Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Archives of Osteoporosis
Published in: Archives of Osteoporosis 1/2022

01-12-2022 | Care | Review Article

Quality improvement initiatives in the care and prevention of fragility fractures in the Asia Pacific region

Authors: Paul James Mitchell, Seng Bin Ang, Leilani Basa Mercado-Asis, Reynaldo Rey-Matias, Wen-Shiang Chen, Leon Flicker, Edward Leung, David Choon, Sankara Kumar Chandrasekaran, Jacqueline Clare Therese Close, Hannah Seymour, Cyrus Cooper, Philippe Halbout, Robert Daniel Blank, Yanling Zhao, Jae-Young Lim, Irewin Tabu, Maoyi Tian, Aasis Unnanuntana, Ronald Man Yeung Wong, Noriaki Yamamoto, Ding-Cheng Chan, Joon Kiong Lee, on behalf of the Asia Pacific Fragility Fracture Alliance

Published in: Archives of Osteoporosis | Issue 1/2022

Login to get access

Abstract

Summary

This narrative review summarises ongoing challenges and progress in the care and prevention of fragility fractures across the Asia Pacific region since mid-2019. The approaches taken could inform development of national bone health improvement Road Maps to be implemented at scale during the United Nations ‘Decade of Healthy Ageing’.

Purpose

This narrative review summarises recent studies that characterise the burden of fragility fractures, current care gaps and quality improvement initiatives intended to improve the care and prevention of fragility fractures across the Asia Pacific region.

Methods

The review focuses on published studies, reports and quality improvement initiatives undertaken during the period July 2019 to May 2022.

Results

Epidemiological studies conducted in countries and regions throughout Asia Pacific highlight the current and projected increasing burden of fragility fractures. Recent studies and reports document a persistent and pervasive post-fracture care gap among people who have sustained fragility fractures. Global initiatives developed by the Fragility Fracture Network and International Osteoporosis Foundation have gained significant momentum in the Asia Pacific region, despite the disruption caused by the COVID-pandemic. The Asia Pacific Fragility Fracture Alliance has developed educational resources including a Hip Fracture Registry Toolbox and a Primary Care Physician Education Toolkit. The Asia Pacific Osteoporosis and Fragility Fractures Society—a new section of the Asia Pacific Orthopaedic Association—is working to engage orthopaedic surgeons across the region in the care and prevention of fragility fractures. The Asia Pacific Consortium on Osteoporosis developed a framework to support national clinical guidelines development groups. Considerable activity at the national level is evident in many countries across the region.

Conclusion

Development and implementation of national Road Maps informed by the findings of this review are urgently required to respond to the epidemiological emergency posed by fragility fractures during the United Nations ‘Decade of Healthy Ageing’.
Literature
1.
2.
3.
4.
5.
Wikipedia (2022) List of countries and dependencies by population. https://​en.​wikipedia.​org/​wiki/​List_​of_​countries_​and_​dependencies_​by_​population.​ Accessed 16 Aug 2022
6.
7.
Wu A-M, GBD 2019 Fracture Collaborators (2019) Global, regional, and national burden of bone fractures in 204 countries and territories, 1990–2019: a systematic analysis from the Global Burden of Disease Study 2019. Lancet Healthy Longev 2:e580–e592CrossRef
8.
Ebeling PR, Chan DC, Lau TC, Lee JK, Songpatanasilp T, Wong SH, Hew FL, Sethi R, Williams M (2020) Secondary prevention of fragility fractures in Asia Pacific: an educational initiative. Osteoporos Int 31:805–826PubMedCrossRef
9.
Mitchell PJ, Magaziner J, Costa M, Seymour H, Marsh D, Falaschi P, Beaupre L, Tabu I, Eleuteri S, Close J, Agnusdei D, Speerin R, Kristensen MT, Lord S, Rizkallah M, Caeiro JR, Yang M (2020) FFN clinical toolkit, 1st edn. Fragility Fracture Network, Zurich. https://​fragilityfractur​enetwork.​org/​. Accessed 16 Aug 2022
10.
11.
Cheung CL, Ang SB, Chadha M et al (2018) An updated hip fracture projection in Asia: the Asian Federation of Osteoporosis Societies study. Osteoporos Sarcopenia 4:16–21PubMedCrossRefPubMedCentral
12.
Ong T, Khor HM, Kumar CS, Singh S, Chong E, Ganthel K, Lee JK (2020) The current and future challenges of hip fracture management in Malaysia. Malays Orthop J 14:16–21PubMedCrossRefPubMedCentral
13.
Pandey D, Barakoti R, Upreti A, Hamal PK (2021) A retrospective look at fragility hip fractures in elderly. J Orthop Dis 4:1–3
14.
15.
Tatangelo G, Watts J, Lim K et al (2019) The cost of osteoporosis, osteopenia, and associated fractures in Australia in 2017. J Bone Miner Res 34:616–625PubMedCrossRef
16.
Giummarra MJ, Ekegren CL, Gong J, Simpson P, Cameron PA, Edwards E, Gabbe BJ (2020) Twelve month mortality rates and independent living in people aged 65 years or older after isolated hip fracture: a prospective registry-based study. Injury 51:420–428PubMedCrossRef
17.
Lv H, Chen W, Zhang T et al (2020) Traumatic fractures in China from 2012 to 2014: a National Survey of 512,187 individuals. Osteoporos Int 31:2167–2178PubMedCrossRef
18.
19.
Wong RMY, Ho WT, Wai LS, Li W, Chau WW, Chow KS, Cheung WH (2019) Fragility fractures and imminent fracture risk in Hong Kong: one of the cities with longest life expectancies. Arch Osteoporos 14:104PubMedCrossRef
20.
Takusari E, Sakata K, Hashimoto T, Fukushima Y, Nakamura T, Orimo H (2021) Trends in hip fracture incidence in Japan: estimates based on nationwide hip fracture surveys from 1992 to 2017. JBMR Plus 5:e10428PubMedCrossRef
21.
Hagino H, Jackson M, Gitlin M, Wessler Z (2021) Estimating the future clinical and economic benefits of improving osteoporosis diagnosis and treatment among women in Japan: a simulation projection model from 2020 to 2040. Arch Osteoporos 16:156PubMedCrossRef
22.
Yong EL, Ganesan G, Kramer MS, Logan S, Lau TC, Cauley JA, Tan KB (2019) Hip fractures in Singapore: ethnic differences and temporal trends in the new millennium. Osteoporos Int 30:879–886PubMedCrossRef
23.
Chandran M, Lau TC, Gagnon-Arpin I, Dobrescu A, Li W, Leung MYM, Patil N, Zhao Z (2019) The health and economic burden of osteoporotic fractures in Singapore and the potential impact of increasing treatment rates through more pharmacological options. Arch Osteoporos 14:114PubMedCrossRef
24.
Yoo JI, Ha YC, Park KS, Kim RB, Seo SH, Koo KH (2019) Incidence and mortality of osteoporotic refractures in Korea according to Nationwide Claims Data. Yonsei Med J 60:969–975PubMedCrossRefPubMedCentral
25.
Jackson M, Yang KH, Gitlin M, Wessler Z (2021) Estimating the future clinical and economic benefits of improving osteoporosis diagnosis and treatment among women in South Korea: a simulation projection model from 2020 to 2040. Arch Osteoporos 16:115PubMedCrossRef
26.
Abeygunasekara T, Lekamwasam S, Lenora J, Alwis G (2020) Current incidence and future projections of fragility hip fractures in Sri Lanka. Arch Osteoporos 15:178PubMedCrossRef
27.
Abeygunasekara T, Lekamwasam S, Alwis G, Lenora J (2020) Factors associated with one-year mortality of patients admitted with fragility hip fracture: a follow-up study in Southern Sri Lanka. Arch Osteoporos 15:95PubMedCrossRef
28.
Daraphongsataporn N, Saloa S, Sriruanthong K, Philawuth N, Waiwattana K, Chonyuen P, Pimolbutr K, Sucharitpongpan W (2020) One-year mortality rate after fragility hip fractures and associated risk in Nan, Thailand. Osteoporos Sarcopenia 6:65–70PubMedCrossRefPubMedCentral
29.
30.
31.
32.
33.
34.
35.
36.
Wang X, Li C, He Y, Wang T, Zhang H, Ma Z, Ma H, Zhao H (2020) Anti-osteoporosis medication treatment pattern after osteoporotic fracture during 2010–2016 in Fujian. China Arch Osteoporos 15:134PubMedCrossRef
37.
Shimodan S, Sato D, Takahashi K et al (2020) Ten years change in post-fracture care for hip fracture patients. J Bone Miner Metab 38:222–229PubMedCrossRef
38.
39.
Nakatoh S, Fujimori K, Ishii S, Tamaki J, Okimoto N, Ogawa S, Iki M (2021) Insufficient increase in bone mineral density testing rates and pharmacotherapy after hip and vertebral fracture: analysis of the National Database of Health Insurance Claims and Specific Health Checkups of Japan. Arch Osteoporos 16:130PubMedCrossRef
40.
Chau YT, Nashi N, Law LS, Goh RKH, Choo SX, Seetharaman SK (2020) Undertreatment of osteoporosis following hip fracture: a retrospective, observational study in Singapore. Arch Osteoporos 15:141PubMedCrossRef
41.
Kim DG, Seo GW, Nam HW (2019) Trends in the diagnosis of osteoporosis in patients with distal radius fractures based on a National Claims Database. J Bone Metab 26:247–252PubMedCrossRefPubMedCentral
42.
Dreinhofer KE, Mitchell PJ, Begue T et al (2018) A global call to action to improve the care of people with fragility fractures. Injury 49:1393–1397PubMedCrossRef
43.
Marsh D, Mitchell PJ, Falaschi P et al (2020) Orthogeriatrics: the management of older patients with fragility fractures. Springer International Publishing, Cham, Switzerland
44.
45.
46.
47.
48.
Akesson K, Marsh D, Mitchell PJ, McLellan AR, Stenmark J, Pierroz DD, Kyer C, Cooper C, Group IOFFW (2013) Capture the fracture: a best practice framework and global campaign to break the fragility fracture cycle. Osteoporos Int 24:2135–2152PubMedCrossRefPubMedCentral
49.
Javaid MK, Sami A, Lems W et al (2020) A patient-level key performance indicator set to measure the effectiveness of fracture liaison services and guide quality improvement: a position paper of the IOF Capture the Fracture Working Group, National Osteoporosis Foundation and Fragility Fracture Network. Osteoporos Int 31:1193–1204PubMedCrossRefPubMedCentral
50.
51.
52.
53.
Close JC, Seymour H, Mitchell PJ, Ahern E, Costa M, Magaziner J, Lee JK, Chan D-C, Ang SB, Mercado-Asis LB, Flicker L, Leung E, Choon D, Kumar CSK, Rey-Matias R, Chen W-S, Halbout P, Cooper C, Blank RD, Zhao Y, on behalf of the Asia Pacific Fragility Fracture Alliance and the Fragility Fracture Network (2021) Hip fracture registry toolbox - a collaboration between the APFFA hip fracture registry working group and the FFN hip fracture audit special interest group. Asia Pacific fragility fracture Alliance. In: Lee JK, Chan D-C (eds). Asia Pacific Orthopaedic Association, Kuala Lumpur. https://​apfractureallian​ce.​org/​hfr-toolbox/​. Accessed 16 Aug 2022
54.
Asia Pacific Fragility Fracture Alliance (2020) Primary care physician education toolkit. Asia Pacific fragility fracture Alliance, Kuala Lumpur. https://​apfractureallian​ce.​org/​education-toolkit/​.​ Accessed 16 Aug 2022
55.
56.
57.
Lee JK, Ebeling P, Hagino H, Songpatanasilp T, Choon DS-W, Korskusuz F, Leung F, Theis J-C (2021) Closing the gap between orthopaedic surgeons and physicians in secondary fracture prevention - a call to action: an Asia-Pacific initiative from the international Osteoporosis Foundation and Asia Pacific Orthopaedic association. Reviewers: Lee JK, Choon DS-W, Pierroz DD, Ferrari S, Harvey N, Halbout P, Cooper C. International Osteoporosis Foundation - Asia Pacific Orthopaedic Association, Nyons and Kuala Lumpur. https://​www.​apoaonline.​com/​pdf/​apoa-brochure.​pdf. Accessed 16 Aug 2022
58.
59.
60.
61.
Chandran M, Mitchell PJ, Amphansap T et al (2021) Development of the Asia Pacific Consortium on Osteoporosis (APCO) Framework: clinical standards of care for the screening, diagnosis, and management of osteoporosis in the Asia-Pacific region. Osteoporos Int 32:1249–1275PubMedCrossRefPubMedCentral
62.
Gallacher SJ, Alexander S, Beswetherick N et al (2019) Effective secondary prevention of fragility fractures: clinical standards for fracture liaison services. Royal Osteoporosis Society, Camerton
63.
Arai H, Ikeda S, Okuro M et al (2019) Clinical Standards for Fracture Liaison Services (FLS) in Japan. Japan Osteoporosis Society and FFN Japan, Tokyo
64.
65.
66.
67.
68.
69.
70.
Accident Compensation Corporation, Ministry of Health, Health Quality & Safety Commission New Zealand, New Zealand Government (2022) Live stronger for longer - prevent falls and fractures website. http://​livestronger.​org.​nz/​. Accessed 16 Aug 2022
71.
72.
Tian M, Gong X, Rath S, Wei J, Yan LL, Lamb SE, Lindley RI, Sherrington C, Willett K, Norton R (2016) Management of hip fractures in older people in Beijing: a retrospective audit and comparison with evidence-based guidelines and practice in the UK. Osteoporos Int 27:677–681PubMedCrossRef
73.
Wu X, Tian M, Zhang J et al (2019) The effect of a multidisciplinary co-management program for the older hip fracture patients in Beijing: a “pre- and post-” retrospective study. Arch Osteoporos 14:43PubMedCrossRef
74.
Peng K, Liu H, Zhang J, Yang M, Liu Y, Tian M, Chu H, Wu X, Ivers R (2020) Applying normalization process theory and process mapping to understand implementation of a co-management program for older hip fracture patients in China: a qualitative study. Arch Osteoporos 15:92PubMedCrossRef
75.
Peng K, Yang M, Tian M, Chen M, Zhang J, Wu X, Ivers R, Si L (2020) Cost-effectiveness of a multidisciplinary comanagement program for the older hip fracture patients in Beijing. Osteoporos Int 31(8):1545–1553
76.
Zhang J, Yang M, Zhang X et al (2022) The effectiveness of a co-management care model on older hip fracture patients in China – a multicentre non-randomised controlled study. Lancet Region Health - Western Pacific 19:100348CrossRef
77.
National Health Commission of the People’s Republic of China (2022) National Health Commission of the People’s Republic of China website. http://​en.​nhc.​gov.​cn/​. Accessed 16 Aug 2022
78.
Australian and New Zealand Hip Fracture Registry (ANZHFR) Steering Group (2014) Australian and New Zealand Guideline for Hip Fracture Care: improving outcomes in hip fracture management of adults. Australian and New Zealand Hip Fracture Registry Steering Group, Sydney
79.
80.
81.
Roberts KC, Brox WT (2015) AAOS Clinical Practice Guideline: management of hip fractures in the elderly. J Am Acad Orthop Surg 23:138–140PubMedCrossRef
82.
Wong RMY, Qin J, Chau WW, Tang N, Tso CY, Wong HW, Chow SK, Leung KS, Cheung WH (2021) Prognostic factors related to ambulation deterioration after 1-year of geriatric hip fracture in a Chinese population. Sci Rep 11:14650PubMedCrossRefPubMedCentral
83.
Wong RMY, Law SW, Lee KB, Chow SKH, Cheung WH (2019) Secondary prevention of fragility fractures: instrumental role of a fracture liaison service to tackle the risk of imminent fracture. Hong Kong Med J 25:235–242PubMedCrossRef
84.
Wong RMY, Ko SY, Chau W-W, Lee LCY, Chow SKH, Cheung WH, Law SW (2021) The first reported fracture liaison service (FLS) for vertebral fractures in China: is muscle the missing gap? Arch Osteoporos 16:168PubMedCrossRef
85.
Shigemoto K, Sawaguchi T, Goshima K, Iwai S, Nakanishi A, Ueoka K (2019) The effect of a multidisciplinary approach on geriatric hip fractures in Japan. J Orthop Sci 24:280–285PubMedCrossRef
86.
87.
Hagino H, Endo N, Harada A, Iwamoto J, Mashiba T, Mori S, Ohtori S, Sakai A, Takada J, Yamamoto T (2017) Survey of hip fractures in Japan: recent trends in prevalence and treatment. J Orthop Sci 22:909–914PubMedCrossRef
88.
89.
90.
91.
Malaysian Orthopaedic Association (2022) Greying gracefully: the new paradigm for orthopaedics in an ageing population – 51st Malaysian Orthopaedic Association Annual Scientific Meeting 9th–11th June 2022 website. https://​moaasm.​com/​. Accessed 16 Aug 2022
92.
93.
Reyes PVSJ, Tabu IA, Sandoval MAS, Mangubat AAS, Bing-Agsaoay DDC (2021) Does adopting a multidisciplinary approach in the management of acute hip fractures in orthopedic geriatric patients lead to better outcomes? A Preliminary Report of the University of the Philippines - Philippine General Hospital (UP-PGH) Orthogeriatric Multidisciplinary Fracture Management Model and Fracture Liaison Service. Acta Med Philipp 55:1–7CrossRef
94.
Cortez KA, Lai JGL, Tabu IA (2021) Economic burden and the effects of early versus delayed hospitalization on the treatment cost of patients with acute fragility hip fractures under the UPM-PGH Orthogeriatric Multidisciplinary Fracture Management Model and Fracture Liaison Service. Osteoporos Sarcopenia 7:63–68PubMedCrossRefPubMedCentral
95.
Ebeling P, Chan D-C, Lau TC, Lee JK, Songpatanasilp T, Wong SH, Hew FL, Sethi R, Williams M (2020) Secondary prevention of fragility fractures in Asia Pacific: an educational initiative. Osteoporos Int 31(5):805–826
96.
97.
Cha YH, Ha Y-C, Lim J-Y (2019) Establishment of Fracture Liaison Service in Korea: where is it stand and where is it going? J Bone Metabolism 26:207–211CrossRef
98.
Min K, Beom J, Kim BR et al (2021) Clinical Practice Guideline for Postoperative Rehabilitation in Older Patients With Hip Fractures. Ann Rehabil Med 45:225–259PubMedCrossRefPubMedCentral
99.
Yoo J-I, Kim H-Y, Jang S, Lee Y-K, Ha Y-C (2020) Risk factors for subsequent hip fractures and fatality after an initial hip fracture in Korea: using nationwide claims data. Arch Osteoporos 15:165PubMedCrossRef
100.
Shim YB, Park JA, Nam JH, Hong SH, Kim JW, Jeong J, Shin JY (2020) Incidence and risk factors of subsequent osteoporotic fracture: a nationwide cohort study in South Korea. Arch Osteoporos 15:180PubMedCrossRef
101.
Hsu CL, Chen HM, Chen HJ, Chou MY, Wang YC, Hsu YH, Liang CK, Chu CS (2020) A national study on long-term osteoporosis therapy and risk of recurrent fractures in patients with hip fracture. Arch Gerontol Geriatr 88:104021PubMedCrossRef
102.
Huang CF, Pan PJ, Chiang YH, Yang SH (2021) A rehabilitation-based multidisciplinary care model reduces hip fracture mortality in older adults. J Multidiscip Healthc 14:2741–2747PubMedCrossRefPubMedCentral
103.
Chang CB, Yang RS, Chang LY, Peng JK, Tsai KS, Huang WJ, Yang TH, Chan DC (2021) One-year outcomes of an osteoporosis liaison services program initiated within a healthcare system. Osteoporos Int 32(11):2163–2172
104.
Chien LN, Li YF, Yang RS, Yang TH, Chen YH, Huang WJ, Tsai HY, Li CY, Chan DC (2021) Real-world cost-effectiveness analysis of the fracture liaison services model of care for hip fracture in Taiwan. J Formos Med Assoc 121(1(Pt 2)):425–433
105.
106.
Sucharitpongpan W, Daraphongsataporn N, Saloa S, Philawuth N, Chonyuen P, Sriruanthong K, Waiwattana K (2019) Epidemiology of fragility hip fractures in Nan, Thailand. Osteoporos Sarcopenia 5:19–22PubMedCrossRefPubMedCentral
107.
Sura-Amonrattana U, Tharmviboonsri T, Unnanuntana A, Tantigate D, Srinonprasert V (2021) Evaluation of the implementation of multidisciplinary fast-track program for acute geriatric hip fractures at a University Hospital in resource-limited settings. BMC Geriatr 21:548PubMedCrossRefPubMedCentral
108.
Amphansap T, Stitkitti N, Arirachakaran A (2020) The effectiveness of Police General Hospital’s fracture liaison service (PGH’s FLS) implementation after 5 years: a prospective cohort study. Osteoporos Sarcopenia 6:199–204PubMedCrossRefPubMedCentral
109.
Chotiyarnwong P, Boonnasa W, Chotiyarnwong C, Unnanuntana A (2021) Video-based learning versus traditional lecture-based learning for osteoporosis education: a randomized controlled trial. Aging Clin Exp Res 33:125–131PubMedCrossRef
110.
Thai Osteoporosis Foundation (2021) Clinical practice guideline on management of osteoporosis 2021. Thai Osteoporosis Foundation, Bangkok
111.
112.
113.
114.
115.
Bussell ME (2021) Improving bone health: addressing the burden through an integrated approach. Aging Clin Exp Res 33:2777–2786PubMedCrossRef
116.
Gill CE, Mitchell PJ, Clark J et al (2022) Experience of a systematic approach to care and prevention of fragility fractures in New Zealand. Arch Osteoporos 17(1):108–117
117.
118.
Metadata
Title
Quality improvement initiatives in the care and prevention of fragility fractures in the Asia Pacific region
Authors
Paul James Mitchell
Seng Bin Ang
Leilani Basa Mercado-Asis
Reynaldo Rey-Matias
Wen-Shiang Chen
Leon Flicker
Edward Leung
David Choon
Sankara Kumar Chandrasekaran
Jacqueline Clare Therese Close
Hannah Seymour
Cyrus Cooper
Philippe Halbout
Robert Daniel Blank
Yanling Zhao
Jae-Young Lim
Irewin Tabu
Maoyi Tian
Aasis Unnanuntana
Ronald Man Yeung Wong
Noriaki Yamamoto
Ding-Cheng Chan
Joon Kiong Lee
on behalf of the Asia Pacific Fragility Fracture Alliance
Publication date
01-12-2022
Publisher
Springer London
Published in
Archives of Osteoporosis / Issue 1/2022
Print ISSN: 1862-3522
Electronic ISSN: 1862-3514
DOI
https://doi.org/10.1007/s11657-022-01153-2

Other articles of this Issue 1/2022

Archives of Osteoporosis 1/2022 Go to the issue

Original Article

Impact of osteoporosis liaison services on the expected lifetime osteoporosis-related medical expenses of patients with fragility fracture in a private hospital in Japan

Original Article

Bone mass in Saudi women aged 20–40 years: the association with obesity and vitamin D deficiency

Original Article

Real-world effectiveness of osteoporosis treatments in Germany

Original Article

Quality of English-language videos available on YouTube as a source of information on osteoporosis

Original Article

Fibula response to disuse: a longitudinal analysis in people with spinal cord injury

Original Article

Impact of the COVID-19 pandemic on osteoporotic hip fractures in Chile