The greatest burden of hip fractures around the world is expected to occur in East Asia, especially China. However, there is a relative paucity of information on the epidemiology and burden of fractures in East Asia. Osteoporosis is greatly under-diagnosed and under-treated, even among the highest-risk subjects who have already suffered fractures. The accessibility to bone densitometry, the awareness of the disease by professionals and the public, and the use and reimbursement of drugs are some of the areas which need improvement especially. Cost-effective analysis on screening strategy and intervention thresholds based on local epidemiology data and economic status are available only in Japan. In addition, clinical risk factor models for the assessment of fracture probability may be ethnic specific. Further research is needed to develop a cost-effective risk assessment strategy to identify high-risk individuals for screening and treatment based on local data. Moreover, inadequate calcium and vitamin D intake is still an issue faced by this region.
Asia ; Calcium ; China ; Densitometry ; Epidemiology ; Far East* ; Hip Fractures ; Japan ; Mass Screening ; Osteoporosis* ; Risk Assessment ; Risk Factors ; Vitamin D

Objectives: To enhance the public awareness and facilitate diagnosis of osteoporosis, we aim to develop a new Chinese Osteoporosis Screening Algorithm (COSA) to identify people at high risk of osteoporosis. Methods: A total of 4747 postmenopausal women and men aged ! 50 from the Hong Kong Osteoporosis Study were randomly split into a development (N ¼ 2373) and an internal validation cohort (N ¼ 2374). An external validation cohort comprising 1876 community-dwelling subjects was used to evaluate the positive predictive value (PPV). Results: Among 11 predictors included, age, sex, weight, and history of fracture were significantly associated with osteoporosis after correction for multiple testing. Age- and sex-stratified models were developed due to the presence of significant sex and age interactions. The area under the curve of the COSA in the internal validation cohort was 0.761 (95% CI, 0.711e0.811), 0.822 (95% CI, 0.792e0.851), and 0.946 (95% CI, 0.908e0.984) for women aged < 65, women aged ! 65, and men, respectively. The COSA demonstrated improved reclassification performance when compared to Osteoporosis Self-Assessment Tool for Asians. In the external validation cohort, the PPV of COSA was 40.6%, 59.4%, and 19.4% forwomen aged < 65, women aged ! 65, and men, respectively. In addition, COSA > 0 was associated with an increased 10-year risk of hip fracture in women ! 65 (OR, 4.65; 95% CI, 2.24e9.65) and men (OR, 11.51; 95% CI, 4.16e31.81). Conclusions We have developed and validated a new osteoporosis screening algorithm, COSA, specific for Hong Kong Chinese.