Osteoporosis epidemiology and demographics

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]

Overview

Osteoporosis is a major health problem involving 43.9% (43.4 million) of the male and female population in the United States. The disease incidence is increased by age. The most common involved age group is 80 years and older. White females and African-American males have the highest incidence among the other races. The incidence of lifetime osteoporotic fracture, as the most important outcome of osteoporosis, is approximately one out of every two women and also one in four men over the age of 50 worldwide. More than 1.5 million fractures occurred secondary to osteoporosis per year; among which are 300,000 hip fracture, 700,000 vertebral fracture, 250,000 wrist fracture, and more than 300,000 other bones fractures. Major epidemiological studies conducted in the US, estimated that 10.3% (10.2 million) of people older than 50 years are affected with osteoporosis. Osteoporosis affects about 75 million people in Europe, USA, and Japan.

Epidemiology and demographics

Incidence

  • The incidence of osteoporosis is approximately 7,000 per 100,000 individuals worldwide.[1]
  • The incidence of lifetime osteoporotic fracture, as the most important outcome of osteoporosis, is approximately 50,000 per 100,000 for female and 25,000 per 100,000 over 50 male individuals worldwide. More than 1.5 million fractures occur secondary to osteoporosis per year, among which are 300,000 hip fracture, 700,000 vertebral fracture, 250,000 wrist fracture, and more than 300,000 other bones fractures.[1]
  • Osteoporosis is the main cause of 8.9 million fractures in a year, worldwide. Hence, it can be assumed that osteoporosis leads to one fracture in every 3 seconds.[2]
  • The estimated women population under the burden of osteoporosis influence is about 200 million, worldwide; two third of them are of age 90, two fifth of them with age 80, one fifth of them 70, and one tenth of them 60 years old.
  • In women, the rates of fracture in forearm, humerus, hip, and spine are 80%, 75%, 70%, and 58%, respectively. However, women encounter the fractures 1.6 times more commonly than men, constituting a total of 61% of osteoporotic fractures.[2]
  • It is estimated that in 2050, the rate of hip fracture will increase by 310% and 240% in male and females, respectively, in contrast with 1990.[3]
  • When the lifetime risks of fractures in hip, forearm, and vertebrae is clinically interpreted, it comes out to be 40%, that is the same as cardiovascular events.[4]
  • It is assumed that large percentage (almost 80%) of individuals with high risk of fracture and already history of at least one osteoporotic fracture, are neither identified nor treated.[5]
  • International Osteoporosis Foundation (IOF) study, done in 11 countries, showed that the following factors lead to lack of osteoporosis diagnosis and management:

Prevalence

Age

  • The prevalence of osteoporosis increase with age in both genders. The highest diagnosis of osteoporosis is found among people 80 years and older.
  • 35% of women and 11% of men older than 80years are affected with osteoporosis. .[8][9]

Race

  • Osteoporosis usually affects individuals of all races.
  • 20% of white postmenopausal women, 10% of Hispanic women, and just 5% of African-American women are affected by osteoporosis (defined as T-score of less than -2.5).

Gender

  • Females are more prone to develop osteoporosis than men.
  • The lifetime risk of fractures is three times more in women than in men, but men are associated with higher mortality rates than that of women.

Region

Europe

  • WHO estimation of the osteoporosis population in Europe is 22 million females and 5.5 million males in 2010 (total of 27.5 million) which is going to rise about 23% until 2025 (total of 33.9 million).
  • New fractures in the EU during 2010 was estimated at 3.5 million, including approximately 620,000 hip fractures, 520,000 vertebral fractures, 560,000 forearm fractures and 1,800,000 other fractures.
  • The number of fractures in a year assumed to grow from 3.5 million in 2010 to 4.5 million in 2025, suggesting a 28% increase.
  • 43,000 people have died in 2010 because of osteoporosis complications. It is assumed that osteoporotic fractures are the main reason of 26,300 life-year lost in Europe, in 2010.[10]
Denmark
  • From 1987-1997, in a 10-year period, the rate of osteoporosis increased by 56%, among which 41% were women and 10.4% were men older than 50 years old.[11]
Finland
  • In Finland, hip fracture rate was found to be increased by 70% from 1992 to 2002, in a 10-year period.[12]
Georgia
  • In Georgia, it is assumed that only one patient with hip fracture out of four seeks medical care.[13]
Germany
  • In Germany, a study of fracture rate showed that 45% of men and 31% of women between 25 to 74 years old experience fracture, while 42% of men and 40% of women between 65 to 74 years old had fractures due to osteoporosis.[14]
Greece
  • Hip fracture rate was increased by 7.6% from 1977 until 1992, in a five year period.[15]
Kazakhstan
Romania
Russia
  • In Russia, 14 million people (about 10%) are affected with osteoporosis, while 20 million suffer from osteopenia.
  • About 34 million people are at high risk for osteoporotic fracture.
Slovenia
  • Generally, hip fracture rate increased by 40% from 1998 to 2005 during a seven year period.[16]
Spain
  • The incidence of hip fracture cases increased to 54% from 1998 to 2002 during a 14-year period.
  • This increase was observed more in women (64%) than men (19%).[17]
Sweden
  • Lifetime osteoporotic fractures are 46% in women and 22% in men.[18]
Ukraine
UK
  • Half of women and one-fifth of men older than 50 years are predicted to have osteoporotic fracture.[20]

North America

Canada

USA

  • About 44 million people older than 50 years old in the US are suffering from osteoporosis.
  • More than half of them are over 50 years old. Remaining the current conditions and utilities, it is estimated that more than 61 million people in 2020 will be involved in osteoporosis. Women constitute 80% of the osteoporotic population.[22]

Latin America

  • It is estimated that in a period of 60 years, from 1990 to 2050, Latin America is experiencing a 5 times increase in hip fracture, in men and women between 50 to 64 years of age. Surprisingly, it will be 8 times for age of more than 65 years.[23]
  • Regarding 655,648 hip fractures in 2050, it will directly cost about $13 billion.[24]
  • 23% to 30% of the patients with hip fracture will die in the first year after fracture, more in men compared to women.[25]
  • Vertebral fractures prevalence is 15% in women more than 50 years of age, in which 7% is among 50-60 years and 28% is among more than 80 years women.[26]
Argentina
  • Half of the women, >65 year old, suffer from osteopenia and one fourth of them with osteoporosis. It is estimated to be 5.24 million osteopenic and 2.62 million osteoporotic women in 2050. The population of above 50 years old are encountering 90 hip fractures a day (34,000 per year). It will be more than 63,000 one in women and more than 13,000 in men, by 2050. Vertebral fracture rate in postmenopausal women is 16.2%. The total burden of both hip and vertebral osteoporotic fractures, including hospitalization costs, is more than $190 million per each year.[27]
Brazil
  • One person in every 17 people, totally about 10 million people are suffering from osteoporosis. 37.5% of men and 21% of women would have osteoporotic fracture during life.[28] One person in every 3 patients encountering hip fracture would have osteoporosis, however, one out of five will receive treatment.[29] The total economic burden of osteoporotic fracture is assumed to be $6 million.[30]
Chile
Mexico
Venezuela
  • In Venezuela, 5.5% of women and 1.5% men of 50 years of age would have the hip fracture. For other sites of fractures, the percentages are 13.6% and 3.5% for women and men, respectively. It is assumed that 9.6 hip fracture a day in 1995, will grow to 67 fractures a day in 2030. After 70 years of age, only one out of ten people may have normal bone mineral density.[32]

The Middle East and Africa

  • Vitamin D deficiency is really prevalent in this region, despite the abundance of day hours sun there. The rate of death after osteoporotic fracture in the area is 2-3 times of Western societies. The major reason for the issue is lack of utilities, less than one DXA scan for 1 million people in Morocco.[33]
Egypt
Iran
  • In 2010, the hip fracture rate was 50,000 and will become 62,000 in 2020. The hip fracture rate of Iran is 0.85% of worldwide and 12.4% of the Middle-East whole burden.[35]
Jordan
  • Hip fractures are growing from 1008 per year in 2008 to four times of the original size in 2050.[16]
Lebanon
Saudi Arabia
Syria
  • From approximately 15,000 vertebral osteoporotic fractures per year, only one-fifth seeking medical services.[16]
Turkey
  • It is assumed that 24,000 hip fracture in male and female above 50 years of age will become 36,000 in 2020.[38]

Asia

  • In 2050, more than half of the whole hip fractures of the world would be from Asia. The main reason will be improving the utilities and increasing the medical services availability. Currently, more than half of the population of China are living in rural area, managing fractures conservatively at home and not seeking any medical services. On the other hand, major facilities, like densitometers, will become more accessible for everyone.[39]
China
  • In China, 70 million cases of osteoporosis are leading to 678,000 hip fractures, annually.
  • Men are more suffering from hip fracture than women.
  • The holistic prevalence of osteoporosis in women is about two folds of men.
  • The total economic burden of one hip fracture is about $3,603, which may be measured as $1.5 billion per year. It is assumed to grow to $12.5 billion in 2020 and more than $ 264.7 billion in 2050. Facility limitation is the major problem of China in managing osteoporosis; in 2008 the whole DXA scanners number for the whole 1.3 billion Chinese was 450. [40][41]
Hong Kong, China
  • In a 6 million population, hip fracture management is of 1% of whole hospital economic burden that is $17 million.[42]
India
Japan
Korea
  • During a 10-year period, the number of hip fractures raised to 300%. In the population above 75 years of age, hip fracture occurs in 4.3 per 1000 women and 2.97 per 1000 men.
Singapore
  • In Singapore, hip fracture in men and women has increased to 1.5 times and 5 times, respectively, in 1998 compared to 1960's.[46]

Oceania

Australia
  • The total economic burden of the osteoporosis is $7.4 billion, annually.
  • There are 2.2 million cases of osteoporosis, while 42% of men and 51% of women are encountering bone density loss.
  • The lifetime risk of women for fragility fractures is about twice the risk of men.[47]
New Zealand
  • The total economic burden of osteoporosis is more than $1.15 billion, annually.
  • It is assumed to be increased by more than 30%, in 2020.
  • Women encounter osteoporotic fractures more than men.
  • 5% of all fractures occurred in hip[48]

References

  1. ↑ 1.0 1.1 Masi L (2008). "Epidemiology of osteoporosis". Clin Cases Miner Bone Metab. 5 (1): 11–3. PMC 2781190. PMID 22460840.
  2. ↑ 2.0 2.1 Johnell O, Kanis JA (2006). "An estimate of the worldwide prevalence and disability associated with osteoporotic fractures". Osteoporos Int. 17 (12): 1726–33. doi:10.1007/s00198-006-0172-4. PMID 16983459.
  3. ↑ Gullberg, B.; Johnell, O.; Kanis, J.A. (1997). "World-wide Projections for Hip Fracture". Osteoporosis International. 7 (5): 407–413. doi:10.1007/PL00004148. ISSN 0937-941X.
  4. ↑ Kanis JA (2002). "Diagnosis of osteoporosis and assessment of fracture risk". Lancet. 359 (9321): 1929–36. doi:10.1016/S0140-6736(02)08761-5. PMID 12057569.
  5. ↑ Nguyen TV, Center JR, Eisman JA (2004). "Osteoporosis: underrated, underdiagnosed and undertreated". Med. J. Aust. 180 (5 Suppl): S18–22. PMID 14984358.
  6. ↑ "How Fragile is Her Future | International Osteoporosis Foundation".
  7. ↑ "Who are candidates for prevention and treatment for osteoporosis?". Osteoporos Int. 7 (1): 1–6. 1997. PMID 9102057.
  8. ↑ Wright NC, Looker AC, Saag KG, Curtis JR, Delzell ES, Randall S; et al. (2014). "The recent prevalence of osteoporosis and low bone mass in the United States based on bone mineral density at the femoral neck or lumbar spine". J Bone Miner Res. 29 (11): 2520–6. doi:10.1002/jbmr.2269. PMC 4757905. PMID 24771492.
  9. ↑ Trombetti A, Herrmann F, Hoffmeyer P, Schurch MA, Bonjour JP, Rizzoli R (2002). "Survival and potential years of life lost after hip fracture in men and age-matched women". Osteoporos Int. 13 (9): 731–7. doi:10.1007/s001980200100. PMID 12195537.
  10. ↑ Hernlund E, Svedbom A, Ivergård M, Compston J, Cooper C, Stenmark J; et al. (2013). "Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA)". Arch Osteoporos. 8: 136. doi:10.1007/s11657-013-0136-1. PMC 3880487. PMID 24113837.
  11. ↑ Giversen IM (2006). "Time trends of age-adjusted incidence rates of first hip fractures: a register-based study among older people in Viborg County, Denmark, 1987-1997". Osteoporos Int. 17 (4): 552–64. doi:10.1007/s00198-005-0012-y. PMID 16408148.
  12. ↑ Lönnroos E, Kautiainen H, Karppi P, Huusko T, Hartikainen S, Kiviranta I, Sulkava R (2006). "Increased incidence of hip fractures. A population based-study in Finland". Bone. 39 (3): 623–7. doi:10.1016/j.bone.2006.03.001. PMID 16603427.
  13. ↑ "www.iofbonehealth.org" (PDF).
  14. ↑ Meisinger C, Wildner M, Stieber J, Heier M, Sangha O, Döring A (2002). "[Epidemiology of limb fractures]". Orthopade (in German). 31 (1): 92–9. PMID 11963475.
  15. ↑ Paspati I, Galanos A, Lyritis GP (1998). "Hip fracture epidemiology in Greece during 1977-1992". Calcif. Tissue Int. 62 (6): 542–7. PMID 9576984.
  16. ↑ 16.0 16.1 16.2 16.3 16.4 16.5 "Eastern European & Central Asian Audit | International Osteoporosis Foundation".
  17. ↑ Hernández JL, Olmos JM, Alonso MA, González-Fernández CR, Martínez J, Pajarón M, Llorca J, González-Macías J (2006). "Trend in hip fracture epidemiology over a 14-year period in a Spanish population". Osteoporos Int. 17 (3): 464–70. doi:10.1007/s00198-005-0008-7. PMID 16283063.
  18. ↑ Kanis JA, Johnell O, Oden A, Sembo I, Redlund-Johnell I, Dawson A, De Laet C, Jonsson B (2000). "Long-term risk of osteoporotic fracture in Malmö". Osteoporos Int. 11 (8): 669–74. PMID 11095169.
  19. ↑ Kanis JA, Oden A, Johnell O, De Laet C, Jonsson B, Oglesby AK (2003). "The components of excess mortality after hip fracture". Bone. 32 (5): 468–73. PMID 12753862.
  20. ↑ van Staa TP, Dennison EM, Leufkens HG, Cooper C (2001). "Epidemiology of fractures in England and Wales". Bone. 29 (6): 517–22. PMID 11728921.
  21. ↑ Tarride JE, Hopkins RB, Leslie WD, Morin S, Adachi JD, Papaioannou A, Bessette L, Brown JP, Goeree R (2012). "The burden of illness of osteoporosis in Canada". Osteoporos Int. 23 (11): 2591–600. doi:10.1007/s00198-012-1931-z. PMC 3483095. PMID 22398854.
  22. ↑ "cdn.nof.org" (PDF).
  23. ↑ Cooper C, Campion G, Melton LJ (1992). "Hip fractures in the elderly: a world-wide projection". Osteoporos Int. 2 (6): 285–9. PMID 1421796.
  24. ↑ Johnell O (1997). "The socioeconomic burden of fractures: today and in the 21st century". Am. J. Med. 103 (2A): 20S–25S, discussion 25S–26S. PMID 9302894.
  25. ↑ Riera-Espinoza G (2009). "Epidemiology of osteoporosis in Latin America 2008". Salud Publica Mex. 51 Suppl 1: S52–5. PMID 19287895.
  26. ↑ Clark P, Cons-Molina F, Deleze M, Ragi S, Haddock L, Zanchetta JR, Jaller JJ, Palermo L, Talavera JO, Messina DO, Morales-Torres J, Salmeron J, Navarrete A, Suarez E, Pérez CM, Cummings SR (2009). "The prevalence of radiographic vertebral fractures in Latin American countries: the Latin American Vertebral Osteoporosis Study (LAVOS)". Osteoporos Int. 20 (2): 275–82. doi:10.1007/s00198-008-0657-4. PMID 18584111.
  27. ↑ Siqueira FV, Facchini LA, Hallal PC (2005). "The burden of fractures in Brazil: a population-based study". Bone. 37 (2): 261–6. doi:10.1016/j.bone.2005.04.002. PMID 15921970.
  28. ↑ Zabaglia, Silval Fernando Cardoso; Costa-Paiva, Lúcia Helena Simões; Pinto-Neto, Aarão Mendes (2001). "A Ligadura Tubária é Fator de Risco para a Redução da Densidade Mineral Óssea em Mulheres na Pós-menopausa?". Revista Brasileira de Ginecologia e Obstetrícia. 23 (10). doi:10.1590/S0100-72032001001000002. ISSN 0100-7203.
  29. ↑ Araújo, Denizar Vianna; Oliveira, Juliana H. A. de; Bracco, Oswaldo Luís (2005). "Custo da fratura osteoporótica de fêmur no sistema suplementar de saúde brasileiro". Arquivos Brasileiros de Endocrinologia & Metabologia. 49 (6): 897–901. doi:10.1590/S0004-27302005000600007. ISSN 0004-2730.
  30. ↑ Clark P, Carlos F, Barrera C, Guzman J, Maetzel A, Lavielle P, Ramirez E, Robinson V, Rodriguez-Cabrera R, Tamayo J, Tugwell P (2008). "Direct costs of osteoporosis and hip fracture: an analysis for the Mexican healthcare system". Osteoporos Int. 19 (3): 269–76. doi:10.1007/s00198-007-0496-8. PMID 18060586.
  31. ↑ "www.iofbonehealth.org" (PDF).
  32. ↑ Baddoura R, Hoteit M, El-Hajj Fuleihan G (2011). "Osteoporotic fractures, DXA, and fracture risk assessment: meeting future challenges in the Eastern Mediterranean Region". J Clin Densitom. 14 (4): 384–94. doi:10.1016/j.jocd.2011.03.009. PMID 21839659.
  33. ↑ "Osteopoorosis Cairo April 2011 v1".
  34. ↑ Ahmadi-Abhari S, Moayyeri A, Abolhassani F (2007). "Burden of hip fracture in Iran". Calcif. Tissue Int. 80 (3): 147–53. doi:10.1007/s00223-006-0242-9. PMID 17340222.
  35. ↑ Maalouf G, Bachour F, Hlais S, Maalouf NM, Yazbeck P, Yaghi Y, Yaghi K, El Hage R, Issa M (2013). "Epidemiology of hip fractures in Lebanon: a nationwide survey". Orthop Traumatol Surg Res. 99 (6): 675–80. doi:10.1016/j.otsr.2013.04.009. PMID 24007698.
  36. ↑ Bubshait D, Sadat-Ali M (2007). "Economic implications of osteoporosis-related femoral fractures in Saudi Arabian society". Calcif. Tissue Int. 81 (6): 455–8. doi:10.1007/s00223-007-9090-5. PMID 18066484.
  37. ↑ Tuzun S, Eskiyurt N, Akarirmak U, Saridogan M, Senocak M, Johansson H, Kanis JA (2012). "Incidence of hip fracture and prevalence of osteoporosis in Turkey: the FRACTURK study". Osteoporos Int. 23 (3): 949–55. doi:10.1007/s00198-011-1655-5. PMID 21594756.
  38. ↑ Gullberg B, Johnell O, Kanis JA (1997). "World-wide projections for hip fracture". Osteoporos Int. 7 (5): 407–13. PMID 9425497.
  39. ↑ Zhang L, Cheng A, Bai Z, Lu Y, Endo N, Dohmae Y, Takahashi HE (2000). "Epidemiology of cervical and trochanteric fractures of the proximal femur in 1994 in Tangshan, China". J. Bone Miner. Metab. 18 (2): 84–8. PMID 10701163.
  40. ↑ Luo LZ, Xu L (2005). "[Study on direct economic-burden and its risk factors of osteoporotic hip fracture]". Zhonghua Liu Xing Bing Xue Za Zhi (in Chinese). 26 (9): 669–72. PMID 16471214.
  41. ↑ Lau EM (2001). "Epidemiology of osteoporosis". Best Pract Res Clin Rheumatol. 15 (3): 335–44. doi:10.1053/berh.2001.0153. PMID 11485333.
  42. ↑ Shatrugna V, Kulkarni B, Kumar PA, Rani KU, Balakrishna N (2005). "Bone status of Indian women from a low-income group and its relationship to the nutritional status". Osteoporos Int. 16 (12): 1827–35. doi:10.1007/s00198-005-1933-1. PMID 15959616.
  43. ↑ Iki M, Kagamimori S, Kagawa Y, Matsuzaki T, Yoneshima H, Marumo F (2001). "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. 12 (7): 529–37. doi:10.1007/s001980170073. PMID 11527049.
  44. ↑ Hagino H, Katagiri H, Okano T, Yamamoto K, Teshima R (2005). "Increasing incidence of hip fracture in Tottori Prefecture, Japan: trend from 1986 to 2001". Osteoporos Int. 16 (12): 1963–8. doi:10.1007/s00198-005-1974-5. PMID 16133645.
  45. ↑ Koh LK, Sedrine WB, Torralba TP, Kung A, Fujiwara S, Chan SP, Huang QR, Rajatanavin R, Tsai KS, Park HM, Reginster JY (2001). "A simple tool to identify asian women at increased risk of osteoporosis". Osteoporos Int. 12 (8): 699–705. PMID 11580084.
  46. ↑ Sambrook PN, Seeman E, Phillips SR, Ebeling PR (2002). "Preventing osteoporosis: outcomes of the Australian Fracture Prevention Summit". Med. J. Aust. 176 Suppl: S1–16. PMID 12049064.
  47. ↑ Brown P, McNeill R, Leung W, Radwan E, Willingale J (2011). "Current and future economic burden of osteoporosis in New Zealand". Appl Health Econ Health Policy. 9 (2): 111–23. doi:10.2165/1153150-000000000-00000. PMID 21271750.

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