Burden of Osteoporosis in the Countries of the Eurasian Region

The public health burden of osteoporosis estimated by the results of clinical and population-based researches in most of the former USSR is uncertain for today. The objective of this audit (Audit-2020) was the epidemiological, medico-social and economic analyse of current and future osteoporosis challenges for the future years for eight countries of the Eurasian region.

Methods. We did a search and critical analysis of the publications, including of regional in English, Russian or national languages, did organize a structured survey among national osteoporosis societies members in Armenia, Belarus, Georgia, Kazakhstan, Moldova, Uzbekistan, Kyrgyz Republic, Russia, as well as explored the demographic trends in these countries.

Results. Scientific researches including the wide population-based EVA project discovered that the expected number of patients with osteoporosis varies from 240,000 in Armenia to 16 million in Russia. All the countries should be categorized as a moderate risk of hip fractures for women (200–300 cases /100,000 per year). Belarus, Moldova, Armenia, Georgia and Kyrgyzstan have moderate risk for men (100–150/100,000), as well as Russia, Uzbekistan and Kazakhstan are distinguished by a high risk for men (over 150 cases/100,000). Population aging trends are predicting the future growth in the osteoporosis-associated health challenges throughout the region. It is likely the number of osteoporotic fractures to rise in Uzbekistan, Kazakhstan and Kyrgyzstan the most: 2.5–3.5 times by 2050. However current hospitalization rates for hip fracture persons are low in most countries (33–80%), the diagnostic equipment is insufficient (0.2–1.3 per million), DXA testing are expensive. Although modern treatments are available, the cure expenses remain high. Hereby, immediate action is required in each country of audit, including admit osteoporosis is a priority public health problem.

Conclusion. Osteoporosis is a challenge for the countries of the Eurasian region. Its burden is about to get worse due to the expected demographic changes.

1. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. World Health Organ Tech Rep Ser. 1994; 843: 1‐129.

2. Svedbom A, Borgstöm F, Hernlund E, et al. Quality of life for up to 18 months after low-energy hip, vertebral, and distal forearm fractures — results from the ICUROS. Osteoporos Int. 2018;29(3):557-566. doi: https://doi.org/10.1007/s00198-017-4317-4

3. Harvey N, Dennison E, Cooper C. Osteoporosis: impact on health and economics. Nat Rev Rheumatol. 2010;6(2):99-105. doi: https://doi.org/10.1038/nrrheum.2009.260

4. IOF COMPENDIUM OF OSTEOPOROSIS. Доступно по: http://www.worldosteoporosisday.org/sites/default/WOD-2019/resources/compendium/2019-IOF-Compendium-of-Osteoporosis-WEB.pdf. Ссылка активна на: 01.11.2020.

5. Audit sostoyaniya problemy osteoporoza v stranah vostochnoj Evropy i Central’noj Azii 2010. Available from: https://www.osteoporosis.foundation/sites/iofbonehealth/files/2019-06/2010_Eastern_European_Central_Asian_Audit_Russian.pdf (assess 01.11.2020).

6. Lesnyak OM. Audit sostoyaniya problemy osteoporoza v stranakh vostochnoy Evropy i tsentral’noy Azii 2010. Osteoporosis and Bone Diseases. 2011;14(2):3-6. (In Russ.). doi: https://doi.org/10.14341/osteo201123-6

7. United Nations, Department of Economic and Social Affairs, Population Division (2017). World Population Prospects: The 2017 Revision, DVD Edition. Доступно по: https://www.un.org/development/desa/publications/world-population-prospects-the-2017-revision.html. Ссылка активна на: 01.11.2020.

8. Mihajlov EE, Benevolenskaya LI. Epidemiologiya osteoporoza i perelomov. In: Rukovodstvo po osteoporozu. Ed. by LI Benevolenskaja. Moscow: BINOM. Laboratoriya znanij; 2003:10-55. (In Russ.).

9. Lesnyak O, Ershova O, Belova K, et al. Epidemiology of fracture in the Russian Federation and the development of a FRAX model. Arch Osteoporos. 2012;(7):67-73. doi: https://doi.org/10.1007/s11657-012-0082-3

10. Evstigneeva LP, Piven’ AI. Epidemiologiya osteoporoticheskih perelomov pozvonochnika po dannym rentgenomorfometricheskogo analiza sredi populyacionnoj vyborki zhitelej g. Ekaterinburga 50 let i starshe. Osteoporosis and Bone Diseases. 2001:2:2-6 (In Russ.).

11. Gladkova EN, Khodyrev VN, Lesnyak OM. An epidemiological survey of osteoporotic fractures in older residents from the Middle Urals. Rheumatol Sci Pract. 2014;14(6):643-649. (In Russ.). doi: https://doi.org/10.14412/1995-4484-2014-643-649

12. Lesnyak O, Sahakyan S, Zakroyeva A, et al. Epidemiology of fractures in Armenia: Development of a country-specific FRAX model and comparison to its surrogate. Arch Osteoporos. 2017;12(1):98. doi: https://doi.org/10.1007/s11657-017-0392-6

13. Ramanau H, Chernyanin I, Rudenka E, et al. Epidemiology of hip fracture in Belarus: development of a country-specific FRAX model and its comparison to neighboring country models. Arch Osteoporos. 2018;13:42. doi: https://doi.org/10.1007/s11657-018-0454-4

14. Zakroyeva A, Lesnyak O, Cazac V, et al. Epidemiology of osteoporotic fracture in Moldova and development of a country specific FRAX model. Arch Osteoporos. 2020;15:13. doi: https://doi.org/10.1007/s11657-019-0669-z

15. Issayeva S, Lesnyak O, Zakroyeva A, et al. Epidemiology of osteoporotic fractures in the Republic of Kazakhstan and the development of country specific FRAX model. Arch Osteoporos. 2020;15(1):30. doi: https://doi.org/10.1007/s11657-020-0701-3

16. Lesnyak O, Ismailov S, Shakirova M., et al. Epidemiology of hip fracture and the development of a FRAX model for Uzbekistan. Arch Osteoporos. 2020;15(1):119 doi: https://doi.org/10.1007/s11657-020-00792-7

17. Kanis J, Odén A, Mccloskey E, et al. A systematic review of hip fracture incidence and probability of fracture worldwide on behalf of the IOF Working Group on Epidemiology and Quality of Life. Osteoporos Int. 2012;23:2239-2256.

18. Ershova OB, Belova KYu, Degtyarev AA, et al. Analysis of mortality in patients with a fracture of the proximal femur. Osteoporosis and Bone Diseases. 2015;18(3):3-8. (In Russ.). doi: https://doi.org/10.14341/osteo201533-8

19. Raskina TA, Averkieva YV. Letal’nost’ pri perelomah shejki bedra v starshej vozrastnoj gruppe zhitelej Kemerovo kak obosnovanie neobhodimosti medikamentoznoj profilaktiki osteoporoza. Sovremennaya revmatologiya. 2011;(1):39-46 (In Russ.).

20. Raskina TA, Averkieva YuV. Iskhody pri perelomakh bedra u lits starshei vozrastnoi gruppy g. Kemerovo v zavisimosti ot taktiki vedeniya bol’nykh. Sibirskii meditsinskii zhurnal. 2011;1:151-154 (In Russ.).

21. Kryukova IV, Marchenkova LA, Gerasimenko MY. Sravnitel’naya ocenka kachestva okazaniya rannej medicinskoj pomoshchi bol’nym s perelomami proksimal’nogo otdela bedra v Moskovskoj oblasti. Osteoporosis and Bone Diseases. 2016;19(2):24-25. (In Russ.). doi: https://doi.org/10.14341/osteo2016224-25

22. Belova KY, Ershova OB. Organizaciya medicinskoj pomoshchi pacientam s tyazhelym osteoporozom. Krasnoyarsk: Nauchno-innovacionnyj centr; 2016. 162 р. (In Russ.).

23. IOF Capture the Fracture https://capturethefracture.org/map-ofbest-practice. Ссылка активна на 10.11.2020.

24. Giorgadze E, Tsagareli M, Lomidze M, et al. Recommendations by Georgian association of skeletal metabolic diseases on the initiation of treatment with use of age-dependent intervention threshold based on frax in patients with osteoporosis. Georgian Med News. 2019;291:89-93.

25. Lesnyak O, Zakroyeva A, Lobanchenko O, et al. A surrogate FRAX model for the Kyrgyz Republic. Zmijewski M, ed. Arch Osteoporos. 2020;15(1):68. doi: https://doi.org/10.1007/s11657-020-00743-2

26. Kanis JA, Johnell O. Requirements for DXA for the management of osteoporosis in Europe. Zmijewski M, ed. Osteoporos Int. 2005;16(3):229-238. doi: https://doi.org/10.1007/s00198-004-1811-2

27. Toropcova NV, Lesnyak OM, Dobrovol’skaya OV. Ekonomicheskie aspekty oslozhnennogo osteoporoza: stoimost’ lecheniya v techenie pervogo goda posle pereloma. Sovremennaya revmatologiya. 2016;10(3):29-34 (In Russ.).