Prevalence of Osteoporosis and Fracture in China

Lınhong Wang ,Lin Chen,Zhongjian Xie,Zhixin Li,Wei Yu,Steven R Cummings,Yuhong Zeng,Xiaolan Jin,Ruilin Meng,Qian Lin ,Xianbin Ding,Jieming Zhong,Jin Song Dong ,Ning Jiang,Shunyu Tang,Xiangjun Yin,Wen Wang ,Mengmeng Zhang,Dong Zhao ,Zhulin Hou,Zeping Ren,Hua Lin,Nan Zhao,Jingang Ma,Yuan Liu,Lijia Cui,Lü Cui ,Qifeng Ying,Yongqing Zhang,Ying Deng,Shun-Xiang Cai ,Lin Shen,Weibo Xia

doi:10.1001/jamanetworkopen.2021.21106

Abstract

The aging of the population is associated with an increasing burden of fractures worldwide. However, the epidemiological features of fractures in mainland China are not well known. To assess the prevalence of and factors associated with osteoporosis, clinical fractures, and vertebral fractures in an adult population 40 years or older in mainland China. This cross-sectional study, the China Osteoporosis Prevalence Study, was conducted from December 2017 to August 2018. A random sample of individuals aged 20 years or older who represented urban and rural areas of China were enrolled, with a 99% participation rate. Weighted prevalence of osteoporosis, clinical fracture, and vertebral fracture by age, sex, and urban vs rural residence as determined by x-ray absorptiometry, questionnaire, and radiography. A total of 20 416 participants were included in this study; 20 164 (98.8%; 11 443 women [56.7%]; mean [SD] age, 53 [13] years) had a qualified x-ray absorptiometry image and completed the questionnaire, and 8423 of 8800 (95.7%) had a qualified spine radiograph. The prevalence of osteoporosis among those aged 40 years or older was 5.0% (95% CI, 4.2%-5.8%) among men and 20.6% (95% CI, 19.3%-22.0%) among women. The prevalence of vertebral fracture was 10.5% (95% CI, 9.0%-12.0%) among men and 9.7% (95% CI, 8.2%-11.1%) among women. The prevalence of clinical fracture in the past 5 years was 4.1% (95% CI, 3.3%-4.9%) among men and 4.2% (95% CI, 3.6%-4.7%) among women. Among men and women, 0.3% (95% CI, 0.0%-0.7%) and 1.4% (95% CI, 0.8%-2.0%), respectively, with osteoporosis diagnosed on the basis of bone mineral density or with fracture were receiving antiosteoporosis treatment to prevent fracture. In this cross-sectional study of an adult population in mainland China, the prevalence of osteoporosis and vertebral fracture were high and the prevalence of vertebral fracture and clinical fracture was similarly high in men and women. These findings suggest that current guidelines for screening and treatment of fractures among patients in China should focus equally on men and women and should emphasize the prevention of vertebral fractures.

Highlights

Fractures are associated with a substantial burden on health systems that increases with the increasing number of older adults.[1]
0.3% and 1.4%, respectively, with osteoporosis diagnosed on the basis of bone mineral density or with fracture were receiving antiosteoporosis treatment to prevent fracture
In this cross-sectional study of an adult population in mainland China, the prevalence of osteoporosis and vertebral fracture were high and the prevalence of vertebral fracture and clinical fracture was high in men and women

Summary

Introduction

Fractures are associated with a substantial burden on health systems that increases with the increasing number of older adults.[1]. A previous study[5] showed that vertebral fractures are common in women in Beijing, China. Defining fractures on the basis of the reduction of vertebral heights on lateral radiographs of the thoracic and lumbar spine,[6] a study reported that the prevalence of vertebral fractures among women in Beijing ranged from 13% among those aged 50 to 59 years to more than 50% among women older than 80 years.[5] to our knowledge, there have been no nationwide community-based studies on the epidemiological characteristics of osteoporosis and osteoporotic fracture in China that have included men and women in urban and rural areas.[3]

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Discussion

Conclusion