An Increase In Fragility Fractures In Latin America
New IOF Audit compiles epidemiological data and quantifies burden; warns of impending explosion in number of fractures as ageing population surges
The International Osteoporosis Foundation (IOF), in cooperation with medical and patient societies from throughout Latin America, has today published a landmark report which compiles osteoporosis-related data on 14 countries and the region as a whole. The report shows that fragility fractures due to osteoporosis are predicted to more than double in some countries in the coming decades.
Osteoporosis, which literally means ℠porous bones´, is a disease which causes bones to become fragile and more likely to break. Older adults, and post-menopausal women in particular, are the population groups most susceptible to fractures caused by osteoporosis.
One of the key findings of the report ℠Latin America Audit: Epidemiology, Costs and Burden of Osteoporosis in 2012´ is the expected increase in the ageing population. In the 14 countries examined in the report, between 13 and 29 per cent of the current population is aged 50 years and older. By 2050, these estimations will increase from between 28 to 49 per cent. More significantly, the percentage increase in the 70 and over population will average 280%. Due to continued advances in healthcare, the developing nations highlighted in the Audit are expected to have, on average, life expectancy increases of six years by the year 2050. The impact of these ageing populations will undoubtedly include an increase in the percentage of the population diagnosed with osteoporosis and an increase in the number of people with related fragility fractures. Other age-related chronic diseases of the musculoskeletal system, such as osteoarthritis, will also be on the rise.
“Personal suffering and disability are just one side of the coin,” said Professor JosÃ© Zanchetta, lead author of the report, head of the Metabolic Research Institute and Professor of Osteology at the USAL University in Buenos Aires. “Vertebral and hip fractures caused by osteoporosis also have a wider socio-economic impact on health care systems and communities. Hip fractures are not only costly to treat, but as a result of these fractures many seniors who would otherwise live independent, productive lives will either die prematurely or become dependent on their families or spend the rest of their lives in nursing homes.”
The Latin America Audit, which includes data from Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Cuba, Guatemala, Mexico, Nicaragua, Panama, Peru, Uruguay, and Venezuela, had many key findings, including;
The majority of the countries represented in the audit can expect at least a doubling if not a tripling of their 70 and over populations by the year 2050.
A study in Bogota, Colombia found that in a group of women 50 years of age or older, 15.7% and 11.4% had osteoporosis at the spine and proximal femur (hip) respectively. As many as 49.7% and 47.5% had osteopenia (lower than normal bone density) at the same sites respectively.
Based on the Latin American Vertebral Osteoporosis Study (LAVOS) which included five countries in the region (Argentina, Brazil, Colombia, Mexico and Puerto Rico), overall vertebral fracture prevalence rate of 14.77% was found for all ages and countries combined. The prevalence rate reached as high as 38% in women 80 years and over.
Data from Argentina revealed an annual rate for hip fractures as high as 488 per 100,000 for the over 50 population.
Osteoporosis guidelines are available in nine of the 14 countries, but none, with the exception of Bolivia and Cuba, are government approved.
Access to DXA machines for the diagnosis of osteoporosis is limited to urban areas and private clinics in the majority of the countries in the region. Machine availability estimates range from 1-10 per 1 million inhabitants.
A general lack of prevalence data on osteopenia, osteoporosis and fracture rates.
Currently, only Argentina, Colombia, Ecuador and Mexico have an online WHO Fracture Risk Assessment (FRAX) calculator. FRAX, which can be used freely online to calculate individual 10-year fracture risk, is particularly useful in countries where access to DXA is limited.
Available evidence reveals an abundance of vitamin D insufficiency or deficiency throughout Latin America. Vitamin D is essential for bone and muscle health at all ages.
Access to diagnostics and care, as well as reimbursement, is highly variable, particularly in regard to urban versus rural settings.
Speaking at the launch of the Audit in Sao Paulo, Brazil, IOF President Professor John A. Kanis noted, “As this Audit report confirms, two core problems are the lack of reliable data and the fact that health care authorities are not addressing the far-reaching consequences of undiagnosed and untreated osteoporosis.” He added, “With advances in life expectancy and growing ageing populations, health care authorities in Latin America must give increased attention to the costly chronic diseases which will have such a profound impact on their communities in the near future.”
Following the launch of the Audit national IOF member societies in the region will meet to discuss efforts to implement the recommendations of the Audit.
“This Audit serves as a call to action for collaborative efforts to be sustained between national osteoporosis societies, key opinion leaders, academic institutions, policy makers and government bodies throughout Latin America,” said Professor Patricia Clark, rheumatologist and Head of the Clinical Epidemiology Unit, Hospital Infantil de Mexico-Faculty of Medicine UNAM, Mexico City. “There is an urgent need to gather solid epidemiological data, improve awareness and education, put in place effective preventive strategies, and improve availability of diagnostic tests and affordable medication to stop the fragility fracture cascade. Only with collaborative and focused strategies can the care gap be closed.”
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