In Asia the disease is greatly underdiagnosed and undertreated, this is especially acute in rural areas particularly in China and India where massive populations live predominantly in those rural areas. Given the lack of access to diagnostic equipment it suggests that the number of cases may be higher in these areas. It also suggests, perhaps predictably, that the cases are far higher in poorer nations than in wealthier. Studies across South and South east Asia showed there is widespread vitamin D deficiency and nearly all Asian countries fall below the WHO recommendation for daily calcium intake.
Similar issues are at work in Latin America the local issues are exacerbated by the number of people living in rural areas, the number of people living in poverty and the difficulty of getting access to equipment to get a full diagnosis. This pattern is repeated across areas of the world where there are a similar raft of social issues. These problems are encapsulated in Brazil, where just 1 in 3 hip fracture patients are identified as having osteoporosis and of those only 1 in 5 receive any kind of treatment.
The familiar tale of large rural populations, poverty and lack of equipment is repeated in Africa and the Middle east. Additionally, despite ample sunshine there is widespread vitamin D deficiency. This causes a variety of issues, for example rickets is highly prevalent in these areas. As a result, low bone mass is higher here than in western counties. It is also estimated that mortality after a hip fracture is 3 times higher in the Middle East and Africa than in Europe.
Even given the access to medical equipment and the relative wealth of the nations in the western world osteoporosis is still a considerable financial burden the health services have to consider. In Australia and New Zealand alone the annual bill for the effects of osteoporosis are in the region of $10 billion. In Canada and North America there are estimated to be 12 million people effected by osteoporosis with the costs associated with such a large percentage of the population effected. In EU in 2019 it was reported there were 248,487 deaths due to fracture events.
We can see in this quick snapshot that this is a health, wellbeing, financial and political issue that affects countries right across the globe. Fixing osteoporosis needs a holistic general health approach so fixing the diagnostic and healthcare issues around the world will take a political solution. Fortunately the WHO take osteoporosis seriously and have released several reports hoping to tackle the problem in developing nations.
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