Hi Everybody,
As a member of AFLAR osteoporosis working group, we choose for this first epirheum English post (:-) to speak about: The State of the art of Osteoporosis in Africa and challenges ahead.
The lack of data on-trend and the incidence of hip fractures in Africa making planning and management difficult.
Global ‘Call to Action’ on fragility fractures was done: AFLAR Osteoporosis Working group, SAMSON are two initiatives that tried to break the myths.
Past years, Osteoporosis has been neglected as a health priority in Africa for several reasons.[1]
- Health authorities are overwhelmed by the burden of communicable diseases such as tuberculosis (TB) and human immunodeficiency virus (HIV),
- There is a perception that OP and its consequent fragility fractures are rare among Black Africans.
- Dual x-ray absorptiometry (DXA) equipment the gold standard for the diagnosis of osteoporosis by is not widely available, hampering early diagnosis and treatment.
But Africa trend change[2]
– Africa is experiencing an exponential increase in the number of older persons.
– The population of people aged 60 years and over is expected to triple across the continent, from 46 million in 2015 to 147 million by the year 2050 [3]
– The number of persons surviving with human immunodeficiency virus is simultaneously increasing due to improved availability of antiretroviral therapy.
– The burden of non-communicable diseases, in particular, osteoporosis and its consequent fragility fractures, is also predicted to increase and so are the associated morbidity, mortality, and cost of managing patients with hip fractures.
– Mortality rates (MR) post-HF in Africa are postulated to be 2–3-fold higher than the reported rates of 25–30 (twenty -five to thirty )% in developed countries
The lack of data on-trend and incidence of hip fractures in Africa making planning and management difficult.
There is a limited number of studies on the prevalence of osteoporosis and vertebral fractures, and the incidence pattern of hip fractures from Africa. However, compared with early initial studies, the more recent studies show that osteoporosis and fractures are increasing across the continent.[2]
Global ‘Call to Action’ on fragility fractures was done.
The International Osteoporosis Foundation (IOF) audit of Africa and the Middle East in 2011 found that generally in Africa, there is limited awareness of OP and few countries have national guidelines or OP societies. Osteoporosis is usually not part of the undergraduate medical curriculum in medical schools across Africa.
AFLAR Osteoporosis Working group, SAMSON as an initiative that tried to break the myths.
As Africa undergoes an epidemiological transition as a result of rapid urbanisation, the burden of non-communicable diseases, including osteoporosis, is rising. Similar to many chronic diseases osteoporosis often remains undiagnosed until a fracture occurs.
Increasing evidence is dispelling the outdated myth that fragility fractures are not a problem in sub-Saharan Africa.
The myth that osteoporotic fragility fractures only occur in older white women is outdated. An urgent and compelling need exists to deliver research that can inform prevention and management of fragility fractures in n Africa.
In 2018 Sub-Saharan African MuSculOskeletal Network – SAMSON research network across West, East and Southern Africa was established which aims to build sustainable capacity in Musculoskeletal Health Research. SAMSON focuses on Musculoskeletal Health Research in human populations throughout the life course.
The group had its first strategic meeting first meeting in South Africa in 2018. The group is about to undertake The FRACTURES-E³ Study in South Africa, Zimbabwe and The Gambia which will establish how frequently two key age-related fractures occur: spine fractures (the commonest) and hip fractures (the most life-challenging) and the consequent outcomes. This study is an initiative to address the evidence gap in Africa.
In August 2020, the AFLAR Working Group on Osteoporosis has started a multicentric project, under the umbrella of AFLAR. This group aims to be a platform for exchange and sharing of experiences in the field of osteoporosis management. It also aims to conduct studies in order to address the lack of data currently available.
Thank you for supporting our African Initiative!
Ihsane Hmamouchi & Farhanah Paruk
[1] Fuleihan GEH, Adib G, Itani N, Nauroy L, Arabi A, Baddoura R (2011) the middle East& Africa regional audit. Osteoporos Int 22: S677–S678
[2] F. Paruk, M. Tsabasvi and A. A. Kalla. Osteoporosis in Africa—where are we now. Clinical Rheumatology August 2020. https://doi.org/10.1007/s10067-020-05335-6
[3] World Health Organization: Africa: the time to ensure healthy and dignified ageing for Africans is now. Available at https://www.afro.who.int/regional-director/regional-directorcommentaries/timeensure-healthy-and-dignified-ageing-africans. Accessed 4 Feb 2020
