1. Nguyen Thi Thanh Huong Hanoi Medical University Hanoi, Vietnam

2. 2025 2050 2007 The Urbanization of the world

3. 70% of the population will be in urban regions by 2050 World Urbanization Prospects: the 2007 Revision Urban population Rural population 6.4 billion Equal total world population in 2004 2008

4. Most of urban population will be absorbed in less developed regions Urban population, less developed World Urbanization Prospects: the 2007 Revision > 60% will be in Asia

5. Incidence of hip fracture was higher in Oceania, N. America, and Europe 1.B. Gullberg, et al, Osteoporosis Int, 1997 2.Anonymous, World Urbanization Prospects: The 2007 Revision < 20%21-40 41-60> 60% % of Urban Population Incidence/100.000 person - years

6. Incidence of hip fractures was highest in northern Europe Incidence/100.000 person - years 1.B. Gullberg et al, Osteoporosis Int, 1997 2.Anonymous, World Urbanization Prospects: The 2007 Revision 61-80%> 81% % of Urban Population

7. Incidence of hip fractures was higher in Hong Kong and Singapore Incidence/100.000 person - years 1. E. M. C. Lau et al. Osteoporosis Int (2001) 12: 239-243. 2. Anonymous, World Urbanization Prospects: The 2007 Revision 30-60% > 90% % of Urban Population

8. L. J. Melton III et al, Osteoporos Int (1999) ROCHESTER TASMANIA, AUSTRALIA B. Jonsson et al, Osteoporosis Int (1992) SWEDEN % Incidence of fractures was higher in urban than in rural regions within country

9. TASMANIA, AUSTRALIA AUSTRALIA K M Sanders, et al, J Epidemiol Community Health, 2002, 56: 466-470 Incidence/100,000 Incidence of fractures was higher in urban regions than in rural regions within a country All fractures Hip fracture

10. The urban-rural difference pattern is consistent The more urbanized, the higher incidence of fracture Asia is rapidly urbanized at the present and in the future Burden of fracture will be rapidly increased in Asia in the next decades

11. K. M. Sanders, et al, J Epidemiol Community Health (2002) 56: 466-470 H. M. Cooley et al, Osteoporos Int (2002) 13: 317- 322 AUSTRALIA TASMANIA, AUSTRALIA The urban-rural difference in fracture incidence was more pronounced in those aged 60+ Lifestyle factors

12. A. J. Sogaard et al, Osteoporos Int 2007) 18: 1063- 1072 Fracture H.E.Maye et al, American Journal of Epidemiology, 2004 BMD BMD is considered the primary predictor of fracture risk Rural residents had higher BMD at the forearm than urban residents in Norway

13. C. Pongchaiyakul et al, BMC Musculoskeletal Disorders, 2005, 6:5 Rural individuals had higher femoral neck BMD than urban individuals in Thailand

14. C. Pongchaiyakul et al, Osteoporos Int, 2005 16: 1761-8 Lean mass was an independent predictor of urban- rural differences in BMD (lean mass is an indicator of physical activity)

15. Implications Physical activity is probably an important risk factor of fracture in the world. Physical activity may hold the key to prevention of fractures in Asia.