The Vietnam Osteoporosis Study (VOS)

Goals and Aims

The Study is primarily aimed at investigating the extent and determinants of osteoporosis and osteoporotic fractures in the Vietnamese population. Another aim of VOS is to understand how osteoporosis is related to other chronic diseases, including osteoarthritis, sarcopenia, obesity, diabetes, metabolic syndrome, and cardiovascular disease. The overall goal of VOS is to map genetic and environmental factors that underlie the risk of fragility fracture and the co-occurrence of related chronic diseases (i.e., the so-called “diseasome”) in the Vietnamese people. It is also my intention that through VOS we will help building the capacity for high quality population based research and bioinformatics for the next generation of Vietnamese scientists.


VOS is designed as a cohort, family-based study. Participants will be drawn from multiple families who are living in Ho Chi Minh City and rural areas. The participants, all aged 18 years and older, will then be followed for 10 years to record the incidence of fractures and chronic diseases.

Extensive baseline data are collected. At baseline, participants are required to complete two questionnaires concerning their demographic factors, medical history, medication, physical activity, dietary habits, and lifestyle factors. Skeletal assessments include digital X-ray (of the knee, hip, spine, and hand), whole body, spinal and hip bone mineral density by DXA (Hologic Horizon, USA), architectural properties of cortical and trabecular bone by peripheral quantitative computed tomography (pQCT, Stratec, Germany). Measurements of carotid intima-media thickness (IMT) are performed at Tam Duc Hospital using a Philips HD7XE ultrasound device with the 7 MHz B-type linear transducer.

In addition, fasting blood samples are collected for analyzing glucose, HbA1c, creatinine, lipid parameters, and vitamin D. Genomic DNA is extracted from blood for further genetic and exposome analyses. We plan to conduct whole-genome sequencing (WGS) on 200 individuals from the Study. The individuals will be selected to ensure a spectrum of diseases of interest, including osteoporosis. We hope that the WGS data will serve as a reference for the Vietnamese population. Once the Study is completed, we will archive all de-identified data in the internet so that they are publicly available to researchers worldwide.


We have recruited 4517 participants from 817 families. The average age of participants was 51, with approximately 45% of the individuals aged 50 years and older. Approximately 3% of participants were obese (body mass index ≥ 30 kg/m2), and 21% were overweight. Notably, 11% of participants aged 40 years and older were diabetic. Among those aged 50 years and older, approximately 14% of women and 5% of men had osteoporosis (i.e., femoral neck BMD T-scores ≤ -2.5).

In summary, VOS is a major osteoporosis research project in Vietnam and Asia. The Project will make use of advances in new scientific disciplines of network medicine, “exposome”, and genome to develop a unified predictive framework for annotating the human genome for genetic variants and network of environmental factors (eg chemical exposures) that likely contribute to the co-occurrence of osteoporosis and chronic diseases. I hope that the outcome of VOS will provide an insight into the pathogenesis of osteoporosis and its related conditions.

Some recent publications

Ho-Pham LT, Doan MC, Van LH, Nguyen TV. Development of a model for identification of individuals with high risk of osteoporosis. Arch Osteoporos. 2020 Jul 22;15(1):111. doi: 10.1007/s11657-020-00788-3.

Ho-Pham LT, Chau PMN, Do AT, Nguyen HC, Nguyen TV. Type 2 diabetes is associated with higher trabecular bone density but lower cortical bone density: the Vietnam Osteoporosis Study. Osteoporosis Int 2018;29:2059-2067

Ho-Pham LT, Ho-Le TP, Mai LD, Do TM, Doan MC, Nguyen TV. Sex-difference in bone architecture and bone fragility in Vietnamese. Scientific Reports 2018;8:7707. doi: 10.1038/s41598-018-26053-9.

Nguyen LT, Nguyen UD, Nguyen TD, Ho-Pham LT, Nguyen TV. Contribution of bone turnover markers to the variation in bone mineral density: a study in Vietnamese men and women. Osteoporosis International 2018.

Ho-Pham LT, Nguyen TV. The Vietnam Osteoporosis Study: Rationale and design. Osteoporosis and Sarcopenia 2017;3:90-97.

Ho-Pham LT, Do TT, Campbell LV, et al. HbA1c-Based Classification Reveals Epidemic of Diabetes and Prediabetes in Vietnam. Diabetes Care. 2016 Jul;39(7):e93-4.

Ho-Pham LT, Hans D, Doan MC, et al. Genetic determinant of trabecular bone score (TBS) and bone mineral density: A bivariate analysis. Bone. 2016 Aug 20;92:79-84.

Ho-Pham LT, Lai TQ, Nguyen MT, et al. Relationship between Body Mass Index and Percent Body Fat in Vietnamese: Implications for the Diagnosis of Obesity. PLoS ONE. 2015 May 27;10(5):e0127198.

Ho-Pham LT, Lai TQ, Mai LD, et al. Prevalence of radiographic osteoarthritis of the knee and its relationship to self-reported pain. PLoS ONE. 2014 Apr 10;9(4):e94563.

Ho-Pham LT, Nguyen UD, et al. Association between lean mass, fat mass, and bone mineral density: a meta-analysis. J Clin Endocrinol Metab. 2014 Jan;99(1):30-8.

Ho-Pham LT, Nguyen UDT, Tran TX, Nguyen TV. Discordance in the diagnosis of diabetes: Comparison between HbA1c and fasting plasma glucose. PLoS ONE. 2017 Aug 17;12(8):e0182192.