Osteoporosis (OP) and fragility fractures are a public health problem due to the increase in morbidity and mortality that they generate. Because prevalence of the disease is directly proportional to age, OP is becoming increasingly frequent in a population that tends to live longer.1 However, OP is not on the agenda of public health priorities in Colombia, where other chronic diseases such as cancer, HIV infection, chronic kidney disease, cardiovascular disease, diabetes mellitus, among others, are the focus of the state budget and the interventions of health decision-makers.2 This paper aims to establish the prevalence of OP in Colombia, describe the basic demographic characteristics of patients with this disease and give visibility to a problem that is silent but with multiple repercussions on our country’s health system.

A cross-sectional study was conducted based on official data from the Colombian Ministry of Health. The official data from the Colombian Ministry of Health come from an information collection and storage tool called the Integral Social Protection Information System (SISPRO), which has four components: health, pensions, occupational risks, and social promotion. The first component stores and processes the basic and minimum data required by the General System of Social Security in Health for management, regulation, and control processes. This data is entered from the Individual Registry of Health Service Delivery. The information contained in these databases is for public use. The dynamic tables that the Ministry of Health has online were consulted and the data were obtained to conduct this study. Information was obtained for Colombia for the period from 1 January 2012 to 31 December 2018, for which an analysis of the Individual Registry of Health Service Delivery databases was undertaken, using the international codes of diseases (ICD-10) for osteoporosis (M800, M801, M802, M803, M804, M805, M808, M809, M810, M811, M812, M813, M814, M815, M818, M819), and we analysed variables such as sex, type of insurance and distribution in five-year age groups, according to the official projections of the National Administrative Department of Statistics, based on the projections of the 2005 national census.3 The data collected were analysed with descriptive statistics, using means and measures of central tendency for quantitative variables and proportions for qualitative variables. Prevalence was adjusted by sex and age group to the 2015 population over 50 years of age, projected for each of the 32 departments during the period analysed. The diagnostic criteria for OP in the SISPRO database are not standardised; they depend on the clinical and diagnostic judgement of each physician when registering a patient with an ICD-10 code related to OP. Patients who were registered with a diagnosis of OP as the “principal diagnosis” were included. It is important to highlight that the coverage of the Colombian health system is one of the highest in Latin America (95.1%),4 which allows for a significant amount of data from the entire population of the country. This project was approved by our institution’s Central Research Committee.

We identified 249,803 cases (“persons attended”) with a principal diagnosis of OP, which allowed us to calculate an unadjusted prevalence of 2440 cases per 100,000 inhabitants over 50 years of age, and to establish that the condition is more frequent in women (92% of cases), with a female: male ratio of 12.3:1. An analysis of the prevalence of OP by five-year age groups shows an increase in prevalence as the population ages (Table 1 and Fig. 1). The number of patients according to sex and age group is presented in Table 2. It can be observed that the prevalence of OP is higher in women (4210 per 100,000 inhabitants) compared to men (395 per 100,000 inhabitants), and that prevalence increases as the population ages.

Fig. 1.

Non-age adjusted prevalence of patients with osteoporosis during the years 2012–2018. Prevalence is calculated with the mean population of the period as the denominator per 100,000 inhabitants.

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We also analysed the presence of OP with fractures, which corresponded to 18% of the total cases of osteoporosis. Due to the characteristics of the Registry, it was not possible to establish the fracture site. In the analysis by sex, we observed that 22% of men with OP have fractures compared to 18% of women. Given these results, we undertook an analysis of the prevalence of OP with fracture adjusted for sex and age, which showed that the prevalence of OP with fracture is 1% in women and .1% in men.

Regarding the distribution of OP by department, we found that the national population-adjusted prevalence in men ranged between 2.3 and 206.2 per 100,000 inhabitants, while the adjusted prevalence in women was between 12 and 2190 per 100,000 inhabitants (Fig. 2). The areas with the highest adjusted prevalence in both men and women are three departments of the coffee-growing region: Risaralda (6.8 per 100,000 inhabitants), Antioquia (6.2 per 100,000 inhabitants) and Caldas (5.8 per 100,000 inhabitants).

Fig. 2.

Geographical distribution of the prevalence of osteoporosis for the period 2012–2018, adjusting for sex and age group of the Columbian population. Prevalence is calculated with the mean population of the period as the denominator per 100,000 inhabitants. (A) Males. (B) Females.

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Colombia is in a process of demographic transition, as are other countries in the region, due to increased longevity of the population. Life expectancy according to the WHO for Colombia is 77 years, and when differentiated by sex, it is 80 years for women and 74 years for men.5,6 One of the notable consequences of this demographic phenomenon is an increase in the prevalence of chronic non-communicable diseases. This phenomenon has been documented worldwide in the case of OP, which is a disease considered a public health problem because it affects postmenopausal women and the elderly population, increasing the risk and incidence of fractures, with significant social and economic costs for health systems.7,8 It is estimated that approximately 200 million people suffer from OP worldwide, with a progressive increase associated with the global ageing of the population, although the prevalence of OP is difficult to establish, given its asymptomatic course until the onset of fractures.7–9

According to the projections of the International Osteoporosis Foundation’s report presented in 2012, it was evident that the data in Latin America were insufficient, but the estimates indicated that there were 1,423,559 women with OP in Colombia and 8000–10,000 hip fractures per year.2 However, the data obtained from the Ministry of Health registry reports only 249,803 people with OP, which is one-fifth of the estimate of the International Osteoporosis Foundation. Other work such as that by Morales-Torres et al. collected data from Latin America, where the range of vertebral OP was 7.6%–12.1% and of femoral neck OP was 7.9%–22%,8 which again is higher than that found in our study, where the overall prevalence is 2.4% in those over 50 years of age. A report from Bogota in 1999 reported a prevalence of OP of 32% in a group of patients who underwent bone scans,10 which again contrasts with the findings of the national registry.

The results of this study show that OP occurs more frequently in women of all age ranges and its prevalence increases in a directly proportional manner, which is in line with that reported in other studies in Latin America (LAVOS, Brazil)11,12 and in other regions (Spain, China, Canada).13–15 However, the lower prevalence than that reported in other studies may be due to under-diagnosis and under-recording in the SISPRO information system, as well as the difference in the methodology of the studies, since the methodology used to measure prevalence in the studies that we took as the reference for this article’s discussion was taking densitometry measurements of specific population groups using the active search mode, or by analysing hospital records in at-risk populations.

In terms of the prevalence of OP fractures, these are two to three times more common in women.16 Worldwide, about 8.9 million fractures per year are attributable to OP.16 However, there is likely to be under-reporting, because some fragility fractures are under-diagnosed and under-treated,17,18 leading to the functional impairment of sufferers, decreased quality of life and high mortality rates.11,16 In 2010, around 3.5 million fractures in Europe were attributed to OP, hip fracture being the most frequent.19 The LAVOS study, conducted in 5 Latin American countries (Argentina, Brazil, Colombia, Mexico and Puerto Rico) showed a standardised prevalence of vertebral fractures in women over 50 years of age of 11.18% (95% CI 9.23–13.4), which increases from 6.9% in women aged 50–59 years to 27.8% in women over 80 years.12 This direct relationship between ageing and increased prevalence of fractures is also determined by the findings of our study, as is the higher prevalence of OP among women.

The Colombian health system is based on single-payer public financing and mixed public and private provision, with almost universal coverage (95.1% according to the latest official measurement in June 2019).4 However, the main limitation of this study is underreporting, due to the characteristics of the Registry, which only records the main diagnoses, not comorbidities, which in the case of OP, as it is often a comorbidity, is not adequately recorded. Neither is it possible to calculate the incidence because there is no criterion to determine the “main diagnosis” from one year to another. As there can be variations in recording, it is not possible to calculate the incidence or duration of the disease.20 Also, due to the nature of the data, it is not possible to establish the course of the disease, the patients’ specific clinical characteristics, fracture sites, or response to treatment.

Our study shows information taken from the Colombian Ministry of Health database. From this information we made demographic and epidemiological analyses of the population and projections for the care of patients with OP in our country. These results alert us to the importance of improving the characteristics of the Registry, and of designing public health policies for a disease which is possibly being under-diagnosed and therefore, with a lower rate of treatment for patients.

The authors have no conflict of interests to declare.