About osteoporosis

About Osteoporosis

  • Osteoporosis is a common disease characterised by porous brittle bones, low bone density and quality, and structural deterioration.1
  • In 2000 (the most recent global estimate), osteoporosis was thought to account for nearly nine million fractures each year, worldwide,2 noting more than 200 million people worldwide live with osteoporosis.3
  • Osteoporosis is defined as having a bone mineral density (BMD) 2.5 standard deviations below the average value of a young healthy person,4,5 which leads to enhanced bone fragility, and increased fracture risk.4,5
  • Osteoporosis and consequent fragility fractures, compound the burden of Asia Pacific’s rapidly ageing society.6
  • People often only discover they have osteoporosis after sustaining a first fracture.7 It is therefore important to diagnose and treat osteoporosis as early as possible.7
  • Lack of investigation into the cause of a fracture means osteoporosis often goes undiagnosed, resulting in a fragility fracture.7
  • Osteoporosis can compromise a person’s quality of life through loss of independence and productivity, chronic pain, disability, emotional distress, reduced social interaction, and self-limitation caused by a fear of falling.8
  • Among all osteoporotic fractures, hip fractures incur the greatest morbidity, mortality, and social and financial costs.9
  • Osteoporosis not only affects those living with the disease, but also their family, and the community at large.8
  • Despite the presence of generally safe and effective treatments, only a minority of low trauma fracture patients are evaluated and treated for underlying osteoporosis.10
  • In some countries, as little as five per cent of those who have sustained fractures have undergone treatment post- fracture.11
  • Consequently, a large number of people sustain further debilitating secondary fractures, which places a substantial, but preventable burden on already strained healthcare systems.12

About Fragility Fractures

  • Fragility fractures, also known as osteoporotic fractures, are caused by reduced bone strength, and occur following minimal trauma, such as a fall from standing height or less.13
  • Fractures can also be caused by a simple movement, or even a sneeze or cough. Other risk factors for fracture include age, poor nutrition, smoking and a history of falls.14-16
  • The bones most commonly affected by these fractures include the hip, spine and wrist.1
  • Sustaining a fracture heightens a person’s risk of any type of further fracture by 86 per cent.3
  • A fragility fracture, which occurs every three seconds worldwide,17 compromises quality of life, and places the affected individual at twice the risk for further fracture, and loss of independence.17,18
  • Concerningly, one-in-four patients who sustain a hip fracture die within a year, and less than half of those who survive, regain their previous level of function.15,16
  • In 2010, an estimated 158 million people aged 50 years and above were at high risk of osteoporotic fracture – a figure which is set to double by 2040.19
  • One-third of all subsequent fractures occurred within the first year after initial fracture of the spine, shoulder or hip.20
  • Fragility fractures with the highest health burden are hip and spinal (vertebral) fractures.13 Approximately three-in-four of these fractures occur among those aged 65 years and above.13
  • In 2018, the Asian Federation of Osteoporosis Societies (AFOS) estimated a substantial 485,000 and 332,000 hip fractures had occurred in China and India, respectively.9
  • In 2018, more than 1.1 million hip fractures were anticipated to occur in China, Chinese Taipei, Hong Kong SAR, India, Japan, Malaysia, Singapore, South Korea and Thailand, incurring an estimated direct cost of USD 7.4 billion. By 2050, the number of hip fractures are projected to increase by 2.3-fold, to more than 2.5 million cases each year, resulting in staggering projected costs of almost USD 13 billion.20
  • With pharmacological intervention, the relative risk reductions (RRR) observed for hip fracture and vertebral fracture fall within the range of 25–50 per cent, and 30–65 per cent respectively, contingent upon the agent used, and characteristics of the populations treated. The RRRs for non-vertebral fracture were shown to vary from 20 to 53 per cent.20
  1. International Osteoporosis Foundation (IOF). What is Osteoporosis. [cited Jan, 2020]; Available from: https://www.iofbonehealth.org/what-is-osteoporosis.
  2. National Institute for Health and Care Excellence. Osteoporosis assessing the risk of fragility fracture. [cited Jan, 2020]; Available from: https://www.nice.org.uk/guidance/cg146/resources/osteoporosis-assessing- the-risk-of-fragility-fracture-pdf-35109574194373.
  3. International Osteoporosis Foundation (IOF). Osteoporosis Facts and Statistics. [cited Jan, 2020]; Available from: https://www.iofbonehealth.org/facts-and- statistics/calcium-studies-map.
  4. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. World Health Organ Tech Rep Ser, 1994. 843: p. 1-129.
  5. Sözen, T., L. Özışık, and N.Ç. Başaran, An overview and management of osteoporosis. European journal of rheumatology, 2017. 4(1): p. 46-56.
  6. The Economist Intelligence Unit, Ageing with strength: Addressing fragility fractures in Asia-Pacific. 2019.
  7. Osteoporosis Australia. What you need to know about osteoporosis. Consumer guide. [cited Jan, 2020]; Available from: https://www.osteoporosis.org.au/sites/default/files/files/oa_consumer_ed2_Aug2014.pdf.
  8. Office of the Surgeon General (US). Bone Health and Osteoporosis. A Report of the Surgeon General. Rockville (MD): Office of the Surgeon General (US) - The Burden of Bone Disease. 2004. [cited Jan, 2020]; Available from: https://www.ncbi.nlm.nih.gov/books/NBK45502/.
  9. Cheung, C.-L., et al., An updated hip fracture projection in Asia: The Asian Federation of Osteoporosis Societies study. Osteoporosis and sarcopenia, 2018. 4(1): p. 16-21.
  10. Unnanuntana, A., et al., The assessment of fracture risk. The Journal of Bone and Joint Surgery. American volume, 2010. 92(3): p. 743-753.
  11. Feldstein, A., et al., Bone Mineral Density Measurement and Treatment for Osteoporosis in Older Individuals With Fractures: A Gap in Evidence-Based Practice Guideline Implementation. Archives of Internal Medicine, 2003. 163(18): p. 2165-2172.
  12. Australian and New Zealand Bone and Mineral Society. Position Paper on Secondary Fracture Prevention. 2015 [cited Jan, 2020]; Available from: https://www.anzbms.org.au/downloads/ANZBMSPositionPaperonSecondaryFr acturePreventionApril2015.pdf.
  13. Sanchez-Riera, L. and N. Wilson, Fragility Fractures & Their Impact on Older People. Best Pract Res Clin Rheumatol, 2017. 31(2): p. 169-191.
  14. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Smoking and bone health. [cited Jan, 2020]; Available from: https://www.bones.nih.gov/health-info/bone/osteoporosis/conditions- behaviors/bone-smoking.
  15. Cosman, F., et al., Clinician's Guide to Prevention and Treatment of Osteoporosis. Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2014. 25(10): p. 2359-2381.
  16. Australian Institute of Health and Welfare. Musculoskeletal fact sheet. Osteoporosis. [cited Jan, 2020]; Available from: https://www.aihw.gov.au/getmedia/61866386-568b-41fa-93e4- 090ad201ab2b/phe187-osteoporosis-factsheet.pdf.aspx.
  17. International Osteoporosis Foundation (IOF). Capture the fracture. [cited Jan, 2020]; Available from: https://www.capturethefracture.org/about.
  18. Madureira, M.M., R.M. Ciconelli, and R.M.R. Pereira, Quality of life measurements in patients with osteoporosis and fractures. Clinics (Sao Paulo, Brazil), 2012. 67(11): p. 1315-1320.
  19. Stolnicki, B. and L.G. Oliveira, For the first fracture to be the last. Revista brasileira de ortopedia, 2016. 51(2): p. 121-126.
  20. Ebeling, P., et al., Secondary prevention of fragility fractures in Asia Pacific: an educational initiative. Osteoporosis International, 2019.
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