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      Osteoporosis in East Asia: Current issues in assessment and management

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          Abstract

          The greatest burden of hip fractures around the world is expected to occur in East Asia, especially China. However, there is a relative paucity of information on the epidemiology and burden of fractures in East Asia. Osteoporosis is greatly under-diagnosed and under-treated, even among the highest-risk subjects who have already suffered fractures. The accessibility to bone densitometry, the awareness of the disease by professionals and the public, and the use and reimbursement of drugs are some of the areas which need improvement especially. Cost-effective analysis on screening strategy and intervention thresholds based on local epidemiology data and economic status are available only in Japan. In addition, clinical risk factor models for the assessment of fracture probability may be ethnic specific. Further research is needed to develop a cost-effective risk assessment strategy to identify high-risk individuals for screening and treatment based on local data. Moreover, inadequate calcium and vitamin D intake is still an issue faced by this region.

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          Hip fractures in the elderly: a world-wide projection.

          C. Cooper, G. Campion, L J Melton (1992)
          Hip fractures are recognized to be a major public health problem in many Western nations, most notably those in North America, Europe and Oceania. Incidence rates for hip fracture in other parts of the world are generally lower than those reported for these predominantly Caucasian populations, and this has led to the belief that osteoporosis represents less of a problem to the nations of Asia, South American and Africa. Demographic changes in the next 60 years, however, will lead to huge increases in the elderly populations of those countries. We have applied available incidence rates for hip fracture from various parts of the world to projected populations in 1990, 2025 and 2050 in order to estimate the numbers of hip fractures which might occur in each of the major continental regions. The projections indicate that the number of hip fractures occurring in the world each year will rise from 1.66 million in 1990 to 6.26 million by 2050. While Europe and North America account for about half of all hip fractures among elderly people today, this proportion will fall to around one quarter in 2050, by which time steep increases will be observed throughout Asia and Latin America. The results suggest that osteoporosis will truly become a global problem over the next half century, and that preventive strategies will be required in parts of the world where they are not currently felt to be necessary.
          Article 0 comments Cited 330 times – based on 0 reviews     Review now
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            World-wide projections for hip fracture.

            B Gullberg, O. Johnell, J Kanis (1997)
            The aims of this study were to estimate the present and future incidence of hip fracture world-wide. From a survey of available data on current incidence, population trends and the secular changes in hip fracture risk, the numbers of hip fractures expected in 2025 and 2050 were computed. The total number of hip fractures in men and women in 1990 was estimated to be 338,000 and 917,000 respectively, a total of 1.26 million. Assuming no change in the age- and sex-specific incidence, the number of hip fractures is estimated to approximately double to 2.6 million by the year 2025, and 4.5 million by the year 2050. The percentage increase will be greater in men (310%) than in women (240%). With modest assumptions concerning secular trends, the number of hip fractures could range between 7.3 and 21.3 million by 2050. The major demographic changes will occur in Asia. In 1990, 26% of all hip fractures occurred in Asia, whereas this figure could rise to 37% in 2025 and to 45% in 2050. We conclude that the socioeconomic impact of hip fractures will increase markedly throughout the world, particularly in Asia, and that there is an urgent need to develop preventive strategies, particularly in the developing countries.
            Article 0 comments Cited 210 times – based on 0 reviews     Review now
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              Collagen cross-links as a determinant of bone quality: a possible explanation for bone fragility in aging, osteoporosis, and diabetes mellitus.

              M. Saito, K Marumo (2010)
              Collagen cross-linking, a major post-translational modification of collagen, plays important roles in the biological and biomechanical features of bone. Collagen cross-links can be divided into lysyl hydroxylase and lysyloxidase-mediated enzymatic immature divalent cross-links,mature trivalent pyridinoline and pyrrole cross-links, and glycation- or oxidation-induced non-enzymatic cross-links(advanced glycation end products) such as glucosepane and pentosidine. These types of cross-links differ in the mechanism of formation and in function. Material properties of newly synthesized collagen matrix may differ in tissue maturity and senescence from older matrix in terms of crosslink formation. Additionally, newly synthesized matrix in osteoporotic patients or diabetic patients may not necessarily be as well-made as age-matched healthy subjects. Data have accumulated that collagen cross-link formation affects not only the mineralization process but also microdamage formation. Consequently, collagen cross-linking is thought to affect the mechanical properties of bone. Furthermore,recent basic and clinical investigations of collagen cross-links seem to face a new era. For instance, serum or urine pentosidine levels are now being used to estimate future fracture risk in osteoporosis and diabetes. In this review, we describe age-related changes in collagen cross-links in bone and abnormalities of cross-links in osteoporosis and diabetes that have been reported in the literature.
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                Author and article information

                Contributors
                Elaine Y.N. Cheung
                Journal
                Journal ID (nlm-ta): Osteoporos Sarcopenia
                Journal ID (iso-abbrev): Osteoporos Sarcopenia
                Title: Osteoporosis and Sarcopenia
                Publisher: Korean Society of Osteoporosis
                ISSN (Print): 2405-5255
                ISSN (Electronic): 2405-5263
                Publication date PMC-release: 30 July 2016
                Publication date (Print): September 2016
                Publication date (Electronic): 30 July 2016
                Volume: 2
                Issue: 3
                Pages: 118-133
                Affiliations
                [a ]Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong, China
                [b ]Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
                [c ]Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
                [d ]Centre for Genomic Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
                Author notes
                [∗ ]Corresponding author. Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong, China. c4366@ 123456hotmail.com
                Article
                Publisher ID: S2405-5255(16)30031-0
                DOI: 10.1016/j.afos.2016.07.001
                PMC ID: 6372753
                PubMed ID: 30775478
                SO-VID: 439ed9ec-cf05-43c7-99c2-5825c331a8f4
                Copyright © © 2016 The Korean Society of Osteoporosis. Publishing services by Elsevier B.V.
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 16 April 2016
                Date revision received : 27 June 2016
                Date accepted : 1 July 2016
                Categories
                Subject: Review Article

                Keywords: osteoporosis,asia,epidemiology,management,assessment
                Data availability:
                Keywords: osteoporosis, asia, epidemiology, management, assessment

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