Trends in Osteoporosis Prevalence in Korea Using Korea National Health and Nutrition Examination Survey (KNHANES) 2024 and 2008–2011: The KSBMR KNHANES DXA Task Force Report

Background: National estimates of osteoporosis prevalence in Korea has been based on dual energy X-ray absorptiometry (DXA) data from the Korea National Health and Nutrition Examination Survey (KNHANES) conducted between 2008 and 2011. In 2024, KNHANES resumed nationwide DXA testing, enabling updated prevalence estimates. Methods: We compared the prevalence of osteoporosis (DXA T-score ≤-2.5 at lumbar spine, femoral neck, or total hip) and low bone mass (-1.0>T-score>-2.5 at any sites) among Korean adults aged ≥50 years between KNHANES 2008-2011 and 2024. Agestandardized prevalence estimates accounting for complex sampling were calculated. The Poisson regression model was used to assess prevalence ratios (PRs) between survey periods, with adjustment for anthropometric measures, lifestyle factors, and nutritional intake. Results: The prevalence of osteoporosis declined between KNHANES 2008-2011 and 2024 from 20.8% to 14.6% (women, 32.6%-22.0%; men, 7.0%-4.9%; P<0.001 for all), with higher mean BMD at all skeletal sites in 2024. In women, the prevalence of low bone mass increased from 47.9% to 56.0%, while it declined from 47.4% to 33.3% in men. The proportions of physician-diagnosed osteoporosis (24.9%-34.5%) and treatment (11.1%-22.8%) increased over time, particularly among women. In men, PR of osteoporosis between periods was attenuated after adjustment for height and weight, whereas changes in anthropometry, lifestyle, and nutrition did not fully account for the decline in women. Conclusions: From 2008 to 2011 and 2024, the prevalence of osteoporosis among Korean adults aged ≥50 years decreased, accompanied by improvements in the proportion of diagnosis and treatment.