Osteoporosis in South Africa: an emerging silent epidemic

Abstract

Osteoporosis is a progressive skeletal disorder characterised by reduced bone strength and an increased risk of fragility fractures. It arises from qualitative and quantitative changes in bone – including low bone mineral density (BMD), altered macro- and microarchitecture, and impaired bone remodelling – and is now recognised as a major cause of morbidity and mortality worldwide.^1,2

Globally, osteoporosis predominantly affects postmenopausal women, but the burden in men is increasingly acknowledged. International data suggest that 1 in 3 women and 1 in 5 men over 50 years will sustain an osteoporotic fracture, with hip and vertebral fractures driving excess disability, loss of independence and premature death. Up to 37 million fragility fractures occur annually in people older than 55 years, equating to around 70 fractures every minute.³

In sub-Saharan Africa (SSA), osteoporosis and osteopenia are more common than previously appreciated, with emerging evidence from South Africa and neighbouring countries highlighting high fracture rates, an ageing population, the impact of HIV, and persistent barriers to diagnosis and treatment.^1,4,5

South African data show high one-year mortality after hip fracture, limited access to dual-energy X-ray absorptiometry (DEXA), and underdiagnosis and undertreatment of osteoporosis, particularly in the public sector.^1,4

This review summarises the epidemiology and impact of osteoporosis in South Africa, outlines the diagnostic approach (including the role of DEXA and FRAX-based fracture risk tools), reviews key lifestyle and pharmacological management principles, and provides practical, context-specific recommendations for clinicians and pharmacists. Early identification of high-risk patients and evidence based, resource-appropriate management remain essential to reduce the growing fracture burden in South Africa.