Rising trends in Osteoporosis

Osteoporosis – Rising Trends in Asia


In earlier times, Osteoporosis has not been considered a significant challenge for countries in Asia because of the lower incidence of hip fractures reported at per capita basis.

Hip Fracture Incidence Map – Women

Map showing the per capital incidence of Hip fracture in World

Source: International Osteoporosis Foundation

Despite the fact that India has a lower daily intake of Calcium, the incidence of fractures has been lower. Studies have attributed this to better absorption of Calcium, lower Calcium loss rate among the Indian body type. [2]

Interestingly, in relative terms, Indian men do not fare as well as Indian women in the overall rate of hip fractures.

Hip Fracture Incidence Map – Men

Hip Fracture Incidence among men in World

 

Source: International Osteoporosis Foundation

Seeing green when compared to other developed countries can lead us to assume that we are performing better in containing Osteoporosis than other developed countries. Nothing can be farther from the reality.

Osteoporosis is a disease that mostly affects an individual above the age of 50 years. As the Asian countries are going to age, the incidence of Osteoporosis induced fractures is expected to increase.

A survey carried out in China between 2003 and 2006 found that Osteoporosis affected roughly 8.8% Chinese men above 50 years and 30.8% women.  China is still a relatively healthy and richer country as compared to India. As per the India 2001 census, we had 163 million people above the age of 50. Even if same prevalence percentages are assumed, India had roughly 30 million Osteoporotic people.

As the Asian countries begin to age, the incidence of Osteoporosis and the issues such as hip fractures, vertebral fractures are expected to grow as well. According to projections from International Osteoporosis Foundation, 50% of all osteoporotic fractures are expected to occur in Asian countries.  As a forewarning of what is to come for relatively young countries like India, few data points from developed Asian regions like Singapore and Hong Kong can help bring more clarity. The incidence of per capital hip fractures rose nearly 5 times in Singapore between 1960 and 1998.

Hip fracture treatment comes at a high cost. In a country like India, only a few have the ability or insurance to bear the total hospitalization and hip replacement procedure cost. As the incidence of hip fractures begin to rise, these can create a big personal cost for a large population that is otherwise not prepared to bear the same.

Another challenge associated with a country like India is that the availability of DEXA test, used for measuring the bone mineral density, is not high. Secondly, it is costly to undergo such tests at each test costing about Rs 2500-3000 INR. The lack of access to such test in tier 2, 3 and remote areas as well as the cost means that many patients who could benefit from an early detection of Osteoporosis sadly come to know about it when a serious injury such as hip fracture or vertebral fracture has occurred.

Despite few advances, the response of both the government and healthcare sector in developing greater awareness of the dangers of Osteoporosis lacks a clear strategy and momentum. As a matter of fact, the Indian Council of Medical Research guidelines peg the daily calcium intake requirements to only 600 mg/day as compared to 1000 mg/day suggested by WHO.

There is a strong need to develop awareness of the looming danger that Osteoporosis poses on the Indian population, especially given the fact that remedy like a hip replacement to deal hip fracture is a costly treatment alternative, and out of reach for many.

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References:

  1. Osteoporosis in Asia: A Call to Action; Ambrish, Mithal; Parjeet, Kaur; Current Osteoporosis Reports, Volume 10 (4) – Dec 1, 2012
  2. http://icmr.nic.in/final/rda-2010.pdf
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