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The epidemiology of fractures in Asia
Dr. Lau EMC, MDPresident, Asian Pacific Osteoporosis Foundation
Board member, International Osteoporosis FoundationDirector, CEMED, Hong Kong
Dr. Lau EMC, MDPresident, Asian Pacific Osteoporosis Foundation
Board member, International Osteoporosis FoundationDirector, CEMED, Hong Kong
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1 in every 3 women
1 in every 8 men
suffer from osteoporosis
1 in every 3 women
1 in every 8 men
suffer from osteoporosis
The global epidemic of osteoporosisThe global epidemic of osteoporosis
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Osteoporosis is an Osteoporosis is an epidemic disease in epidemic disease in
Hong Kong, it Hong Kong, it affectsaffects……....
1/3 women
1/5 men
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Hip fracture is most important from the public health
perspective
Mortality Rate 20 %
Morbidity Rate 30%
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Life time risk of osteoporotic Life time risk of osteoporotic fracture fracture
Life time risk of osteoporotic Life time risk of osteoporotic fracture fracture
All Hip Spine forearm
Women 40% 18% 16% 16%
Men 13% 6% 5% 3%
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1 500 0001
0
500
1000
1500
2000
Osteoporotic Fractures
1National Osteoporosis Foundation (2000)2National Institutes of Health (2000)
3US Department of Health and Human Services (2000)
500 0002
240 0003180 0003
Annual incidence (per 1000)
HeartAttack
Stroke BreastCancer
Osteoporotic Fractures in Women: Osteoporotic Fractures in Women: Comparison With Other DiseasesComparison With Other Diseases
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Percentage of women who rank the following disease to be most threatening
(N=1045)
Breast Cancer 54%
Cardiovascular DS 38%
Osteoporosis 8%
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Men(1.8 million)
Asia Asia 51%51%
Hip fracture for men and Hip fracture for men and women in 2050women in 2050
Asia Asia 54%54%
EuropeEurope11%11%
Others Others 8%8%
Latin Latin AmericaAmerica6%6%
North North AmericaAmerica13%13%
Women(4.5 million)
Middle EastMiddle East8%8%
EuropeEurope12%12%
Others Others 6%6% Latin Latin
AmericaAmerica12%12%
North North AmericaAmerica12%12%
Middle EastMiddle East6%6%
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Global projection of hip fracture
Assuming no increase, > 2 millions in Asia by 2050
Assuming an intermediate rate between Hong Kong and Korea
(Gullberg, 1997)
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0
500
1000
1500
2000
2500
1966
2001
1985
Incidence of hip fracture in Hong KongIncidence of hip fracture in Hong Kong
2006
Per
100
,000
50-59 60-69 70-79 80+
Age
Women
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0
400
800
1200
1600
Per
100
,000
50-59 60-69 70-79 80+
Age
1966
20011985
Incidence of hip fracture in Hong KongIncidence of hip fracture in Hong Kong
Men
2006
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Age-adjusted incidence rates in
women
0
100
200
300
400
500
600
Adj
uste
d R
ates
(10
0,00
0)
US (White) Hong KongSingapore Thailand Malaysia
535
459 442
269218
Beijing
88
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Age-adjusted incidence rates in
men
0
50
100
150
200
Adj
uste
d R
ates
(10
0,00
0)
187180
164
1148897
US (White)
Hong Kong
SingaporeThailand Beijing Malaysia
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Korea
Hip fracture incidence increased by 4 folds
(Rowe, 2002)
1991 3.3/ 10, 000
2001 13.3 / 10, 000
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Japan Incidence of hip fracture in increased by 1.6 folds in
men and 1.5 folds in women (rates per 100, 000 in 2005)
Men Women
70 – 74 108 249
75 – 79 209 505
80 – 84 449 1115
> 84 780 2066
(Hagino, 2005)
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Singapore Incidence of fracture increased by 1.5 folds in
men and 5.0 folds increase in women
Rates per 100, 000 in 2005
(Koh, 2001)
Men 152
Women 402
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Fracture incidence in elderly men (per 100,000)(Mr Os Hong Kong and US)
Site Hong Kong Chinese US Caucasian
Hip 271 281
Wrist 194 172
Ribs/ chest/ sternum 104 374
Leg 104 133
Ankle/ Foot/ Toes 78 278
All sites 1022 1818
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Fracture incidence in elderly women (Ms Os Hong Kong)
Incidence of fracture (per 100,000 person-years)
Site Hong Kong Chinese Caucasian (Dubbo*)
Hip 296 771
Wrist 610 709
Ribs/ chest/ sternum 141 277
Leg 183 216
Ankle/ Foot/ Toes 197 385
All sites 2159 3250
*>=60 years old, Dubbo Osteoporosis Epidemiology Study (DOES), 1994
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Prevalence of vertebral fracturePrevalence of vertebral fracturein Chinese and Americansin Chinese and Americans
Chinese Americans
Women 30% 25% (Black et al)
Men 16% 10% (Mann et al)
(using – 3SD VHR as cut-off)
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Prevalence of vertebral fractures in China (Beijing) in 2000
Age Group Prevalence
50 – 59 4%
60 – 69 10%
70 – 79 15%
80 + 31%
(Xu Ling, 2000)
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Prevalence of vertebral fractures in Japanese (Hiroshima) women in 1995 (Ross, 1995)
Age Group Prevalence
60 – 64 4%
65 – 69 8%
70 – 74 25%
75 – 79 37%
80 – 84 43%
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FRAX –
The Brand New WHO Tool for
diagnosing Osteoporosis
Prof John Kanis
www.shef.ac.uk/FRAX
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Risk factor for osteoporotic fx
Family history Prior fx history Tobacco smoking Alcohol consumption for 3 units or more Oral Glucocorticoid use Rheumatoid arthritis Diseases : DM, hyperthyroidism, etc
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Dual X ray densitometryDual X ray densitometry
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Methodology of FRAX
Poisson Regression
Hazard functions
exp (β0+ β1-x1+…+ βk – Xk)
The probability of a hip fx event
t v
P = ∫h (v) exp ( - ∫g (u) du ) dv. 0 0
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Methodology of FRAXGlobal cohort data from 9 cohort studies
Rotterdam studyEuropean Vertebral Osteop StudyCanadian MC Osteo StudyRochesterSheffieldDubboHiroshimaGothenberg
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WHO FRAX MODELInput Sex Nationality Age No. of CRF’s Femoral Neck BMD
Outcome 10 year probability of Osteoporotic fx 10 year probability of hip fx
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Ten year probability of osteoporotic fractures in women aged 65 years, BMD T-score = -2.5
Number of cRF’s China Sweden
0 4.2 9.8
1 6.1 15
2 8.8 21
3 13 30
4 17 41
5 24 53
6 31 67
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Why is FRAX a breakthrough?
Allows for selecting patients for treatment in a cost-effective manner on a national scale
Quantify fracture risk for communication between doctors and patient
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Conclusions
Osteoporosis is a major health problem in Asia
Cost-effective means of fracture prevention are required
Evidence-based research are vital for Asia