“By 2050, half of the world's hip fractures will occur in Asia.” 

Philippe Halbout, CEO of the International Osteoporosis Foundation (IOF), the largest global organization focused on bone, muscle, and joint health, warned of a “health tsunami” in Korea, where life expectancy is projected to reach 88, among the longest in the world. With a rapidly aging population, fractures are becoming a critical public health issue.

When Halbout returned to Korea this October, five years after his first visit, the situation had grown more dire. “The demographic shift is accelerating, and not in a good way,” he said in an interview with Korea Biomedical Review in Seoul on Oct. 8.

The population of older adults was surging, and with it came a crisis: Osteoporosis was no longer just a senior issue; fractures now threatened even the active workforce, leaving them vulnerable in a society where aging doesn’t equal retirement.  

Without immediate action, the rising incidence of fractures could impose a significant economic and social burden on Korean society, particularly due to the enormous costs associated with treating hip fractures. Within a year of such an injury, nearly 60 percent of patients would require assistance, while 20 percent may need long-term nursing care. 

“A disease, not merely a natural part of aging.” That’s how Halbout defines osteoporosis. Many people mistakenly view the gradual wear and tear of bone loss and fractures as an inevitable decay of time—something that doesn’t warrant medical attention. But in truth, this misconception can have serious consequences, especially since so many believe they are immune, failing to recognize that osteoporosis is preventable.

When Halbout became CEO of IOF in 2016, osteoporosis was already responsible for an estimated 9 million fractures annually. Today, that figure has soared to 37 million fragility fractures each year in individuals over 55 worldwide. 

Consider Korea. The average adult consumes just 483 mg of calcium per day—far below the recommended minimum of 1,000 mg necessary for maintaining healthy bones. 66 percent of men and 77 percent of women are also vitamin D deficient, a critical nutrient for calcium absorption, leaving over 800,000 people undiagnosed and caught in a web of nutritional neglect.

What makes osteoporotic fractures particularly debilitating is their tendency to set off a chain reaction. Without early identification and treatment, the risk of another fracture skyrockets—five times for a vertebral break, double for a hip.  The risk of suffering a subsequent fracture is especially high within the two years following an initial injury.

“Identifying patients with hidden osteoporosis before a fracture occurs is crucial,” Halbout said. “By doing so, we can significantly reduce mortality rates and alleviate the healthcare and socioeconomic burdens that come with these fractures.”

For this reason, the IOF has been actively advocating for global secondary fracture prevention through initiatives like Capture the Fracture, which supports healthcare systems in implementing multidisciplinary care models. This includes fracture liaison services (FLS), coordinator-based models developed by the Korean Society for Bone and Mineral Research (KSBMR) that focus on secondary fracture prevention.

Since 2019, Halbout has seen these efforts start to bear fruit. “There has been some improvement in the establishment of FLS,” he said, “but we still have significant ground to cover.”

While many countries are already taking steps to address osteoporosis and its fractures, Korea is just beginning to catch up. “The implementation of services like FLS is the single most important action we can take to directly enhance fracture patient care and curb the soaring healthcare costs associated with fractures worldwide,” Halbout said, emphasizing that Korea has been a “focal point” for this initiative since 2019. 

Currently, four hospitals in Korea have established FLS: Seoul National University Bundang Hospital, Ajou University Hospital, Konyang University Hospital, and Daejeon Eulji Medical Center.

Another crucial pillar of the foundation rests on its partners—private companies that trust the IOF to spearhead its global operations. Recently, Halbout met with Promedius, a member of IOF’s committee of corporate advisors dedicated to advancing bone and musculoskeletal health worldwide.

Promedius, a Korean startup specializing in AI medical diagnostics, is also a member of the Precompetitive Consortium on Osteoporosis and Bone Health (PRECCO). This global network, established by the European Society for Clinical and Economic Aspects of Osteoporosis (ESCEO) and the World Health Organization (WHO), aims to enhance the understanding, diagnosis, prevention, and treatment of osteoporosis and fractures while raising international awareness of these conditions.

The company is proposing a new approach to osteoporosis detection with the world’s first AI solution that screens for the disease using chest X-rays. Promedius developed PROS CXR: OSTEO, a deep-learning technology that analyzes often-overlooked images to identify patients at risk for osteoporosis, achieving a diagnostic accuracy with an area under the curve (AUC)  score of 0.91. “It’s a radical departure from traditional diagnostic tools like dual-energy X-ray absorptiometry (DEXA), which measures bone mineral density,” Eric Park, marketing team leader at Promedius, said in the interview with Halbout and Korea Biomedical Review.

Osteoporosis is diagnosed using the T-score, which measures bone mineral density (BMD) by translating complex bone structures into a 2D image. A T-score between -1 and -2.5 indicates osteopenia, where bone density is low but not severely risky. A score below -2.5 signifies osteoporosis, reflecting a significant reduction in bone density and an increased risk of fractures.

But osteoporosis isn't merely about how much bone is lost; it also hinges on the quality of the bone itself. Yet in Korea, current practices overlook this factor, putting countless individuals at risk for fractures. “Cutting-edge technologies could change how we understand bone structure,” Halbout said. “These innovations could identify high-risk osteoporosis patients before fractures occur.”

Every year, Korea acquires about 600 DEXA machines, a figure that surpasses many countries. Yet, the asymptomatic nature of osteoporosis often leaves many undiagnosed despite this availability. “Wherever chest X-rays are taken,” Park said, “we have an opportunity to draw hidden patients into the light of diagnosis and treatment.”

Promedius aims to seize this chance with “opportunistic screening.” Many Koreans undergo X-rays for various reasons, yet osteoporosis is rarely assessed. During these X-ray analyses, physicians and radiologists frequently overlook vertebral fractures, leaving countless injuries undetected—only a third receive the clinical attention they require. “AI is changing that,” Park said. “Advanced solutions can flag these missed fractures, ensuring patients receive the timely care they deserve.”

While DEXA scans are expensive and often scarce, X-rays are widely available. “By leveraging existing X-ray images,” Park said, “we hope to expand access to early fracture identification, reaching even the most remote regions of the country.”

The real danger isn’t only in patients with severe osteoporosis but also in those who are osteopenic. “The fracture risk for osteopenic patients is just as high, if not higher. We’re targeting those patients too,” Park added.