Abstract
The frequency of osteoporosis and fragility fractures has been studied to a very limited extent in few developing countries. The aim of this paper is to review briefly the burden of osteoporosis and fragility fractures in these countries and to propose some strategies for the prevention and control of those conditions, considering barriers and facilitators for their implementation. The evolution of the demographic composition in most regions with developing countries shows a considerable increase in life expectancy and therefore, a significant growth in elderly population can be expected. Reports on the incidence of fragility fractures show figures in many of those countries that are comparable to those found in developed nations. Health resources (for acute treatment of fractures, their rehabilitation and chronic management, for diagnostic centers and drug therapy for osteoporosis) are limited in most of those regions and are allocated to other health priorities. Internationally accepted guidelines can be adapted to the realities of developing nations and may be promoted by organizations of health professionals and patients, but require endorsement and support by health authorities. The steps should include: (a) campaigns to increase awareness, both among the population at risk and relevant health workers; (b) the promotion of a preventive lifestyle in the general population; (c) the development of national or regional, evidence-based guidelines for the diagnosis and treatment of osteoporosis; (d) development and implementation of guidelines for the treatment of fragility fractures, their rehabilitation and prevention of falls; (e) collection of economic data on fractures and osteoporosis; and (f) development of country-specific fracture databases. These steps may help in reducing the increasing burden of osteoporotic fractures. Their implementation will require solid scientific basis and commitment from policy makers, health professionals, patient organizations, and ultimately the general population.
Similar content being viewed by others
References
Population Division, Department of Economic and Social Affairs (1998) World population 1995–2050. (The 1998 Revision) Europe, America, and Australasia (excluding Melanesia). United Nations, New York
World Development Indicators (2003) Size of the economy. The World Bank Group, Washington (http://www.worldbank.org)
Morales-Torres J, Gutiérrez-Ureña S (2004) The burden of osteoporosis in Latin America. Osteoporos Int 15:625—632
al-Nuaim AR, Kremli M, al-Nuaim M, Sandkgi S (1995) Incidence of proximal femur fracture in an urbanized community in Saudi Arabia. Calcif Tissue Int 56:536–538
Baddoura R (2001) Incidence of hip fractures in the Lebanese population. East Mediterr Health J 7:725–729
Lau EM, Lee JK, Suriwongpaisal P, Saw SM, Das De S, Khir A, Sambrook P (2001) The incidence of hip fracture in four Asian countries: the Asian Osteoporosis Study (AOS). Osteoporos Int 12:239–243
Memon A, Pospula WM, Tantawy AY, Abdul-Ghafar S, Suresh A, Al-Rowaih A (1998) Incidence of hip fracture in Kuwait. Int J Epidemiol 27:860–865
Xu L, Lu A, Zhao X, Chen X, Cummings SR (1996) Very low rates of hip fracture in Beijing, People’s Republic of China the Beijing osteoporosis project. Am J Epidemiol 144:901–907
Compston J (2004) Action plan for the prevention of osteoporotic fractures in the European community. Osteoporos Int 15:259–262
Morales-Torres J, Hernández Ochoa C, Alvarez-Cisneros JA (2000) Un análisis de las actitudes y conocimientos sobre Osteoporosis entre los médicos de primer contacto en León, Gto. Rev Endocrino Nut 8:62–66
Atli T, Gullu S, Uysal AR, Erdogan G (2005) The prevalence of vitamin D deficiency and effects of ultraviolet light on vitamin D levels in elderly Turkish population. Arch Gerontol Geriatr 40:53–60
Ghannam NN, Hammami MM, Bakheet SM, Khan BA (1999) Bone mineral density of the spine and femur in healthy Saudi females: relation to vitamin D status, pregnancy, and lactation. Calcif Tissue Int 65:23–28
Elizondo-Alanís LJ, Espinoza Zamora JR, Zayas-Jaime FJ (2006) Niveles Séricos de vitamina D en mujeres postmenopáusicas sanas de 4 ciudades de México (Abstract). Rev Metab Oseo Min 4:329
Sen SS, Rives VP, Messina OD, Morales-Torres J, Riera G, Angulo-Solimano JM, Neto JF, Frisoli A Jr, Saenz RC, Geling O, Ross PD (2005) A risk assessment tool (OsteoRisk) for identifying Latin American women with osteoporosis. J Gen Intern Med 20:245–250
Pande I, Hosking DJ (2004) Oral antiresorptive therapy. Curr Osteoporos Rep 2:116–122
Lecart MP, Bruyere O, Reginster JY (2004) Combination/Sequential therapy in osteoporosis. Curr Osteoporos Rep 2:123–130
Gambacciani M, Vacca F (2004) Postmenopausal osteoporosis and hormone replacement therapy. Minerva Med 95:507–520
Rejnmark L, Vestergaard P, Mosekilde L (2005) Reduced fracture risk in users of thiazide diuretics. Calcif Tissue Int 76:167–175
Ott SM, LaCroix AZ, Ichikawa LE, Scholes D, Barlow WE (2003) Effect of low-dose thiazide diuretics on plasma lipids: results from a double-blind, randomized clinical trial in older men and women. J Am Geriatr Soc 51:340–347
Schlienger RG, Kraenzlin ME, Jick SS, Meier CR (2004) Use of beta-blockers and risk of fractures. JAMA 292:1326–1332
Reid IR, Gamble GD, Grey AB, Black DM, Ensrud KE, Browner WS, Bauer DC (2005) Beta-blocker use, BMD, and fractures in the study of osteoporotic fractures. J Bone Miner Res 20:613–618
Rizzo M, Di Fede G, Mansueto P, Castello F, Carmina E, Rini GB (2004) Statins and osteoporosis: myth or reality? Minerva Med 95:521–527
Slemenda C (1997) Prevention of hip fractures: risk factor modification. Am J Med 103(Suppl 2A):65S–71S
Gennari C (2001) Calcium and vitamin D nutrition and bone disease of the elderly. Public Health Nutr 4:547–559
Lilliu H, Pamphile R, Chapuy MC, Schulten J, Arlot M, Meunier PJ (2003) Calcium-vitamin D3 supplementation is cost-effective in hip fractures prevention. Maturitas 44:299–305
Bean JF, Vora A, Frontera WR (2004) Benefits of exercise for community-dwelling older adults. Arch Phys Med Rehabil 85(Suppl 3):S31–S44
Fleurence RL (2004) Cost-effectiveness of fracture prevention treatments in the elderly. Int J Technol Assess Health Care 20:184–191
Gardner MJ, Brophy RH, Demetrakopoulos D et al (2005) Interventions to improve osteoporosis treatment following hip fracture. A prospective, randomized trial. J Bone Joint Surg Am 87-A:3–7
Patel S, Tweed K, Chinappen U (2005) Fall-related risk factors and osteoporosis in older women referred to an open access densitometry service. Age Ageing 34:67–71
Allander E, Gullberg B, Johnell O, Kanis JA, Ranstam J, Elffors L (1998) Circumstances around the fall in a multinational hip fracture risk study: a diverse pattern for prevention. MEDOS Study Group. Mediterranean Osteoporosis Study. Accid Anal Prev 30:607–616
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Morales-Torres, J. Strategies for the prevention and control of osteoporosis in developing countries. Clin Rheumatol 26, 139–143 (2007). https://doi.org/10.1007/s10067-006-0314-2
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10067-006-0314-2