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Osteoporosis cases to rise with growth in elderly population

June 19, 2017

ISLAMABAD: Warning that Pakistan’s 30 per cent population crossing 50 years of age by 2050 will be vulnerable to osteoporosis, according to a report on Sunday.

The ‘Asia-Pacific Regional Audit’ report says the steep growth curve occurring in just a few decades poses a tremendous challenge to the government as well as an opportunity to care for the elderly.

Conducted by the International Osteoporosis Foundation, the report says in just over a decade, by 2025, the number of people aged over 50 years in Pakistan, will increase by 50 per cent, from 24.8 million to 37.3 million, and increase again by 134 per cent to 87.2 million by 2050.

The disease is a significant public health problem in country, but not a national health priority, says a report

The audit of 16 Asia-Pacific countries, including Pakistan, says that Asia is well below the FAO-WHO recommendation of 1,000mg to 1,300mg per day. Most Asian countries have seen a two-to-three times increase in the incidence of hip fracture during the past 30 years.

Osteoporosis is a disease in which density and quality of bone are reduced, leading to weakness of skeleton and increased risk of fracture, particularly of spine, wrist, hip, pelvis and upper arm. Osteoporosis and associated fractures are an important cause of mortality and morbidity.

Osteoporosis-related bone fractures are a significant public health problem in Pakistan. The prevalence of osteoporosis in Pakistan is high, as observed in several studies measuring bone mineral density using ultrasound.

However, osteoporosis is not a national health priority in Pakistan at present and currently there are no clinical guidelines regarding the public health problem, notes the report. It is mostly managed by primary care physicians and orthopaedic surgeons in the country. Other physicians who are responsible for osteoporosis patients are: rheumatologists, gynaecologists and rehabilitation medicine physicians.

Traditionally in Pakistan, osteoporosis has primarily been considered a natural consequence of ageing. In a country where life expectancy is only 67 years and only 6.4 per cent of the population is aged over 60 years, it naturally has not figured high on the list of priorities.

Additionally, the country’s financial resources are limited. The total expenditure on health in 2011 was 2.5 per cent of GDP, and the government expenditure was only 27 per cent of total expenditure. Besides, the priority of international donor agencies in Pakistan is not osteoporosis, but other health issues such as HIV/AIDS, polio, maternal and child health.

The Pakistan Society for the Rehabilitation of the Disabled, a leading provider of orthopaedic, medical and surgical health care and rehabilitation, estimates that 50 to 75 per cent of hip fracture cases are treated surgically in the urban areas. The average waiting time for surgery is two to three days once the patient has entered the tertiary health care system, which may be altered depending on the age and health of the patient.

The cases of osteopenia have been observed in younger and premenopausal Pakistani women, who are likely to be at greater risk of developing osteoporosis in later life. There are different factors that may contribute to this, including poor nutrition, and low vitamin D and exercise levels.

The audit report recommends establishment of a fracture registry to compile a list of high risk patients and patients with hip fractures and other fragility fractures. The registry will help to develop prevention and treatment parameters for osteoporosis.

Expanding osteoporosis awareness among the rural communities through the existing rural health project will help in spreading awareness of the disease to more remote areas of the country.

Increasing overall efforts to raise awareness about osteoporosis so that effective steps can be taken to prevent the first and subsequent fractures is imperative, particularly with life expectancy gradually increasing from 61 years in 1990 to: 67 years in 2011; 70 years in 2025; and 77 years in 2050.

Supporting patients with the goal of improving the quality of life of those living with the disease will help to ease the burden on the patient and family system, the report suggests.

Published in Dawn, June 19th, 2017