteoporosis as a socially important disease due to high incidence, socio-economic burden and medical consequences;
- Organize the collection of official statistics on fragility fractures, including hip fractures;
- Increase the proportion of patients with hip fractures who can get surgical care within the first days after the trauma – this will reduce the high rate of mortality and disability;
- Provide the population with widely available DXA and modern methods of treatment of osteoporosis, free of charge for people at high risk of fractures;
- Provide government funding for widespread education and prevention programmes on bone health for the general public.
Speaking on behalf of IOF, CEO Judy Stenmark supported the CIS Summit call for action. “As representatives of osteoporosis medical and patient societies, the delegates of the CIS Summit on Osteoporosis have seen at first hand the devastating effect of osteoporotic fractures on the senior populations of their countries. IOF strongly supports their Appeal and asks that health authorities take concerted action to combat osteoporosis and thereby reduce the unnecessary loss of life and costly long-term disability caused by fractures.”
*Caption for image, from left to right:
Professor Alizade Chingiz, President of Azerbaijan Society of Traumatologists (Azerbaijan); Dr Umida Rustamova, Institute of Traumatology (Uzbekistan); Dr Gulzhan Gabdulina, President of Doctor’s Osteoporosis Association of Kazakhstan Republic (Kazakhstan); Professor Liliana Groppa, President of Moldovan Anti-osteoporosis Association (Republic of Moldova); Professor Emma Rudenka, President of Belorussian Public Association “Overcome Osteoporosis Together” (Republic of Belarus); Professor Olga Lesnyak, President of Russian Association on Osteoporosis (Russian Federation); Professor Vladislav Povoroznyuk, President of Ukrainian Association on Osteoporosis (Ukraine); Dr Olga Lobanchenko, President of Kyrgyz Association on Osteoporosis (Kyrgyz Republic); Dr Armine Haroyan, President of Armenian Osteoporosis Association (Armenia); Professor Abduvali Razzakov, Ministry of Health Care (Tajikistan)