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

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

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

Hip fracture is most important from the public health

perspective

Mortality Rate 20 %

Morbidity Rate 30%

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%

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

Percentage of women who rank the following disease to be most threatening

(N=1045)

Breast Cancer 54%

Cardiovascular DS 38%

Osteoporosis 8%

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%

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)

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

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

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

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

Korea

Hip fracture incidence increased by 4 folds

(Rowe, 2002)

1991 3.3/ 10, 000

2001 13.3 / 10, 000

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)

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

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

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

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)

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)

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%

FRAX –

The Brand New WHO Tool for

diagnosing Osteoporosis

Prof John Kanis

www.shef.ac.uk/FRAX

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

Dual X ray densitometryDual X ray densitometry

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

Methodology of FRAXGlobal cohort data from 9 cohort studies

Rotterdam studyEuropean Vertebral Osteop StudyCanadian MC Osteo StudyRochesterSheffieldDubboHiroshimaGothenberg

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

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

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

Conclusions

Osteoporosis is a major health problem in Asia

Cost-effective means of fracture prevention are required

Evidence-based research are vital for Asia