Osteoporosis in rural women of the Ural Region: clinical and metabolic profile, comorbidity, and diagnostic opportunities at the primary health care level

BACKGROUND: Rural populations remain underrepresented in osteoporosis research in the Russian Federation.

AIM: This study aimed to describe the clinical and metabolic profile of rural women with osteoporosis, taking into account comorbidity and risk factors for chronic noncommunicable diseases, in the context of osteoporosis detection opportunities in primary health care.

METHODS: A single-center, population-based, cross-sectional study was conducted including all women aged ≥50 years residing in the settlement of Kalinovo, Sverdlovsk Region. Osteoporosis was diagnosed; anthropometric, clinical, and laboratory parameters were assessed, along with pain level, physical activity, alcohol consumption, smoking status, and questionnaire-based measures using the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and the “Age Is Not a Barrier” questionnaire. Comorbid conditions were recorded.

RESULTS: A total of 533 women were included. Osteoporosis was diagnosed in 113 participants (110 newly diagnosed), corresponding to 21.2% (95% confidence interval, 17.9%–24.8%); 80% of affected women had already sustained fractures and/or required immediate initiation of therapy. Women with osteoporosis were older than those without the condition (median age, 70 vs 66 years; p < 0.001) but did not differ from age-matched controls in anthropometric parameters, alcohol consumption, smoking status, physical activity, glycemia, cholesterol levels, or prevalence of comorbidities, including hypertension, type 2 diabetes mellitus, and ischemic heart disease. Median PHQ-9 scores (4 vs 3; p = 0.051) and GAD-7 scores (2 vs 1; p = 0.04), as well as the proportion of individuals with frailty syndrome (16.8% vs 10.0%; p = 0.065), were slightly higher among women with osteoporosis.

CONCLUSION: One in five rural women aged ≥50 years has osteoporosis, with prevalence increasing with age. A history of low-energy fractures or a fracture risk exceeding the therapeutic threshold according to FRAX were the only clinical and anamnestic markers that reliably distinguished women with osteoporosis from their age-matched peers during consultations in general practice. The high burden of risk factors for chronic noncommunicable diseases and comorbid conditions, primarily cardiovascular, among rural women likely shifts the rural physician’s focus from osteoporosis diagnosis toward the detection of other diseases, despite the availability of accessible osteoporosis screening tools.