High Prevalence of Osteoporosis and Fractures in Mainland China

A recent cross-sectional study of an adult population in mainland China found that the prevalence of osteoporosis and vertebral fracture were high in the adult population ≥40 years old. Vertebral fracture and clinical fracture were similarly high in men and women.

In the study, investigators led by Linhong Wang, MD, wrote that the aging population in China and the world at large are associated with an increasing burden of fractures.

Additionally, a previous study reported that the prevalence of vertebral fractures among women in Beijing ranged from 13% among those aged 50-59 years to more than 50% among women older than 80 years.

However, 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.

Because of this, Wang and colleagues conducted the China Osteoporosis Prevalence Study, a national population- based screening project of men and women aged 20 years or older from representative regions and urban and rural areas in China that assessed the prevalence of osteoporosis, clinical fractures, and vertebral fractures in a population in mainland China.

The Study

Wang and investigators conducted the cross-sectional study in China from December 2017 to August 2018.

The China Osteoporosis Prevalence Study enrolled a representative sample of 20,416 participants aged 20 years or older from mainland China, specifically urban and rural areas.

From there, trained interviewers administered a standardized questionnaire including information for demographic characteristics, medical history, and risk factors during in-person interviews.

Finally, the team performed multivariable linear regression to investigate factors associated with BMD in the lumbar spine, femoral neck, and total hip.

Multivariable logistic regression was used to investigate factors associated with vertebral fracture of grade 2 or higher and clinical fracture in the past 5 years. Treatment rate and current use of anti-osteoporosis treatment were include in the study.

The Findings

The peak mean (SD) bone mineral density (BMD) at the lumbar spine (L1 to L4), femoral neck, and total hip were 1.00 (0.12) g/cm², 0.87 (1.41) g/cm², and 0.92 (0.14) g/cm², respectively, for men and 1.04 (0.13) g/cm², 0.82 (0.13) g/cm², and 0.89 (0.13) g/cm², respectively, for women.

The peak BMD in men was reached at 20-29 years of age at all measured sites, and the peak BMD in women was reached at 30-39 years of age in the lumbar spine and 20-29 years of age in the femoral neck and total hip.

Overall, the prevalence of osteoporosis was 20.6% among women aged 40 years or older and 5.0% among men 40 years or older.

To the investigators’ knowledge, the cross-sectional study conducted was the largest nationwide, population-based study of BMD, osteoporosis and fracture prevalence in mainland China.

Unlike previous studies, the recent data suggested similar rates of osteoporosis and fracture in all age groups nationwide.

Wang and colleagues believed that the prevalence of osteoporosis and fracture would increase over time due to an aging population in China. As such, they believed their study could provide greater insight into the management of these conditions.

“Current policies regarding osteoporotic fracture prevention in many countries have mainly focused on postmenopausal women, but our data highlighted the importance of early recognition of high risk of fracture in both men and women based on risk factors and not just BMD,” the team wrote. “Specifically, promotion of appropriate weight management and reducing the risk of falls should be public health priorities. This study may provide the information for future guideline development and public policy formulation in China.”

The study, “Prevalence of Osteoporosis and Fracture in China :The China Osteoporosis Prevalence Study,” was published online in JAMA Open Network.