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. 2021 Aug 2;4(8):e2121106.
doi: 10.1001/jamanetworkopen.2021.21106.

Prevalence of Osteoporosis and Fracture in China: The China Osteoporosis Prevalence Study

Linhong Wang  1 , Wei Yu  2 , Xiangjun Yin  3 , Lijia Cui  4 , Shunyu Tang  3 , Ning Jiang  4 , Lu Cui  3 , Nan Zhao  5 , Qiang Lin  2 , Lin Chen  6 , Hua Lin  7 , Xiaolan Jin  8 , Zhong Dong  9 , Zeping Ren  10 , Zhulin Hou  11 , Yongqing Zhang  12 , Jieming Zhong  13 , Shunxiang Cai  14 , Yuan Liu  15 , Ruilin Meng  16 , Ying Deng  17 , Xianbin Ding  18 , Jingang Ma  19 , Zhongjian Xie  20 , Lin Shen  21 , Wen Wu  22 , Mengmeng Zhang  23 , Qifeng Ying  24 , Yuhong Zeng  25 , Jin Dong  26 , Steven R Cummings  27 , Zhixin Li  1 , Weibo Xia  4
Affiliations

Prevalence of Osteoporosis and Fracture in China: The China Osteoporosis Prevalence Study

Linhong Wang et al. JAMA Netw Open. .

Abstract

Importance: The aging of the population is associated with an increasing burden of fractures worldwide. However, the epidemiological features of fractures in mainland China are not well known.

Objective: To assess the prevalence of and factors associated with osteoporosis, clinical fractures, and vertebral fractures in an adult population 40 years or older in mainland China.

Design, setting. and participants: This cross-sectional study, the China Osteoporosis Prevalence Study, was conducted from December 2017 to August 2018. A random sample of individuals aged 20 years or older who represented urban and rural areas of China were enrolled, with a 99% participation rate.

Main outcomes and measures: Weighted prevalence of osteoporosis, clinical fracture, and vertebral fracture by age, sex, and urban vs rural residence as determined by x-ray absorptiometry, questionnaire, and radiography.

Results: A total of 20 416 participants were included in this study; 20 164 (98.8%; 11 443 women [56.7%]; mean [SD] age, 53 [13] years) had a qualified x-ray absorptiometry image and completed the questionnaire, and 8423 of 8800 (95.7%) had a qualified spine radiograph. The prevalence of osteoporosis among those aged 40 years or older was 5.0% (95% CI, 4.2%-5.8%) among men and 20.6% (95% CI, 19.3%-22.0%) among women. The prevalence of vertebral fracture was 10.5% (95% CI, 9.0%-12.0%) among men and 9.7% (95% CI, 8.2%-11.1%) among women. The prevalence of clinical fracture in the past 5 years was 4.1% (95% CI, 3.3%-4.9%) among men and 4.2% (95% CI, 3.6%-4.7%) among women. Among men and women, 0.3% (95% CI, 0.0%-0.7%) and 1.4% (95% CI, 0.8%-2.0%), respectively, with osteoporosis diagnosed on the basis of bone mineral density or with fracture were receiving antiosteoporosis treatment to prevent fracture.

Conclusions and relevance: In this cross-sectional study of an adult population in mainland China, the prevalence of osteoporosis and vertebral fracture were high and the prevalence of vertebral fracture and clinical fracture was similarly high in men and women. These findings suggest that current guidelines for screening and treatment of fractures among patients in China should focus equally on men and women and should emphasize the prevention of vertebral fractures.

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Conflict of interest statement

Conflict of Interest Disclosures: Drs Wang, Yu, Yin, Lijia Cui, Tang, and Jiang; Ms Lu Cui; Drs Zhao, Q. Lin, Chen, H. Lin, and Jin; Ms Z. Dong; Ms Ren; Mr Hou; Ms Y. Zhang; Mr Zhong; Mr Cai; Drs Liu, Meng, and Deng; Mr Ding; Drs Ma and Xie; Mr Wu; Ms M. Zhang; Drs Zeng and J. Dong; Mr Li; and Dr Xia reported receiving grants from the Chinese Central Government Key Project of Public Health Program and grants from the Chinese Red Cross Foundation during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Flowchart of Participant Selection
A multistage stratified cluster random sampling method was used in the study to enroll a sample of people who would be representative of adults in China. Details are given in the Study Design and Participants subsection of the Methods section. BMD indicates bone mineral density; DXA, dual x-ray absorptiometry; and PPS, probability proportionate to size.
Figure 2.
Figure 2.. Prevalence of Fracture in the Population Aged 40 Years or Older in China
Vertebral fracture was defined on the basis of findings of radiography of the thoracic and lumbar spine. Clinical fracture in the past 5 years was defined on the basis of questionnaire response.
See this image and copyright information in PMC

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