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      An updated hip fracture projection in Asia: The Asian Federation of Osteoporosis Societies study

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          Hip fracture is a major public health problem. Earlier studies projected that the total number of hip fracture will increase dramatically by 2050, and most of the hip fracture will occur in Asia. To date, only a few studies provided the updated projection, and none of them focused on the hip fracture projection in Asia. Thus, it is essential to provide the most up to date prediction of hip fracture in Asia, and to evaluate the total direct medical cost of hip fracture in Asia.


          We provide the updated projection of hip fracture in 9 Asian Federation of Osteoporosis Societies members using the most updated incidence rate and projected population size.


          We show that the number of hip fracture will increase from 1,124,060 in 2018 to 2,563,488 in 2050, a 2.28-fold increase. This increase is mainly due to the changes on the population demographics, especially in China and India, which have the largest population size. The direct cost of hip fracture will increase from 9.5 billion United State dollar (USD) in 2018 to 15 billion USD in 2050, resulting a 1.59-fold increase. A 2%–3% decrease in incidence rate of hip fracture annually is required to keep the total number of hip fracture constant over time.


          The results show that hip fracture remains a key public health issue in Asia, despite the available of better diagnosis, treatment, and prevention of fracture over the recent years. Healthcare policy in Asia should be aimed to reduce the burden of hip fracture.

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          Most cited references 32

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

          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.
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            World-wide projections for hip fracture.

            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.
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              The incidence of hip fracture in four Asian countries: the Asian Osteoporosis Study (AOS).

              The Asian Osteoporosis Study (AOS) is the first multicenter study to document and compare the incidence of hip fracture in four Asian countries. Hosital discharge data for the year 1997 were obtained for the Hong Kong SAR, Singapore, Malaysia and Thailand (Chiang Mai). The number of patients who were 50 years of age and older and who were discharged with a diagnosis of hip fracture (ICD9 820) was enumerated. The age-specific incidence rates were deduced and were directly adjusted to the US white population in 1989. The age-adjusted rates for men and women (per 100,000) are as follows: Hong Kong, 180 and 459; Singapore, 164 and 442; Malaysia, 88 and 218; Thailand, 114 and 289; compared with US White rates of 187 in men and 535 in women, published in 1989. We conclude that there is moderate variation in the incidence of hip fracture among Asian countries. The rates were highest in urbanized countries. With rapid economic development in Asia, hip fracture will prove to be a major public health challenge.

                Author and article information

                [a ]Department of Pharmacology and Pharmacy, Centre for Genomic Sciences, The University of Hong Kong, Pokfulam, Hong Kong, China
                [b ]The Osteoporosis Society of Hong Kong, Hong Kong, China
                [c ]Family Medicine Service and Menopause Unit, KK Women's and Children's Hospital, Singapore
                [d ]Osteoporosis Society Singapore, Singapore
                [e ]P. D. Hinduja Hospital, Mumbai, India
                [f ]Indian Society for Bone Mineral Research, India
                [g ]Department of Medicine & Geriatrics, Tuen Mun Hospital, Tuen Mun, Hong Kong, China
                [h ]Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, South Korea
                [i ]Korean Society of Osteoporosis, South Korea
                [j ]Department of Medicine, Subang Jaya Medical Centre, Selangor, Malaysia
                [k ]Malaysian Osteoporosis Society, Malaysia
                [l ]Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
                [m ]Thai Osteoporosis Foundation, Thailand
                [n ]Department of Internal Medicine, Centro Hospitalar Conde S. Januário, Macau, China
                [o ]Osteoporosis Society of Macau, Macau, China
                [p ]Toranomon Hospital Endocrine Center, Tokyo, Japan
                [q ]Japan Osteoporosis Society, Japan
                [r ]Department of Family Medicine, Institute of Gerontology, National Cheng Kung University Hospital, Tainan, Taiwan
                [s ]The Taiwanese Osteoporosis Association, Taiwan
                [t ]Department of Endocrinology, Key Laboratory of Endocrinology of Minister of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
                [u ]Chinese Society of Osteoporosis and Bone Mineral Research, Chinese Medical Association, China
                [v ]Section of Rheumatology, Department of Medicine, University of Santo Tomas Faculty of Medicine and Surgery, Espana, Manila, Philippines
                [w ]The Osteoporosis Society of the Philippines Foundation, Inc, Philippines
                [x ]Health Management & Promotion Center, Hiroshima Atomic Bomb Casualty Council, Hiroshima, Japan
                Author notes
                []Corresponding author. Health Management & Promotion Center, Hiroshima Atomic Bomb Casualty Council, Hiroshima, Japan. s-fujiwara@ saeko737@
                Osteoporos Sarcopenia
                Osteoporos Sarcopenia
                Osteoporosis and Sarcopenia
                Korean Society of Osteoporosis
                22 March 2018
                March 2018
                22 March 2018
                : 4
                : 1
                : 16-21
                © 2018 The Korean Society of Osteoporosis. Publishing services by Elsevier B.V.

                This is an open access article under the CC BY-NC-ND license (

                Original Article

                incidence, hip fracture, asia, osteoporosis


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