Key Statistics for Asia

  • It is projected that more than about 50% of all osteoporotic hip fractures will occur in Asia by the year 2050 [1]Cooper, C., G. Campion, and L.J. Melton, 3rd, Hip fractures in the elderly: a world-wide projection. Osteoporos Int, 1992. 2(6): p. 285-9.

    [2]Gullberg, B., O. Johnell, and J.A. Kanis, World-wide projections for hip fracture. Osteoporos Int, 1997. 7(5): p. 407-13.

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  • 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. Populous countries like China and India, where the majority of the population lives in rural areas (60% in China), have less access to diagnostics and treatment compared to urban areas. This suggests that the number of people with osteoporosis may be underestimated in rural areas throughout the Asian countries [3]International Osteoporosis Foundation: The Asia-Pacific Regional Audit - Epidemiology, costs and burden of osteoporosis in 2013. 2013;

    See link    .
  • DXA technology is relatively expensive and is not widely available in most developing Asian countries, especially in rural areas. Republic of Korea, Japan, Hong Kong, Australia, Singapore and New Zealand have about 12–24 DXA machines per million. In contrast, China, India, Indonesia, Pakistan, Philippines, Sri Lanka and Vietnam are severely under-resourced with less than 1 machine per million population [3]International Osteoporosis Foundation: The Asia-Pacific Regional Audit - Epidemiology, costs and burden of osteoporosis in 2013. 2013;

    See link    .This falls far below the recommended number for Europe, of 0.11 per 10,000 [4]International Osteoporosis Foundation: The Asian Audit - Epidemiology, costs and burden of osteoporosis in Asia 2009. 2009;

    See link    .
  • Nearly all Asian countries fall far below the FAO/WHO recommendations for calcium intake of between 1000 and 1300 mg/day. The calcium intake for Malaysia, the Philippines and India remains below 500 mg/day [3]International Osteoporosis Foundation: The Asia-Pacific Regional Audit - Epidemiology, costs and burden of osteoporosis in 2013. 2013;

    See link    .
  • 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 [5]Mithal, A., et al., Global vitamin D status and determinants of hypovitaminosis D. Osteoporos Int, 2009. 20(11): p. 1807-20.

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  • In a systematic review of hip fracture incidence worldwide, age-standardised hip fracture rates in women were high in Hong Kong, Singapore and Taiwan, i.e. an incidence above 300/100,000 persons [6]Kanis, J.A., et al., A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int, 2012. 23(9): p. 2239-56.

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  • From 1988 to 1992, the incidence of hip fractures in Beijing increased by 34% in women and 33% in men [7]Xu, L., et al., Very low rates of hip fracture in Beijing, People's Republic of China the Beijing Osteoporosis Project. Am J Epidemiol, 1996. 144(9): p. 901-7.

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  • There is a higher incidence of hip fractures in men than in women in China [7]Xu, L., et al., Very low rates of hip fracture in Beijing, People's Republic of China the Beijing Osteoporosis Project. Am J Epidemiol, 1996. 144(9): p. 901-7.

    [8]Yan, L., et al., Epidemiological study of hip fracture in Shenyang, People's Republic of China. Bone, 1999. 24(2): p. 151-5.

    [9]Zhang, L., et al., Epidemiology of cervical and trochanteric fractures of the proximal femur in 1994 in Tangshan, China. J Bone Miner Metab, 2000. 18(2): p. 84-8.

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  • 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 [10]Wang, Y., et al., Osteoporosis in China. Osteoporos Int, 2009. 20(10): p. 1651-62.

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  • The prevalence rate of osteoporosis according to the WHO criteria was found to be of 16.3% at the hip [11]Wu, X.P., et al., Determination of age-specific bone mineral density and comparison of diagnosis and prevalence of primary osteoporosis in Chinese women based on both Chinese and World Health Organization criteria. J Bone Miner Metab, 2004. 22(4): p. 382-91.

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  • The average cost of a hip fracture was estimated at 1,200-4,000 USD based on local data varying across urban and rural areas, across regions and increasing over time [10]Wang, Y., et al., Osteoporosis in China. Osteoporos Int, 2009. 20(10): p. 1651-62.

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  • The majority of hip fractures in Asia will occur in China [3]International Osteoporosis Foundation: The Asia-Pacific Regional Audit - Epidemiology, costs and burden of osteoporosis in 2013. 2013;

    See link    , where the incidence of hip fracture will raise from 411,000 in 2015 to an estimate of more than 1 million hip fractures in 2050 [12]Si, L., et al., Projection of osteoporosis-related fractures and costs in China: 2010-2050. Osteoporos Int, 2015. 26(7): p. 1929-37.

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  • Epidemiological studies showed that hip fracture incidence had increased by 300% from the 1960s to 1990s and stabilized between 2001 and 2006. The reasons are not clear, but may be due to a number of factors including improved availability of medical intervention, increases in BMI, use of HRT, and improved fall prevention strategies [13]Lau, E.M., et al., Hip fracture in Hong Kong over the last decade--a comparison with the UK. J Public Health Med, 1999. 21(3): p. 249-50.

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  • 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 [14]Lau, E.M., Epidemiology of osteoporosis. Best Pract Res Clin Rheumatol, 2001. 15(3): p. 335-44.

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  • The prevalence of vertebral fractures between 70 and 79 years of age is estimated at 30% in women and 17% in men. These rates are comparable to those in American Caucasians [15]Lau, E.M., et al., Normal ranges for vertebral height ratios and prevalence of vertebral fracture in Hong Kong Chinese: a comparison with American Caucasians. J Bone Miner Res, 1996. 11(9): p. 1364-8.

    [17]Ross, P.D., et al., Vertebral fracture prevalence in women in Hiroshima compared to Caucasians or Japanese in the US. Int J Epidemiol, 1995. 24(6): p. 1171-7.
     

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  • The prevalence of osteoporosis in 1996-2001 among those ages 50 years and older was 1.6% in men and 11.4% in women [18]Yang, N.P., et al., Estimated prevalence of osteoporosis from a Nationwide Health Insurance database in Taiwan. Health Policy, 2006. 75(3): p. 329-37.
     

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  • 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 [19]Chie, W.C., et al., High incidence rate of hip fracture in Taiwan: estimated from a nationwide health insurance database. Osteoporos Int, 2004. 15(12): p. 998-1002.

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  • 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%) [20]Shao, C.J., et al., A nationwide seven-year trend of hip fractures in the elderly population of Taiwan. Bone, 2009. 44(1): p. 125-9.

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  • In a 2005 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 [21]Shatrugna, V., et al., Bone status of Indian women from a low-income group and its relationship to the nutritional status. Osteoporos Int, 2005. 16(12): p. 1827-35.

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  • In 2001, the prevalence of osteoporosis in the Japanese female population aged 50-79 years was estimated at about 35% at the spine and 9.4% at the hip [22]Iki, M., et al., Bone mineral density of the spine, hip and distal forearm in representative samples of the Japanese female population: Japanese Population-Based Osteoporosis (JPOS) Study. Osteoporos Int, 2001. 12(7): p. 529-37.

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  • In 2012, the nationwide survey estimated the incidence of hip fractures at 175,700. The western areas showed higher incidence rates for both men and women compared to the east, however this difference observed is declining [23]Orimo, H., et al., Hip fracture incidence in Japan: Estimates of new patients in 2012 and 25-year trends. Osteoporos Int, 2016. 27(5): p. 1777-84.

    . Although, new hip fractures increased 1.7-fold during the 1987 to 1997 period [24]Orimo, H., et al., Trends in the incidence of hip fracture in Japan, 1987-1997: the third nationwide survey. J Bone Miner Metab, 2000. 18(3): p. 126-31.

    , the hip fracture incidence may be starting to decline despite the increasing number of patients [23]Orimo, H., et al., Hip fracture incidence in Japan: Estimates of new patients in 2012 and 25-year trends. Osteoporos Int, 2016. 27(5): p. 1777-84.

    [25]Orimo, H., et al., Hip fracture incidence in Japan: estimates of new patients in 2007 and 20-year trends. Arch Osteoporos, 2009. 4(1-2): p. 71-77.

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  • Investigations in the Tottori prefecture showed that the incidence rates of limb fractures and hip fractures has continued to increase [26]Hagino, H., et al., Recent trends in the incidence and lifetime risk of hip fracture in Tottori, Japan. Osteoporos Int, 2009. 20(4): p. 543-8.

    [27]Tsukutani, Y., et al., Epidemiology of fragility fractures in Sakaiminato, Japan: incidence, secular trends, and prognosis. Osteoporos Int, 2015. 26(9): p. 2249-55.

    . In Sado City (Niigata Prefecture), the same trend was observed for hip and vertebral fractures, although the increase found between 2006 and 2010 was not as significant compared to the increase from 2004 to 2006 [28]Sakuma, M., et al., Incidence of osteoporotic fractures in Sado, Japan in 2010. J Bone Miner Metab, 2014. 32(2): p. 200-5.

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  • When comparing to Northern Europe Caucasian populations, limb fractures occurred less often in Sakaiminato. Contrastingly, clinical vertebral fracture rates were found to be higher when compared to both North Europe and other Asian countries [27]Tsukutani, Y., et al., Epidemiology of fragility fractures in Sakaiminato, Japan: incidence, secular trends, and prognosis. Osteoporos Int, 2015. 26(9): p. 2249-55.

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  • In 2008 hip fracture incidence was of 207/100,000 for women and 98/100,000 for men. When looking at the actual numbers of hip fractures over the five-year period, a 108% increase from 9,817 hip fractures in 2003 to 20,432 hip fractures in 2008 was observed. Studies from 2005 to 2008 found the male mortality rate to be 1.4-times higher than that for females [3]International Osteoporosis Foundation: The Asia-Pacific Regional Audit - Epidemiology, costs and burden of osteoporosis in 2013. 2013;

    See link    .
  • Osteopenia and osteoporosis seems to be a significant problem due to major nutritional issues as well as limited and underutilised diagnostic facilities [3]International Osteoporosis Foundation: The Asia-Pacific Regional Audit - Epidemiology, costs and burden of osteoporosis in 2013. 2013;

    See link    .
  • The incidences of hip fracture in 1998 have gone up 5 times in women and 1.5 times in men compared to those observed in the 1960s [29]Koh, L.K., et al., A simple tool to identify asian women at increased risk of osteoporosis. Osteoporos Int, 2001. 12(8): p. 699-705.

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  • During 1991-1998, the incidence of hip fracture increased by 0.7% annually in men and by 1.2% annually in women [30]Koh, L.K., et al., Hip fracture incidence rates in Singapore 1991-1998. Osteoporos Int, 2001. 12(4): p. 311-8.

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  • In the year 2006, a hip BMD measurement study estimated that there were about 55 000 female Singaporeans above the age of 50 who are suffering from osteoporosis [4]International Osteoporosis Foundation: The Asian Audit - Epidemiology, costs and burden of osteoporosis in Asia 2009. 2009;

    See link    .
  • Age-adjusted rates of osteoporotic fractures among women over the age of 50 years in Singapore are currently among the highest in Asia and approaching those of the USA and Europe [31]Cheen, M.H., et al., Adherence to osteoporosis medications amongst Singaporean patients. Osteoporos Int, 2012. 23(3): p. 1053-60.

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REFERENCES

1.
Cooper, C., G. Campion, and L.J. Melton, 3rd, Hip fractures in the elderly: a world-wide projection. Osteoporos Int, 1992. 2(6): p. 285-9.
2.
Gullberg, B., O. Johnell, and J.A. Kanis, World-wide projections for hip fracture. Osteoporos Int, 1997. 7(5): p. 407-13.
3.
International Osteoporosis Foundation: The Asia-Pacific Regional Audit - Epidemiology, costs and burden of osteoporosis in 2013. 2013; See link
4.
International Osteoporosis Foundation: The Asian Audit - Epidemiology, costs and burden of osteoporosis in Asia 2009. 2009; See link
5.
Mithal, A., et al., Global vitamin D status and determinants of hypovitaminosis D. Osteoporos Int, 2009. 20(11): p. 1807-20.
6.
Kanis, J.A., et al., A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int, 2012. 23(9): p. 2239-56.
7.
Xu, L., et al., Very low rates of hip fracture in Beijing, People's Republic of China the Beijing Osteoporosis Project. Am J Epidemiol, 1996. 144(9): p. 901-7.
8.
Yan, L., et al., Epidemiological study of hip fracture in Shenyang, People's Republic of China. Bone, 1999. 24(2): p. 151-5.
9.
Zhang, L., et al., Epidemiology of cervical and trochanteric fractures of the proximal femur in 1994 in Tangshan, China. J Bone Miner Metab, 2000. 18(2): p. 84-8.
10.
Wang, Y., et al., Osteoporosis in China. Osteoporos Int, 2009. 20(10): p. 1651-62.
11.
Wu, X.P., et al., Determination of age-specific bone mineral density and comparison of diagnosis and prevalence of primary osteoporosis in Chinese women based on both Chinese and World Health Organization criteria. J Bone Miner Metab, 2004. 22(4): p. 382-91.
12.
Si, L., et al., Projection of osteoporosis-related fractures and costs in China: 2010-2050. Osteoporos Int, 2015. 26(7): p. 1929-37.
13.
Lau, E.M., et al., Hip fracture in Hong Kong over the last decade--a comparison with the UK. J Public Health Med, 1999. 21(3): p. 249-50.
14.
Lau, E.M., Epidemiology of osteoporosis. Best Pract Res Clin Rheumatol, 2001. 15(3): p. 335-44.
15.
Lau, E.M., et al., Normal ranges for vertebral height ratios and prevalence of vertebral fracture in Hong Kong Chinese: a comparison with American Caucasians. J Bone Miner Res, 1996. 11(9): p. 1364-8.
16.
Lau, E.M., et al., Vertebral deformity in chinese men: prevalence, risk factors, bone mineral density, and body composition measurements. Calcif Tissue Int, 2000. 66(1): p. 47-52.
17.
Ross, P.D., et al., Vertebral fracture prevalence in women in Hiroshima compared to Caucasians or Japanese in the US. Int J Epidemiol, 1995. 24(6): p. 1171-7.  
18.
Yang, N.P., et al., Estimated prevalence of osteoporosis from a Nationwide Health Insurance database in Taiwan. Health Policy, 2006. 75(3): p. 329-37.  
19.
Chie, W.C., et al., High incidence rate of hip fracture in Taiwan: estimated from a nationwide health insurance database. Osteoporos Int, 2004. 15(12): p. 998-1002.
20.
Shao, C.J., et al., A nationwide seven-year trend of hip fractures in the elderly population of Taiwan. Bone, 2009. 44(1): p. 125-9.
21.
Shatrugna, V., et al., Bone status of Indian women from a low-income group and its relationship to the nutritional status. Osteoporos Int, 2005. 16(12): p. 1827-35.
22.
Iki, M., et al., Bone mineral density of the spine, hip and distal forearm in representative samples of the Japanese female population: Japanese Population-Based Osteoporosis (JPOS) Study. Osteoporos Int, 2001. 12(7): p. 529-37.
23.
Orimo, H., et al., Hip fracture incidence in Japan: Estimates of new patients in 2012 and 25-year trends. Osteoporos Int, 2016. 27(5): p. 1777-84.
24.
Orimo, H., et al., Trends in the incidence of hip fracture in Japan, 1987-1997: the third nationwide survey. J Bone Miner Metab, 2000. 18(3): p. 126-31.
25.
Orimo, H., et al., Hip fracture incidence in Japan: estimates of new patients in 2007 and 20-year trends. Arch Osteoporos, 2009. 4(1-2): p. 71-77.
26.
Hagino, H., et al., Recent trends in the incidence and lifetime risk of hip fracture in Tottori, Japan. Osteoporos Int, 2009. 20(4): p. 543-8.
27.
Tsukutani, Y., et al., Epidemiology of fragility fractures in Sakaiminato, Japan: incidence, secular trends, and prognosis. Osteoporos Int, 2015. 26(9): p. 2249-55.
28.
Sakuma, M., et al., Incidence of osteoporotic fractures in Sado, Japan in 2010. J Bone Miner Metab, 2014. 32(2): p. 200-5.
29.
Koh, L.K., et al., A simple tool to identify asian women at increased risk of osteoporosis. Osteoporos Int, 2001. 12(8): p. 699-705.
30.
Koh, L.K., et al., Hip fracture incidence rates in Singapore 1991-1998. Osteoporos Int, 2001. 12(4): p. 311-8.
31.
Cheen, M.H., et al., Adherence to osteoporosis medications amongst Singaporean patients. Osteoporos Int, 2012. 23(3): p. 1053-60.