Asia Pacific must prepare for catastrophic increase in fragility fractures

A new report launched today by the International Osteoporosis Foundation (IOF) shows that osteoporosis is a serious problem throughout the Asia Pacific, with the number of fracture sufferers to rise dramatically in the coming decades. By 2050, more than half of the world's hip fractures will occur in Asia. The press conference kicked off the IOF Regionals 4th Asia-Pacific Osteoporosis Meeting, being held in Hong Kong from December 12.

The IOF Asia-Pacific Regional Audit provides new and updated information about the status of osteoporosis in the region. In addition to the 14 countries in the 2009 version, it now includes Australia and New Zealand, giving more comprehensive coverage of this geographical area. What is alarmingly clear is that some of the projections made in 2009 clearly underestimated the disease burden and the situation will dramatically worsen if immediate action is not taken.

Asia is ageing rapidly and life expectancy increasing. By 2050 nearly all 16 countries included in this Audit will have at least one-third of their population aged over 50 years, and 5 countries will have at least half of their population aged over 50 years. This is the age group most at risk of osteoporosis. India, for example, will see a 416% rise by 2050, when 620 million (33%) of the population will be aged over 50. In China, more than 636 million people will be aged 50 or over, corresponding to a 78% increase from 2013 to 2050.

Even more alarming is that the majority of the countries represented in the Audit can expect a doubling, if not a tripling, of their populations aged 70 years or over. This is the age group at highest risk of hip fractures, the most serious in terms of disability and premature death. They are also the most costly fractures, requiring surgery, after-care and rehabilitation.

"Altogether, more than 606 million people will be aged over 70 in the Asia-Pacific by 2050 – a 230% increase from 2013. It is evident that prevention efforts and health-care resources must target age-related chronic diseases such as osteoporosis. Without effective prevention strategies, we can expect an enormous increase in fractures which will place a heavy burden on communities and on health-care budgets", said Professor Peter Ebeling, co-author of the report and IOF Board Member.

Additional findings include:

• Asia is increasingly urbanized with a rise in sedentary indoor lifestyles that impact negatively on bone health and fracture risk.
• In the majority of countries there is a scarcity of robust and current epidemiological research on osteoporosis, fracture incidence, and related relevant outcomes.
• Due to urban versus rural disparities in service provision, rural populations generally have less knowledge of osteoporosis, less access to testing and treatment, and are less likely to have timely surgery after hip fracture.
• While the majority of countries report that 95% or more of hip fractures are treated surgically, this may be more representative of urban areas. Pakistan, Philippines, Sri Lanka and Thailand report that only 50% of hip fractures are surgically treated, while Vietnam reports just 25%.
• Timely surgery following hip fracture (ideally within two days) is essential to reduce disability and mortality. India, Malaysia, Philippines, Sri Lanka and Vietnam report waiting times of more than three days.
• In more than half of the countries surveyed, there are insufficient numbers (i.e. fewer than 12 per million population) of DXA scanners, considered the gold standard for measurement of bone mineral density.
• Although some form of reimbursement for medical treatment is provided in a majority of the countries surveyed, there are considerable barriers. These include high co-payments, provision by private health insurance only, age restrictions, or reimbursement only after first fracture. Reimbursement of the most common bisphosphonates is non-existent or extremely limited in several countries, including India, Indonesia, Philippines and Thailand.
• Low levels of vitamin D and calcium consumption are reported throughout the region – and are also seen in the younger population which is building peak bone mass. This is detrimental to bone health at all ages, and in the young has implications for their future risk of osteoporosis.
• Fracture Liaison Services to identify and treat fracture patients who are at high risk of subsequent fractures are lacking in the majority of countries.

The report reveals some welcome advances in the region, including wide availability of the FRAX tool and management guidelines, and increased efforts in health professional training. A notable development is also China's recent designation of osteoporosis as a national health priority, joining Australia, Chinese Taipei and Singapore as the only other countries in the region to do so.

Professor John A. Kanis, President, IOF, speaking at the Audit launch commented, "Despite the enormous and growing burden of fragility fractures, osteoporosis is being dangerously ignored as it competes with other diseases for scarce health-care resources and recognition. The disease remains greatly under-diagnosed and under-treated, and health professional training and service provision is suboptimal in many countries of the Asia Pacific. The result is premature death for many hip fracture sufferers, immense personal suffering, lost productivity and long-term dependence on family members".

He added, "IOF joins local osteoporosis societies throughout the region to urge concerted action to help prevent the rising tide of fractures and their profound socio-economic impact on millions of people and communities throughout the region".