Asia occupies 30% of the worlds landmass and contains 60% of the worlds population encompassing a wide diversity of people and demographics. It has been estimated that by 2050, half of all hip fractures in women >65 years of age will occur in Asia. Hip fracture incidence rates among women vary widely in Asian populations, from as low as 100 up to 500 per 100 000. Within the space of 1 to 3 decades in several countries, hip fracture incidence rates have risen dramatically, constituting an increasing health problem. As in the rest of the world, osteoporosis is under-diagnosed and under-treated in Asia.
FRAX is a computer-based tool which estimates the 10-year probability of major and hip fractures using easily obtained clinical risk factors, with an option to input femoral neck bone mineral density to enhance fracture risk prediction. The recent data that relates high fracture probability with FRAX to densitometric osteoporosis may have important clinical implications in Asia where, except in a few countries, access to bone densitometers is limited.
The FRAX model has been calibrated based on fracture and mortality data for China, Hong Kong, Japan, Philippines, Singapore, South Korea, Sri Lanka, Taiwan, Jordan and Lebanon, and is a work in progress. Unfortunately, there is a lack of epidemiological data from other Asian countries to enable wider calibration. Although using available FRAX models in countries without fracture data may not be suitable, it may be possible to extrapolate fracture risk in neighbouring countries with similar ethnicities and levels of development. Country-specific threshold risk levels for intervention have yet to be established in Asia as health care systems, reimbursement and wealth differ between countries and from the West.
Despite such limitations, with increasing connectivity and easy accessibility, FRAX may prove a useful tool in addressing osteoporosis in Asia.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.