Prevalence of osteoporosis and osteopenia among persons aged 60 years and above: A cross-sectional study

INTRODUCTION

Worldwide, the population of persons aged 60 years and above is significantly increasing and is projected to reach two billion in the next decades, with predictions of bone diseases.^[1,2] The decline in mortality rate due to advances in healthcare services provision, medical sciences, health education, life expectancy, and longevity was a key indicator.^[2] Osteoporosis and osteopenia are medical terms describing the status of bone mineral and disorders in the bone tissues which are diagnosed using bone scans.^[3,4] The decrease in bone mineral density (BMD) below the normal reference values of −1–−2.5 depicts osteopenia, while osteoporosis is diagnostic when the reference values are <−2.5.^[2-4] The variation in reference values of BMD represents a microarchitectural disruption of the bone as well as the disorders of the bone mineral. Bone diseases are age-related disorders characterized by a high risk of bone fragility fractures, particularly in persons over 60 years.^[3,4] A person’s bone mass is affected by low intake of calcium, age, genetic composition, gender, and race.^[3]

Globally, more than 200 million persons are osteoporotic,^[5] with a ratio of 1:5 men and 1:3 women over 50 years having fractured bones.^[6] Low BMD is associated with high morbidity and mortality, increased healthcare costs, medical expenses,^[7] and high economic burdens.^[8] Bone diseases, which are preventable and curable are significant health threats to elderly persons.^[9] Osteoporotic fracture presents severe health consequences relating to distal radius, pelvic, and vertebrae fractures.^[3] The description, evaluation, and management of bone diseases primarily rely on dual-energy X-ray absorptiometry (DEXA) bone scans application by professionals.^[3]

A good number of studies have focused on osteoporosis and osteopenia prevalent rates using different group cohorts and locations.^[1,3-5,7,8] In Nigeria, such studies are scarce and none was reviewed.^[2] Considering the high prevalence of bone fragility fractures and the vulnerability of older adults to osteoporosis and osteopenia,^[2] a study of this kind becomes essentially important in Nigeria. Second, no reviewed studies had explored the association and correlation of osteoporosis and osteopenia with demographic variables of older adults in the Nigerian context and thus, the gap justifying the uniqueness of this present study. The purpose of this study is to determine the prevalence of osteoporosis and osteopenia among persons aged 60 years and above. Furthermore, it aims to determine the association and correlation between osteoporosis and osteopenia with demographic variables. Since bone diseases are preventable and curable, the outcome of this study is expected to form a viable framework for reducing cases of bone fragility fractures and disabilities in an elderly population through health education, awareness campaigns, and mass sensitization, particularly in Nigeria.

MATERIAL AND METHODS

RESULTS

A total of 7400 eligible participants were investigated; 245 (3.3%) of them declined for personal reasons, and 335 (4.5%) copies of the questionnaire were discarded due to incomplete responses. Therefore, 6820 (92.2%) valid copies were used for statistical analysis. Slightly above one-third of the participants (39.1%) were male, with about 81.1% married. More than one-third of them (38.9%) used tobacco, and the majority (71.6%) were 70 years and above, with about 62.0% of them depending on others for daily living. Only 29.5% of them were Muslims, with approximately 60% having university degrees. More than half of the participants (66.2%) consume alcohol, with approximately two-thirds (60.1%) living with their families. Only 33.5% of the participants resident/live/reside in urban area [Table 1].

Overall, osteoporosis (72.2%) and osteopenia (27.8%) were prevalent among older adults in Nigeria. The female older adults had a high prevalence of osteoporosis (73.8%), while osteopenia (30.0%) was high on male counterparts. The prevalence of osteoporosis was less (75.6%) among married older adults, while osteopenia (24.4%) was high. Tobacco users had a low prevalence of osteoporosis (75.2%) while osteopenia (24.8) was high. Older adults aged 70 years and above had a high prevalence of osteoporosis (73.4%), while osteopenia was high among those aged 60–69 years (31.1%). The dependent older adults had a high prevalence of osteoporosis (71.6%), while osteopenia (28.4%) was low. The Muslims had a high prevalence of osteoporosis (84.8%), while osteopenia (22.0%) was high among Christians. Older adults with university degrees had a low prevalence (73.2%) of osteoporosis while osteopenia (26.8%) was high. The prevalence of osteopenia was high (40.1%) among alcohol consumers while osteoporosis (59.9%) was low. Those living with families had a low prevalence of osteoporosis (72.9%) while osteopenia (27.1%) was high. The rural dwellers had a high prevalence of osteoporosis (72.5%) while osteopenia (43.1%) was high among the urban counterparts. Furthermore, there was significant association between osteoporosis and osteopenia and gender (P = 0.002 < 0.05), tobacco use (P = 0.010 < 0.05), personal age (P = 0.038 < 0.05), denomination (P = 0.041 < 0.05), university degree (P = 0.007 < 0.05), living arrangement (P = 0.016 < 0.05), and location (P = 0.031 < 0.05). Furthermore, no significant association existed between osteoporosis and osteopenia with marital status (P = 0.991 > 0.05), daily living (P = 0.810 > 0.05), and alcohol intake (P = 0.102 > 0.05), respectively [Table 2].

Positive correlation existed between osteoporosis and osteopenia with age (odds ratio [OR] = 1.241 ≥ 1), daily living (OR = 1.416 ≥ 1), denomination (OR = 1.569 ≥ 1), and alcohol consumption (OR = 1.907 ≥ 1), respectively. Furthermore, negative correlation existed between osteoporosis and osteopenia with gender (OR = 0.817 ≤ 1), marital status (OR = 0.886 ≤ 1), tobacco use (OR = 0.995 ≤ 1), university degree (OR = 0.628 ≤ 1), living arrangement (OR = 0.782 ≤ 1), and location (OR = 0.500 ≤ 1), respectively [Table 3].

DISCUSSION

It is a cross-sectional representative large-scale sample survey showing the prevalence of osteoporosis (72.2%) and osteopenia (27.8%) among older adults in Nigeria. This finding is not surprising rather expected as it reflects the real situation of bone diseases as characterized by high cases of bone fragility fractures in elderly population. Similarly, a large scale sample of 13,347 involving 30 studies revealed 34% prevalence of osteoporosis and 47% prevalence of osteopenia among persons aged 60 years and above in Iran.^[17] A meta-analysis study of 34,814 participants reported 0.17 prevalence of osteoporosis and 0.35% prevalence of osteopenia in the Iranian population.^[18] Furthermore, a sample of 2425 elderly men and women over 60 years revealed 41.5% prevalence of osteoporosis.^[14] Another meta-analysis study involving 562 female participants revealed 25.26% and 45.23% prevalence of osteoporosis and osteopenia, respectively.^[19] A similar gender-specific systematic review and meta-analysis study involving 6735 female participants reported 33.70% prevalence of osteoporosis and 47.60% prevalence of osteopenia, respectively.^[20] Furthermore, a cross-sectional survey involving 1779 persons over 60 years reported a 7.99% prevalence of osteoporosis in the province of Hamadan.^[13] A survey of 199 elderly patients in England reported 72% prevalence of osteoporosis and 43% prevalence of osteopenia.^[21] Similarly, 25.55% osteoporosis prevalent rate was reported among 759 older adults with an average mean age of 62.55 years.^[22] These findings suggest the need for education-based interventions, sensitization, and awareness campaigns on bone health particularly in Nigeria. Furthermore, these findings may be linked to inadequate knowledge of bone health, onset of menopause, lifestyle, and limited access to medical care services.

Our study revealed that osteoporosis was high in occurrence among female elderly, unmarried older adults, non-tobacco users, those over 70 years old, those depending on others for survival, Muslims, low education group, alcohol consumers, those living alone, and rural dwellers. Furthermore, osteopenia was high among older men, married older adults, tobacco users, those below 70 years, independent adults, Christians, educated elders, non-alcohol consumers, those living with families, and urban dwellers. These findings are expected due to certain factors such as menopause, physiological decline due to age, lifestyle modifications, access to media, and gained experiences. Similarities relating to differences in osteoporosis and osteopenia prevalent rates in different population cohorts based on demographic factors were explored and properly documented.^{[13,18,19,21,22]}

We found that osteoporosis and osteopenia were significantly associated with gender, tobacco use, personal age, religious affiliation, university degree, living arrangement, and geographical location (P < 0.05) while no association was found between osteoporosis and osteopenia with marital status, daily living, and alcohol intake (P > 0.05), respectively. Furthermore, a positive correlation existed between osteoporosis and osteopenia with age, daily living, religious affiliation, and alcohol intake (OR ≥ 1), while a negative correlation was observed with gender, marital status, tobacco use, university degree, living arrangement, and location (OR ≤ 1), respectively. Similar studies reporting the status of association and correlation of osteoporosis and osteopenia with demographic variables are documented.^{[13,14,17,19,21-24]}

CONCLUSION

Both osteoporosis and osteopenia are prevalent among older adults in Nigeria. Bone diseases are associated and correlated with demographic characteristics. Considering the severe health consequences such as bone fragility fracture, intervention approaches are paramount.