Prevalence of osteoporosis and its spatiotemporal patterns in a community-dwelling Chinese population: a systematic review and meta-analysis of data from 982 563 individuals

Abstract

BackgroundOsteoporosis is becoming a common skeletal disorder characterised by reduced bone strength that leads to an increased risk for fractures. Despite its increasing prevalence among the Chinese population, osteoporosis remains both underdiagnosed and undertreated. Many observational studies have reported prevalence of osteoporosis in China; however, the estimated prevalence varies within a certain range because of the diverse ways of life and diverse genetic heritage of the populations in different Chinese regions, and few studies have examined the sex-specific prevalence of osteoporosis in China across time. We did a systematic review and meta-analysis to compare the prevalence and temporal trends of osteoporosis in Chinese women and men. MethodsIn accordance with MOOSE and PRISMA, we did literature searches in PubMed, MEDLINE, Embase, the China National Knowledge Infrastructure, and the Chinese WanFang databases for epidemiological studies that reported osteoporosis prevalence in Chinese individuals from their inception to Jan 31, 2020, without language restrictions. Studies were considered eligible if they reported sufficiently detailed results about prevalence of osteoporosis among Chinese individuals aged at least 18 years, and if they used either WHO or Chinese criteria for osteoporosis diagnosis. Studies were excluded if they were reviews, case reports, editorials, guidelines, and other article forms without available full-texts, if they were duplicate papers or evaluating the same sample, and if the studies were done in a population with other specific diseases. We assessed prevalence of osteoporosis using a random-effects model by applying binomial distribution and Freeman-Tukey double arcsine transformation to stabilise the variances, and the pooled Freeman-Tukey prevalence estimates were then back transformed to their original scale for ease of interpretation. We also did a subgroup analysis by sex, age, region, and screening period. FindingsWe identified 129 eligible studies that included 982 563 individuals. The overall prevalence of osteoporosis in China was 20·80% (95% CI 17·95–23·79). Its prevalence was higher in women (23·57%, 18·50–29·04) than in men (12·22%, 7·23–18·29), and in rural (23·06%, 16·80–29·99) than urban regions (20·95%, 17·09–25·09). From 2001–05 to 2016–19, prevalence of osteoporosis progressed steadily from 19·35% (14·86–24·28) to 21·30% (17·17–25·73) in 2006–10 and 22·61 (19·27–26·12) to 23·58% (17·08–30·78) in 2011–15. In terms of temporal stratification, the prevalence increased with age in both sexes, with a greater rise in women from age 50–59 (10·22%) years to 80 years and older (62·24%) than in men of the same age groups (from 5·62% to 30·55%). In terms of regional stratification, the pooled prevalence estimates were higher among Chinese individuals in the south, north, and southwest (prevalence of more than 25%) by a factor of 1·5, compared with their counterparts in the northeast of China. Regional prevalence of osteoporosis ranged from 25·78% (19·79–32·26) in the south, 22·55% (14·32–32·02) in the east, 19·60% (13·25–26·85) in the northwest, and 17·33% (11·23–24·44) in the northeast. InterpretationThis up-to-date meta-analysis provides a comprehensive overview of the burden of osteoporosis among Chinese women and men. Our findings suggest a considerable prevalence of osteoporosis, especially in older Chinese women. Our findings also emphasise the urgent need for control measures and preventive management of osteoporosis because of a rapidly ageing population in China. FundingNational Natural Science Foundation of China (81803329) and China Postdoctoral Science Foundation (2018M631780).