The epidemiology of fractures in Asia

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The epidemiology of fractures in Asia
Dr. Lau EMC, MD President, Asian Pacific
Osteoporosis Foundation Board member,
International Osteoporosis Foundation Director,
CEMED, Hong Kong
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The global epidemic of osteoporosis

• 1 in every 3 women
• 1 in every 8 men
• suffer from osteoporosis

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Osteoporosis is an epidemic disease in Hong Kong,
it affects..

• 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 fracture
All Hip Spine forearm
Women 40 18 16 16
Men 13 6 5 3
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Osteoporotic Fractures in Women Comparison With
Other Diseases
2000
1 500 0001
1500
Annual incidence (per 1000)
1000
500 0002
500
240 0003
180 0003
0
Osteoporotic Fractures
Heart Attack
Breast Cancer
Stroke
1National Osteoporosis Foundation
(2000)2National Institutes of Health (2000)3US
Department of Health and Human Services (2000)
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Percentage of women who rank the following
disease to be most threatening(N1045)

• Breast Cancer 54
• Cardiovascular DS 38
• Osteoporosis 8

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Hip fracture for men and women in 2050
Men (1.8 million)
Women (4.5 million)
Asia 51
Asia 54
North America 12
North America 13
Europe 12
Others 8
Europe 11
Others 6
Latin America 6
Latin America 12
Middle East 8
Middle East 6
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Global projection of hip fracture

• Assuming no increase, gt 2 millions in Asia by
  2050
• Assuming an intermediate rate between Hong Kong
  and Korea

(Gullberg, 1997)
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Incidence of hip fracture in Hong Kong
Women
2001
2006
1985
Per 100,000
1966
50-59
60-69
70-79
80
Age
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Incidence of hip fracture in Hong Kong
Men
2006
2001
1985
Per 100,000
1966
50-59
60-69
70-79
80
Age
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Age-adjusted incidence rates in women
535
459
442
269
Adjusted Rates (100,000)
218
88
US (White)
Hong Kong
Singapore
Thailand
Malaysia
Beijing
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Age-adjusted incidence rates in men
187
180
164
114
97
88
Adjusted Rates (100,000)
US (White)
Hong Kong
Singapore
Thailand
Beijing
Malaysia
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Korea Hip fracture incidence increased by 4
folds
1991 3.3/ 10, 000
2001 13.3 / 10, 000
(Rowe, 2002)
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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
gt 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
Men 152
Women 402
(Koh, 2001)
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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) 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
gt60 years old, Dubbo Osteoporosis Epidemiology
Study (DOES), 1994
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Prevalence of vertebral fracturein 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 densitometry
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Methodology of FRAX

• Poisson Regression
• Hazard functions
• exp (ß0 ß1-x1 ßk 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 FRAX

• Global cohort data from 9 cohort studies
• Rotterdam study
• European Vertebral Osteop Study
• Canadian MC Osteo Study
• Rochester
• Sheffield
• Dubbo
• Hiroshima
• Gothenberg

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WHO FRAX MODEL

• Input
• Sex
• Nationality
• Age
• No. of CRFs
• 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 cRFs 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