Current Osteoporosis Reports

, Volume 3, Issue 3, pp 84–91 | Cite as

Burden of osteoporosis and fractures in developing countries

  • Anthony D. Woolf
  • Bruce Pfleger


The burden of osteoporosis in developing countries is increasing dramatically with the aging of the population and demographic trends; however, there is a lack of direct epidemiologic data. There are clear differences at present between and within populations that limits the validity of many estimates and more data is needed. Existing data and estimates are considered in terms of bone mass, bone structure, 10-year and lifetime probability of fracture, numbers sustaining fractures, the outcome of fracture, importance of differences in fracture management, and risk factors for their occurrence and outcome. Future trends are also considered.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Consensus development conference: prophylaxis and treatment of osteoporosis. Am J Med 1991, 90:107–110.Google Scholar
  2. 2.
    Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: report of a World Health Organization Study Group. WHO Technical Report Series No. 843. Geneva, World Health Organization 1994.Google Scholar
  3. 3.
    NIH Consensus Statement Vol 17 no 1 March 27–29 2000. Scholar
  4. 4.
    Johnell O, Kanis JA: An estimate of the worldwide prevalence, mortality and disability associated with hip fracture. Osteoporos Int 2004, 15:897–902. An attempt is made to quantify the global burden of osteoporosis as measured by hip fracture. Incidences were computed for the different world regions based on the estimates of Gullberg et al. [12] or from more recent studies. Impact was estimated in terms of years of life lost and disability adjusted life-years. This is a good first attempt but highlights the need for better data to measure the burden in all regions of the world. It is difficult to make assumptions about mortality and morbidity with the paucity of present data about differences in management and outcome of hip fracture between countries.PubMedCrossRefGoogle Scholar
  5. 5.
    The Burden of Musculoskeletal Diseases at the Start of the New Millenium. Report of a WHO Scientific Group. WHO Technical Report Series No 919. Geneva, Switzerland, World Health Organization 2003. The global burden of musculoskeletal conditions is reviewed including osteoporosis and fracture. The available evidence is identified for incidence, prevalence, and impact has been collated. Recommendations are made about health and economic indicators that need to be collected. How to describe health status and the consequences of a musculoskeletal condition has been considered and recommendations made.Google Scholar
  6. 6.
    van Staa TP, Dennison EM, Leufkens HG, Cooper C: Epidemiology of fractures in England and Wales. Bone 2001, 29:517–522.PubMedCrossRefGoogle Scholar
  7. 7.
    Kanis JA, Johnell O, Oden A, et al.: Risk of hip fracture according to the World Health Organization criteria for osteopenia and osteoporosis. Bone 2000, 27:585–590.PubMedCrossRefGoogle Scholar
  8. 8.
    Barrett-Connor E, Siris ES, Wehren LE, et al.: Osteoporosis and fracture risk in women of different ethnic groups. J Bone Miner Res 2005, 20:185–194.PubMedCrossRefGoogle Scholar
  9. 9.
    Looker AC, Orwoll ES, Johnston CC, Jr., et al.: Prevalence of low femoral bone density in older U.S. adults from NHANES III. J Bone Miner Res 1997, 12:1761–1768.PubMedCrossRefGoogle Scholar
  10. 10.
    Marshall D, Johnell O, Wedel H: Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ 1996, 312:1254–1259.PubMedGoogle Scholar
  11. 11.
    Lau EM, Woo J, Leung PC, Swaminthan R: Low bone mineral density, grip strength and skinfold thickness are important risk factors for hip fracture in Hong Kong Chinese. Osteoporos Int 1993, 3:66–70.PubMedCrossRefGoogle Scholar
  12. 12.
    Gullberg B, Johnell O, Kanis JA: World-wide projections for hip fracture. Osteoporos Int 1997, 7:407–413. Estimates are given for present and future incidence of hip fracture world-wide and demographic changes will result in a doubling by 2025 from 1.26 million fractures in 1990, rising up to 4.5 million by 2050. The greatest increase is predicted in Asia where 45% of all hip fractures may occur in 2050 compared with 26% in 1990.PubMedCrossRefGoogle Scholar
  13. 13.
    Lau EM, Lee JK, Suriwongpaisal P, et al.: The incidence of hip fracture in four Asian countries: the Asian Osteoporosis Study (AOS). Osteoporos Int 2001, 12:239–243.PubMedCrossRefGoogle Scholar
  14. 14.
    Stott S, Gray DH: The incidence of femoral neck fractures in New Zealand. N Z Med J 1980, 91:6–9.PubMedGoogle Scholar
  15. 15.
    Solomon L: Osteoporosis and fracture of the femoral neck in the South African Bantu. J Bone Joint Surg Br 1968, 50:2–13.PubMedGoogle Scholar
  16. 16.
    SIGN: Prevention and management of hip fracture in older people. A national clinical guideline. 2002.Google Scholar
  17. 17.
    Alonge TO, Dongo AE, Nottidge TE, et al.: Traditional bonesetters in south western Nigeria—friends or foes? West Afr J Med 2004, 23:81–84.PubMedGoogle Scholar
  18. 18.
    Sernbo I, Johnell O: Consequences of a hip fracture: a prospective study over 1 year. Osteoporos Int 1993, 3:148–153.PubMedCrossRefGoogle Scholar
  19. 19.
    Cooper C: The crippling consequences of fractures and their impact on quality of life. Am J Med 1997, 103:12S-17S.PubMedCrossRefGoogle Scholar
  20. 20.
    O’Neill TW, Felsenberg D, Varlow J, et al.: The prevalence of vertebral deformity in european men and women: the European Vertebral Osteoporosis Study. J Bone Miner Res 1996, 11:1010–1018.PubMedGoogle Scholar
  21. 21.
    Lau EM, Chan HH, Woo J, et al.: Normal ranges for vertebral height ratios and prevalence of vertebral fracture in Hong Kong Chinese: a comparison with American Caucasians. J Bone Miner Res 1996, 11:1364–1368.PubMedGoogle Scholar
  22. 22.
    Ross PD, Fujiwara S, Huang C, et al.: Vertebral fracture prevalence in women in Hiroshima compared to Caucasians or Japanese in the US. Int J Epidemiol 1995, 24:1171–1177.PubMedCrossRefGoogle Scholar
  23. 23.
    Jacobsen SJ, Cooper C, Gottlieb MS, et al.: Hospitalization with vertebral fracture among the aged: a national population- based study, 1986–1989. Epidemiology 1992, 3:515–518.PubMedGoogle Scholar
  24. 24.
    Bauer RL, Deyo RA: Low risk of vertebral fracture in Mexican American women. Arch Intern Med 1987, 147:1437–1439.PubMedCrossRefGoogle Scholar
  25. 25.
    Incidence of vertebral fracture in europe: results from the European Prospective Osteoporosis Study (EPOS). J Bone Miner Res 2002, 17:716–724.Google Scholar
  26. 26.
    Oleksik A, Lips P, Dawson A, et al.: Health-related quality of life in postmenopausal women with low BMD with or without prevalent vertebral fractures. J Bone Miner Res 2000, 15:1384–1392.PubMedCrossRefGoogle Scholar
  27. 27.
    O’Neill TW, Cooper C, Finn JD, et al.: Incidence of distal forearm fracture in British men and women. Osteoporos Int 2001, 12:555–558.PubMedCrossRefGoogle Scholar
  28. 28.
    Silman AJ: Risk factors for Colles’ fracture in men and women: results from the European Prospective Osteoporosis Study. Osteoporos Int 2003, 14:213–218.PubMedGoogle Scholar
  29. 29.
    Hagino H, Yamamoto K, Teshima R, et al.: The incidence of fractures of the proximal femur and the distal radius in Tottori prefecture, Japan. Arch Orthop Trauma Surg 1990, 109:43–44.PubMedCrossRefGoogle Scholar
  30. 30.
    Griffin MR, Ray WA, Fought RL, Melton LJ, III: Black-white differences in fracture rates. Am J Epidemiol 1992, 136:1378–1385.PubMedGoogle Scholar
  31. 31.
    Kaukonen JP, Karaharju EO, Porras M, et al.: Functional recovery after fractures of the distal forearm. Analysis of radiographic and other factors affecting the outcome. Ann Chir Gynaecol 1988, 77:27–31.PubMedGoogle Scholar
  32. 32.
    Cummings SR, Nevitt MC, Browner WS, et al.: Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group. N Engl J Med 1995, 332:767–773.PubMedCrossRefGoogle Scholar
  33. 33.
    Kanis JA, Johnell O, Oden A, et al.: Ten year probabilities of osteoporotic fractures according to BMD and diagnostic thresholds. Osteoporos Int 2001, 12:989–995.PubMedCrossRefGoogle Scholar
  34. 34.
    Kanis JA, Johnell O, Oden A, et al.: Ten-year risk of osteoporotic fracture and the effect of risk factors on screening strategies. Bone 2002, 30:251–258.PubMedCrossRefGoogle Scholar
  35. 35.
    Kanis JA, Borgstrom F, De Laet C, et al.: Assessment of fracture risk. Osteoporos Int 2005, 16:581–589.PubMedCrossRefGoogle Scholar
  36. 36.
    Seeman E: Periosteal bone formation—a neglected determinant of bone strength. N Engl J Med 2003, 349:320–323.PubMedCrossRefGoogle Scholar
  37. 37.
    Cummings SR, Nevitt MC: Non-skeletal determinants of fractures: the potential importance of the mechanics of falls. Study of Osteoporotic Fractures Research Group. Osteoporos Int 1994, 4(Suppl 1):67–70.PubMedCrossRefGoogle Scholar
  38. 38.
    Nakamura T, Turner CH, Yoshikawa T, et al.: Do variations in hip geometry explain differences in hip fracture risk between Japanese and white Americans? J Bone Miner Res 1994, 9:1071–1076.PubMedGoogle Scholar
  39. 39.
    Health and Ageing: a discussion paper WHO Dept of Health Promotion NCDPS, Population Reference Bureau, Scholar
  40. 40.
    Diet, nutrition and the prevention of chronic diseases. WHO Technical Report Series 916. Geneva, World Health Organization 2003. The role of diet and nutrition in the prevention of chronic diseases is reviewed with recommendations at a global level. This includes reviewing the role of diet and nutrition, in particular calcium intake and vitamin D, in prevention of osteoporosis.Google Scholar
  41. 41.
    Ezzati M, Lopez AD, Rodgers A, et al.: Selected major risk factors and global and regional burden of disease. Lancet 2002, 360:1347–1360.PubMedCrossRefGoogle Scholar
  42. 42.
    Prevention and Management of Osteoporosis. WHO Technical Report Series No 921. Geneva, World Health Organization 2003. The prevention and management of osteoporosis has been reviewed and recommendations made for implementation at a global level. Pathogenesis, epidemiology, risk factors, diagnosis, prevention, and treatment are reviewed and recommendations made where appropriate. How to deliver care and education is also considered.Google Scholar
  43. 43.
    Kanis JA: The use of calcium in the management of osteoporosis. Bone 1999, 24:279–290.PubMedCrossRefGoogle Scholar
  44. 44.
    Meunier PJ: Calcium, vitamin D and vitamin K in the prevention of fractures due to osteoporosis. Osteoporos Int 1999, 9(Suppl 2):S48-S52.PubMedCrossRefGoogle Scholar
  45. 45.
    Pettifor JM, Ross P, Moodley G, Shuenyane E: Calcium deficiency in rural black children in South Africa—a comparison between rural and urban communities. Am J Clin Nutr 1979, 32:2477–2483.PubMedGoogle Scholar
  46. 46.
    Vitamin and mineral requirements in human nutrition. Report of the Joint FAO/WHO Expert Consultation Geneva WHO. Geneva, World Health Organization 2002.Google Scholar
  47. 47.
    Tucker KL, Buranapin S: Nutrition and aging in developing countries. J Nutr 2001, 131:2417S-2423S.PubMedGoogle Scholar
  48. 48.
    Burger H, De Laet CE, van Daele PL, et al.: Risk factors for increased bone loss in an elderly population: the Rotterdam Study. Am J Epidemiol 1998, 147:871–879.PubMedGoogle Scholar
  49. 49.
    Dennison E, Eastell R, Fall CH, et al.: Determinants of bone loss in elderly men and women: a prospective populationbased study. Osteoporos Int 1999, 10:384–391.PubMedCrossRefGoogle Scholar
  50. 50.
    Johnell O, Gullberg B, Kanis JA, et al.: Risk factors for hip fracture in European women: the MEDOS Study. Mediterranean Osteoporosis Study. J Bone Miner Res 1995, 10:1802–1815.PubMedCrossRefGoogle Scholar
  51. 51.
    Kanis J, Johnell O, Gullberg B, et al.: Risk factors for hip fracture in men from southern Europe: the MEDOS study. Mediterranean Osteoporosis Study. Osteoporos Int 1999, 9:45–54.PubMedCrossRefGoogle Scholar
  52. 52.
    WHO Global NCD Infobase, ncd_surveillance/infobase.Google Scholar
  53. 53.
    Seeman E: The effects of tobacco and alcohol use on bone. In Osteoporosis. Edited by Marcus R, Feldman D, Kelsey J. San Diego: Academic Press; 1996:577–597.Google Scholar
  54. 54.
    The Tobacco Atlas. Mackay J, Eriksen M, editors. Geneva, World Health Organization. 2002.Google Scholar
  55. 55.
    Naves DM, O’Neill TW, Silman AJ: The influence of alcohol consumption on the risk of vertebral deformity. European Vertebral Osteoporosis Study Group. Osteoporos Int 1997, 7:65–71.CrossRefGoogle Scholar
  56. 56.
    WHO Global Status Report on Alcohol available at http:// 2004 Geneva, Department of Mental Health and Substance Abuse, World Health Organization.Google Scholar
  57. 57.
    The Injury Chart Book: A graphical overview of the global burden of injuries. Department of Injuries and Violence Prevention, Noncommunicable Diseases and Mental Health Cluster, Geneva, 2002. World Health Organization.Google Scholar
  58. 58.
    Osteoporosis Society of Canada: Clinical practice guidelines for the diagnosis and management of osteoporosis. Can Med Assoc J 1996, 155:1113–1133.Google Scholar
  59. 59.
    Physicians guide to prevention and treatment of osteoporosis. In National Osteoporosis Foundation Report. Washington, DC, National Osteoporosis Foundation 1998.Google Scholar
  60. 60.
    Lau EM: Osteoporosis—a worldwide problem and the implications in Asia. Ann Acad Med Singapore 2002, 31:67–68.PubMedGoogle Scholar

Copyright information

© Current Science Inc 2005

Authors and Affiliations

  • Anthony D. Woolf
    • 1
  • Bruce Pfleger
  1. 1.Duke of Cornwall Department of Rheumatology, Royal Cornwall HospitalPeninsula Medical School, Universities of Exeter and PlymouthTruroUK

Personalised recommendations