IOF LogoIOF World Congress on Osteoporosis 2004, May 14-18, 2004, Rio de Janeiro, Brazil
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Presented at the IOF World Congress on Osteoporosis, a groundbreaking Latin American collaboration shows high rates of osteoporosis and reveals family history as a major risk factor. A long-running European study judges smoking a major risk factor for the disease, and confirms bone mineral density measurement as a predictor of fracture risk.

May 16, 2004

A multinational study of bone health in Latin America finds alarmingly high rates of osteoporosis among Brazilian women, with family history a major risk factor, and a high likelihood that middle-aged and older Mexican women have spinal fractures. Data from a similar large European study help to confirm smoking as an important contributor to osteoporosis and endorse the use of bone mineral density to assess fracture risk.

The findings from both studies were presented this week at the IOF World Congress on Osteoporosis in Rio de Janeiro, Brazil.

Latin America – comparable rate of vertebral fractures to Europe, surprisingly high rate of osteoporosis in Brazil, genetics play key role

The Brazilian and Mexican data form part of the Latin American Vertebral Osteoporosis Study (LAVOS), the first-ever regional survey of the bone disorder. LAVOS was patterned on the long-running European Vertebral Osteoporosis Study / European Prospective Osteoporosis Study (EVOS/EPOS). Both studies receive funding support from IOF.

The coordinator of the LAVOS study, Patricia Clark of the Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, and Universidad Nacional Autonoma de Mexico in Mexico City, presented the results of the first national subset completed to date (conference presentation P198MO). In each of six Latin American countries, researchers will closely examine the bone health of 400 randomly selected women, 100 each in their fifties, sixties, seventies, or over age eighty.

Clark and her colleagues found that 19.5 percent of the women in the Mexican sample had suffered vertebral fractures, and that the rate increased exponentially with age. This overall rate is comparable to that found in some European countries, but higher than rates detected in Beijing, China or in American women of African descent.

Also from the LAVOS study, Sergio Ragi and colleagues from the Centro de Diagn—stico e Pesquisa da Osteoporose do Esp’rito Santo, located in Vit—ria, Brazil, filled a prominent gap in Brazilian public health data when they reported that 33.6 percent of the women in their survey suffer from osteoporosis (conference abstract P211SA).

Ragi admits to being surprised that the osteoporosis incidence in Brazil matches that reported in North America and Europe, given Brazil's diverse ethnic admixture (accurately represented in the study population) and exposure to sun. Sun is a key source of vitamin D, a critical element that ensures that calcium forms bones.

"These data reinforce the idea that Brazilian health authorities and health care providers should look for more resources and programs to prevent osteoporosis and to make osteoporosis therapies more widely available," said Ragi.

In a separate presentation based on the Brazilian LAVOS sample, Ragi, Clark and their collaborators confirmed that a history of osteoporotic fractures among close relatives is a major risk factor for osteoporotic fractures (conference abstract P207MO).

European results – BMD strong indicator of fracture risk, smoking weakens bones

In contrast to the young LAVOS study, EVOS/EPOS is currently the largest epidemiological study of osteoporosis in Europe, involving more than 17,000 men and women, aged 50-79, in 17 European countries. To date, the two studies have resulted in close to 100 scientific publications.

"EVOS/EPOS has been a very valuable study," said. Olof Johnell of Malmo University Hospital in Sweden, vice-chairman of the IOF Committee of Scientific Advisors, who gave his oral presentation on May 15 at the IOF-WCO (conference abstract OC23). When Johnell and his collaborators wanted to resolve the lingering doubts about whether measuring bone mineral density is an accurate way to assess the risk of fractures, they turned to the data from EVOS/EPOS.

Johnell's team combined data from EVOS/EPOS and a number of other studies into a "meta-analysis" of nearly 40,000 subjects. They found that bone mineral density is a strong predictor of fracture risk. Individuals with low bone mineral density have a higher risk of fractures. This was equally true of men and women.

Age became a factor in the case of hip fractures. "Bone mineral density can better identify hip-fracture risk for people at age 50 that it can when they are 80," said. Johnell.

In a separate oral presentation on May 16, John Kanis, director of the World Health Organization Collaborating Centre for Metabolic Bone Diseases at Sheffield University in England, and IOF Board member, described the results of a parallel meta-analysis of nearly 60,000 subjects, also including EVOS/EPOS data (conference abstract OC17).

Kanis and colleagues found that smoking, whether in the past or currently, was associated with a higher risk of fractures. "Smoking can now join the list of risk factors that aid in the identification of patients at high risk who should receive treatment to reduce fracture risk," said Kanis.


The International Osteoporosis Foundation (IOF) is a worldwide organization dedicated to the fight against osteoporosis. It brings together scientists, physicians, patient societies and corporate partners. Working with its 165 member societies in more than 85 locations, and other healthcare-related organizations around the world, IOF encourages awareness and prevention, early detection and improved treatment of osteoporosis.

Osteoporosis, in which the bones become porous and break easily, is one of the world's most common and debilitating diseases. The result: pain, loss of movement, inability to perform daily chores, and in many cases, death. One out of three women over 50 will experience osteoporotic fractures, as will one out of eight men(1). Unfortunately, screening for people at risk is far from being a standard practice. Osteoporosis can, to a certain extent, be prevented, it can be easily diagnosed and effective treatments are available.

1 Melton U, Chrischilles EA, Cooper C et al. How many women have osteoporosis? Journal of Bone Mineral Research, 1992; 7:1005-10

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