Early studies on osteoporosis and fractures in Asian populations indicated a low prevalence of these conditions, which led many to believe that their risk was low.1 It was suggested that the observed low fracture rates may be attributable to differences in bone length and density.1,2 However, according to the International Osteoporosis Foundation, the belief that osteoporosis is prevalent in Western countries and rare in Asia is a myth and osteoporosis and related fractures are a main concern in Asian populations.3,4
In practice
- It is estimated that by 2050, the number of hip fractures in Asia will more than double, reaching over 2.5 million fractures per year;
- The burden of osteoporosis and fractures in Asian populations may not be adequately detected due to barriers to screening and diagnosis;
- Calcium and vitamin D, both important components of bone health, have been found to be very low in the diets of many Asian populations;
- Increases in income and access may facilitate the integration of more milk products in the diet.
The population is aging
As in many other parts of the world, Asia’s aging population is growing rapidly, and the incidence of fracture in these countries is expected to rise rapidly as a consequence.5 According to the Asian Federation of Osteoporosis Societies, it is estimated that by 2050, the number of hip fractures in Asian countries will more than double, reaching over 2.5 million fractures per year.1,5
Osteoporosis and fractures diagnostic methods are progressing
In their 2013 Asia-Pacific Regional Audit, the International Osteoporosis Foundation highlighted that the burden of osteoporosis and fractures was severely underestimated in many Asian countries, leading to lower diagnosis rates.1 The identification of poor bone health has been further hindered by a lack of adapted diagnostic tools and criteria that account for difference linked with ethnic backgrounds.1,6 However, in 2019, an initiative to standardize osteoporosis screening and diagnosis across the Asia-Pacific region was developed.6 As such, improved clinical practices and technological advances are likely to increase the detection of osteoporosis and fragility fractures.6
Calcium and vitamin D intake tends to be lower in Asian populations
The roles of calcium and vitamin D in the development and maintenance of bone health are well-established.7,8 However, dietary intake of these two nutrients has shown to be low in many Asian populations.3,9 A 2017 systematic review assessing global differences in dietary calcium intakes found that South, East, and Southeast Asian countries had the lowest dietary calcium intakes, reaching less than 400-500 mg of calcium per day, which is less than half of the recommended intake.9 This low calcium intake has been associated with a low dairy content in many traditional Asian diets, several of which contain a limited amount of other sources of calcium.3 Increasing incomes and improvements in access may be pushing shifts in dairy consumption patterns.10 For example, China’s milk consumption has doubled per capita between 2007 and 2018, although these amounts remain insufficient to meet calcium requirements.10
Many Asian countries have also been found to have a high prevalence of low vitamin D status.3,11
In their 2013 Asia-Pacific Regional Audit, the International Osteoporosis Foundation noted that the average vitamin D level in Asian countries is between 25 and 49 nmol/L, which is below the recommended 75 nmol/L. 3 Evidence indicates that these low levels of vitamin D may be due to low dietary vitamin D intake, a lack of food fortification with vitamin D, as well as urbanization and decreased sun exposure.3
References
- Lau EM. The epidemiology of hip fracture in Asia: an update. Osteoporos Int 1996;6:19-23.
- Cauley JA. Defining ethnic and racial differences in osteoporosis and fragility fractures. Clinical Orthopaedics and Related Research 2011;469:1891-199.
- International Osteoporosis Foundation. 2013. Asia-Pacific regional audit: epidemiology, costs & burden of osteoporosis in 2013. www.iofbonehealth.org. Accessed September 2, 2014.
- International Osteoporosis Foundation. 2009. The Asian Audit Epidemiology, costs and burden of osteoporosis in Asia 2009. Accessed November 17, 2021.
- Cheung CL et al. An updated hip fracture projection in Asia: The Asian Federation of Osteoporosis Societies study. Osteoporosis and sarcopenia 2018;4:16-21.
- Chandran M et al. Development of the Asia Pacific Consortium on Osteoporosis (APCO) Framework: clinical standards of care for the screening, diagnosis, and management of osteoporosis in the Asia-Pacific region. Osteoporosis International 2021:1-27.
- Weaver CM et al. The National Osteoporosis Foundation’s position statement on peak bone mass development and lifestyle factors: a systematic review and implementation recommendations. Osteoporosis international 2016;27:1281-1386.
- Lewiecki EM et al. Core principles for fracture prevention: North American Consensus from the National Osteoporosis Foundation, Osteoporosis Canada, and Academia Nacional de Medicina de Mexico. Osteoporosis International 2020;31:2073-2076.
- Balk EM et al. Global dietary calcium intake among adults: a systematic review. Osteoporosis International 2017;28:3315-3324.
- Ward M and Inouye A. China-Peoples Republic of Dairy and Products Semi-annual Fluid Milk Consumption Continues to Increase. Washington, DC: United States Department of Agriculture Global Agricultural Information Network. 2018.
- van Schoor N and Lips P. Worldwide vitamin D status. Vitamin D 2018:15-40.
