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Osteoporosis and Fractures Are Under-Recognized Among Asians

There is a growing concern about osteoporosis and fractures among Asian populations. Although milk products can help prevent osteoporosis, they are under-consumed by these population groups.


  • The burden of osteoporosis and fractures among Asians is severely under-estimated;
  • It is estimated that more than 50% of all hip fractures worldwide will occur in Asia by 2050 due to rapidly aging populations;
  • Over the past 30 years, a 2- to 3-fold increase in the incidence of hip fractures has been observed in Asian countries;
  • Although milk product consumption can help counteract osteoporosis, milk products are under-consumed by Asians.

Early studies on osteoporosis and hip fractures among Asians have indicated a low prevalence of these conditions among this ethnic group.1 It was suggested that the observed low fracture rates are due to the shorter hip axis length and higher trabecular volumetric bone mineral density of Asians.1,2 However, in its 2013 Asia-Pacific Regional Audit, the International Osteoporosis Foundation reported that osteoporosis and fractures among Asian populations are a main concern.3

Osteoporosis and fracture incidence among Asians is expected to rise

As in many other parts of the world, Asia’s aging population is growing rapidly, and the incidence of fracture in these countries is consequently expected to rise rapidly as well. It is estimated that by 2050, over half of all hip fractures worldwide will occur in Asia, with the majority in China. In fact, over the past 30 years, the incidence of hip fractures in Asian countries has increased 2- to 3-folds.3

Osteoporosis and fractures under-recognized in Asian countries

The 2013 Asia-Pacific Regional Audit also emphasizes that the burden of osteoporosis and fractures is severely under-estimated in Asian countries. Additionally, osteoporosis remains under-diagnosed and under-treated, which may explain the belief that this condition is less frequent in these populations.

Diagnosing osteoporosis in Asians has proven to be difficult because of the lack of ethnic-specific criteria and the limited access to diagnostic tools. Other issues contributing to this problem include poor access to treatment and low awareness among the public and health professionals.3

Moreover, there is limited epidemiological research and data on osteoporosis in Asian groups. Asians, particularly the Chinese, tend to have relatively high rates of vertebral fractures but lower rates of non-vertebral fractures. This may be because the Chinese have different skeletal microstructure, mechanical competence and bone remodeling.4

Calcium and vitamin D intake is inadequate among Asians

It is well recognized that adequate calcium and vitamin D intakes are necessary for bone health. However, milk products, which are a main source of these nutrients, are under-consumed by Asians.3

Studies have indicated that calcium intakes throughout Asia are well below the daily recommended amount of 1,000 mg to 1,200 mg, and the average daily calcium intake in some Asian countries has been found to be below 500 mg. Furthermore, little improvement in calcium intake has been observed over the past years.3

Low vitamin D status is prevalent among all age groups in Asia. The average vitamin D level in Asian countries is reported to be 25 to 49 nmol/L, which is well below the recommended 75 nmol/L. Evidence indicates that these low levels of vitamin D may be due to inadequate dietary vitamin D intake, a lack of food fortification with vitamin D, as well as urbanization and decreased sun exposure.3


Osteoporosis and fractures are a main concern among all world populations, including Asians. Milk product intake, as well as calcium and vitamin D intake, tends to be low among these population groups.

While additional research is needed to understand the epidemiology and mechanisms of osteoporosis and fractures among Asians, greater efforts are also required to improve their nutritional intake, in terms of milk products, calcium and vitamin D, in order to counter the rise in fracture incidence.

According to Canada’s Food Guide, a balanced diet for adults should include 2 to 3 servings of Milk and Alternatives per day. One serving equals 1 cup (250 mL) of milk, ¾ cup (175 g) of yogurt or 1½ ounces (50 g) of cheese.

For more information, consult Bone Health and Osteoporosis.


  1. Lau EM. The epidemiology of hip fracture in Asia: an update. Osteoporos Int 1996;6:19-23.
  2. Cauley JA. Defining ethnic and racial differences in osteoporosis and fragility fractures. Clin Orthop Relat Res 2011;469:1891-1899.
  3. International Osteoporosis Foundation. 2013. Asia-Pacific regional audit: epidemiology, costs & burden of osteoporosis in 2013. Accessed September 2, 2014.
  4. Cong E and Walker MD. The Chinese skeleton: insights into microstructure that help to explain the epidemiology of fracture. Bone Research 2014;2:14009.

Keywords: calcium , vitamin D

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