Osteoporosis a growing threat in Singapore

The incidence of osteoporotic fractures is expected to grow by more than 50 percent, according to a recent Singapore study. This will be accompanied by a spike in economic burden, both directly and indirectly associated with healthcare.

“Efforts to improve the detection, diagnosis and introduction of new efficacious treatment modalities of osteoporosis are necessary to reduce the growing clinical, economic and societal burden of fractures in Singapore,” said researchers.

Combining population forecast data of men and women (aged ≥50 years) with osteoporosis prevalence rates, researchers determined the change in incidence over time. In 2017, there have been an estimated 15,267 cases, including 3,900 hip fractures, 4,444 vertebral fractures and 6,923 fractures in other anatomic sites. [Arch Osteoporos 2019;14:114]

When status quo is maintained, the overall incidence of fractures is projected to jump by 58 percent to 24,104 cases. These will be distributed among hip fractures (n=6,150), vertebral fractures (n=7,020) and other fractures (n=10,934).

Over the forecast period of 2017–2035, the projections represent a cumulative figure of 381,512 new osteoporotic fractures.

In turn, the rise in cases is expected to yield additional economic burden. Overall costs, including both direct and indirect expenditures, were pegged at S$183.5 million in 2017. This is projected to jump by 57.8 percent, yielding a total of SGD 289.6 million by 2035.

Most of the burden has been attributed to hip fractures, accounting for SGD 88.7 million in 2017 and SGD 139.8 million by 2035. This is followed by other fractures (2017: SGD 64.5 million; 2035: SGD 101.9 million), while vertebral fractures (2017: SGD 30.3 million; 2035: SGD 47.9 million) are found to be the least costly.

Moreover, direct costs to the health system make up majority of the overall economic burden; indirect societal costs explain only a fourth of the total expense. “Our study is the first to estimate the indirect costs associated with osteoporotic fractures in Singapore, which we estimated at SGD 44.2 million in 2017, projected to increase to SGD 69.8 million in 2035,” said the researchers.

Improving treatment is expected to help curb these forecasts. For instance, an increase in the treatment rate by just 10 percent would lead to 6,190 fewer cases of osteoporotic fractures, leading to an estimated SGD 70.3 million in avoided expenses by 2035.

At the most ideal scenario of 75-percent treatment rate, 29,096 osteoporotic cases would be avoided and the savings would amount to SGD 330.6 million.

“[O]ur study still serves to fill an important gap in osteoporosis care in Singapore,” the researchers said. “By assessing the current and future burden of osteoporosis in Singapore, and, quantifying the potential health and economic impact of increased treatment rates, our hope is to shed light on an important public health concern and look at the downstream benefits of tackling the issue of underdiagnoses and undertreatment for these patients.”