Nguyen Thi Thanh Huong

Hanoi Medical UniversityHanoi, Vietnam

2025

2050

2007

The Urbanization of the world

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7000

1950 1960 1970 1980 1990 2000 2010 2020 2030 2040 2050

70% of the population will be in urban regions by 2050

World Urbanization Prospects: the 2007 Revision

Urban population

Rural population

6.4 billion

Equal

total world population

in 2004

2008

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1950 1960 1970 1980 1990 2000 2010 2020 2030 2040 2050

Most of urban population will be absorbed in less developed regions

Urban population, less developed

World Urbanization Prospects: the 2007 Revision

> 60% will be in Asia

Incidence of hip fracture was higher in Oceania, N. America , and Europe

1. B. Gullberg, et al, Osteoporosis Int , 19972. Anonymous, World Urbanization Prospects: The 2007 Revision

< 20% 21-40 41-60 > 60%% of UrbanPopulation

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700

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denc

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erso

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ears

Incidence of hip fractures was highest in northern Europe

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800

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1200

S. Europe E. Europe W. Europe N. EuropeIncid

ence

/100

.000

per

son

- yea

rs

1. B. Gullberg et al, Osteoporosis Int , 19972. Anonymous, World Urbanization Prospects: The 2007 Revision

61-80% > 81%% of UrbanPopulation

Incidence of hip fractures was higher in Hong Kong and Singapore

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Malaysia Thailand Singapore Hong Kong

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denc

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year

s

1. E. M. C. Lau et al. Osteoporosis Int (2001) 12: 239-243. 2. Anonymous, World Urbanization Prospects: The 2007 Revision

30-60% > 90% % of UrbanPopulation

L. J. Melton III et al, Osteoporos Int (1999)

ROCHESTER

TASMANIA, AUSTRALIA

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Men Women

Urban

Rural

B. Jonsson et al, Osteoporosis Int (1992)

SWEDEN%

Incidence of fractures was higher in urban than in rural regions within country

TASMANIA, AUSTRALIA

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Men Women

Urban

Rural

AUSTRALIA

K M Sanders, et al, J Epidemiol Community Health, 2002, 56: 466-470

Incidence/100,000

Incidence of fractures was higher in urban regions than in rural regions within a country

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Men Women

Urban

RuralAll fractures

Hip fracture

The urban-rural difference pattern is consistent

The more urbanized, the higher incidence of fracture

Asia is rapidly urbanized at the present and in the future

Burden of fracture will be rapidly increased in Asia in the next decades

K. M. Sanders, et al, J Epidemiol Community Health (2002) 56: 466-470

H. M. Cooley et al, Osteoporos Int (2002) 13: 317-322

AUSTRALIATASMANIA, AUSTRALIA

The urban-rural difference in fracture incidence was more pronounced in those aged 60+ Lifestyle factors

A. J. Sogaard et al, Osteoporos Int 2007) 18: 1063-1072

Fracture

H.E.Maye et al, American Journal of Epidemiology, 2004

BMD

BMD is considered the primary predictor of fracture risk

Rural residents had higher BMD at the forearm than urban residents in Norway

C. Pongchaiyakul et al, BMC Musculoskeletal Disorders, 2005, 6:5

Rural individuals had higher femoral neck BMD than urban individuals in Thailand

C. Pongchaiyakul et al, Osteoporos Int, 2005 16: 1761-8

Lean mass was an independent predictor of urban-rural differences in BMD

(lean mass is an indicator of physical activity)

Implications

Physical activity is probably an important risk factor of fracture in the world.

Physical activity may hold the key to prevention of fractures in Asia.