Review

. 2022 Aug 20;17(1):115.

doi: 10.1007/s11657-022-01153-2.

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

Paul James Mitchell^{1

2

3}, Seng Bin Ang^{4

5}, Leilani Basa Mercado-Asis^{4

6}, Reynaldo Rey-Matias^{7

8

9}, Wen-Shiang Chen^{7

10}, Leon Flicker^{11

12}, Edward Leung^{11

13}, David Choon^{14

15}, Sankara Kumar Chandrasekaran^{14

15}, Jacqueline Clare Therese Close^{16

17

18}, Hannah Seymour^{16

19}, Cyrus Cooper^{20

21

22

23}, Philippe Halbout²⁰, Robert Daniel Blank^{24

25

26}, Yanling Zhao^{24

27}, Jae-Young Lim²⁸, Irewin Tabu^{29

30}, Maoyi Tian^{31

32}, Aasis Unnanuntana³³, Ronald Man Yeung Wong³⁴, Noriaki Yamamoto³⁵, Ding-Cheng Chan³⁶, Joon Kiong Lee³⁷; Asia Pacific Fragility Fracture Alliance

Affiliations

¹ School of Medicine, University of Notre Dame Australia, Sydney, Australia.
² Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
³ Synthesis Medical NZ Limited, Pukekohe, Auckland, New Zealand.
⁴ Asian Federation of Osteoporosis Societies, c/o KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, Singapore.
⁵ Menopause Unit and Family Medicine Service, KK Women's and Children's Hospital, Singapore, Singapore.
⁶ Department of Endocrinology, Metabolism and Diabetes, Public Health, University of the Philippines, Manila, Philippines.
⁷ Asia-Oceanian Society of Physical and Rehabilitation Medicine, Kowloon, Hong Kong SAR, China.
⁸ Department of Physical and Rehabilitation Medicine, St Luke's Medical Center, Quezon City, Philippines.
⁹ College of Medicine, Philippine Academy of Rehabilitation Medicine, Manila, Philippines.
¹⁰ Department of Physical Medicine and Rehabilitation (University Hospital), National Taiwan University, Taipei, Taiwan.
¹¹ Asia Pacific Geriatric Network, Virtual Network, Perth, Australia.
¹² Internal Medicine, University of Western Australia, Perth, WA, Australia.
¹³ Geriatric Medicine Centre, Hong Kong Sanatorium and Hospital, Happy Valley, Hong Kong SAR, China.
¹⁴ Asia Pacific Orthopaedic Association, Bukit Jalil, Kuala Lumpur, Wilayah Persekutuan, Malaysia.
¹⁵ Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, Wilayah Persekutuan, Kuala LumpurKuala Lumpur, Malaysia.
¹⁶ Fragility Fracture Network, c/o MCI Schweiz AG, Zurich, Switzerland.
¹⁷ Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, NSW, Australia.
¹⁸ Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia.
¹⁹ Department of Geriatrics and Aged Care, Fiona Stanley Hospital, Murdoch, WA, Australia.
²⁰ International Osteoporosis Foundation, Nyons, Switzerland.
²¹ MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
²² NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
²³ NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK.
²⁴ International Society for Clinical Densitometry, Middletown, CT, USA.
²⁵ Osteoporosis and Translational Research Laboratory, Garvan Institute of Medical Research, Sydney, Australia.
²⁶ Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, 53226, USA.
²⁷ Beijing United Family Hospital (Department of Obstetrics and Gynecology), Beijing, China.
²⁸ Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea.
²⁹ Department of Orthopedics, University of the Philippines - Philippine General Hospital, Manila, Philippines.
³⁰ Institute On Aging, National Institutes of Health, UP Manila, Manila, Philippines.
³¹ The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.
³² School of Public Health, Harbin Medical University, Harbin, China.
³³ Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
³⁴ Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China.
³⁵ Department of Orthopaedic Surgery, Niigata Rehabilitation Hospital, Niigata, Japan.
³⁶ Department of Geriatrics and Gerontology and Department of Internal Medicine, National Taiwan University Hospital, No. 1, Changde St, Taipei, Taiwan. dingchengchan@ntu.edu.tw.
³⁷ Department of Orthopaedics, Beacon Hospital, 1, Jalan 215, Section 51, Off Jalan Templer, 46050, Petaling Jaya, Selangor, Malaysia. osteoporosis_jklee@yahoo.com.

PMID: 35987919
PMCID: PMC9392505
DOI: 10.1007/s11657-022-01153-2

Review

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

Paul James Mitchell et al. Arch Osteoporos. 2022.

. 2022 Aug 20;17(1):115.

doi: 10.1007/s11657-022-01153-2.

Authors

Affiliations

¹ School of Medicine, University of Notre Dame Australia, Sydney, Australia.
² Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
³ Synthesis Medical NZ Limited, Pukekohe, Auckland, New Zealand.
⁴ Asian Federation of Osteoporosis Societies, c/o KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, Singapore.
⁵ Menopause Unit and Family Medicine Service, KK Women's and Children's Hospital, Singapore, Singapore.
⁶ Department of Endocrinology, Metabolism and Diabetes, Public Health, University of the Philippines, Manila, Philippines.
⁷ Asia-Oceanian Society of Physical and Rehabilitation Medicine, Kowloon, Hong Kong SAR, China.
⁸ Department of Physical and Rehabilitation Medicine, St Luke's Medical Center, Quezon City, Philippines.
⁹ College of Medicine, Philippine Academy of Rehabilitation Medicine, Manila, Philippines.
¹⁰ Department of Physical Medicine and Rehabilitation (University Hospital), National Taiwan University, Taipei, Taiwan.
¹¹ Asia Pacific Geriatric Network, Virtual Network, Perth, Australia.
¹² Internal Medicine, University of Western Australia, Perth, WA, Australia.
¹³ Geriatric Medicine Centre, Hong Kong Sanatorium and Hospital, Happy Valley, Hong Kong SAR, China.
¹⁴ Asia Pacific Orthopaedic Association, Bukit Jalil, Kuala Lumpur, Wilayah Persekutuan, Malaysia.
¹⁵ Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, Wilayah Persekutuan, Kuala LumpurKuala Lumpur, Malaysia.
¹⁶ Fragility Fracture Network, c/o MCI Schweiz AG, Zurich, Switzerland.
¹⁷ Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, NSW, Australia.
¹⁸ Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia.
¹⁹ Department of Geriatrics and Aged Care, Fiona Stanley Hospital, Murdoch, WA, Australia.
²⁰ International Osteoporosis Foundation, Nyons, Switzerland.
²¹ MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
²² NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
²³ NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK.
²⁴ International Society for Clinical Densitometry, Middletown, CT, USA.
²⁵ Osteoporosis and Translational Research Laboratory, Garvan Institute of Medical Research, Sydney, Australia.
²⁶ Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, 53226, USA.
²⁷ Beijing United Family Hospital (Department of Obstetrics and Gynecology), Beijing, China.
²⁸ Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea.
²⁹ Department of Orthopedics, University of the Philippines - Philippine General Hospital, Manila, Philippines.
³⁰ Institute On Aging, National Institutes of Health, UP Manila, Manila, Philippines.
³¹ The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.
³² School of Public Health, Harbin Medical University, Harbin, China.
³³ Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
³⁴ Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China.
³⁵ Department of Orthopaedic Surgery, Niigata Rehabilitation Hospital, Niigata, Japan.
³⁶ Department of Geriatrics and Gerontology and Department of Internal Medicine, National Taiwan University Hospital, No. 1, Changde St, Taipei, Taiwan. dingchengchan@ntu.edu.tw.
³⁷ Department of Orthopaedics, Beacon Hospital, 1, Jalan 215, Section 51, Off Jalan Templer, 46050, Petaling Jaya, Selangor, Malaysia. osteoporosis_jklee@yahoo.com.

PMID: 35987919
PMCID: PMC9392505
DOI: 10.1007/s11657-022-01153-2

Abstract

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'.

Keywords: Fracture liaison service; Fragility fracture; Orthogeriatrics; Osteoporosis; Systematic approach.

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Conflict of interest statement

Adjunct Associate Professor Paul James Mitchell (PJM) has undertaken consultancy for governments, national and international osteoporosis societies, healthcare professional organisations and private sector companies relating to systematic approaches to fragility fracture care, and prevention since 2005. PJM is a paid consultant and project manager for the Asia Pacific Fragility Fracture Alliance. Adjunct Assistant Professor Seng Bin Ang has no disclosures relating to this work. Professor Leilani Basa Mercado-Asis reports no conflicts of interest. Professor Reynaldo Rey-Matias has no disclosures relating to this work. Professor Wen-Shiang Chen has no disclosures relating to this work. Professor Leon Flicker reports no conflicts of interest. Dr. Edward Leung has no disclosures relating to this work. Professor David Choon has no disclosures relating to this work. Dr. Sankara Kumar Chandrasekaran has no disclosures relating to this work. Professor Jacqueline Clare Therese Close has no disclosures relating to this work. Dr. Hannah Seymour has no disclosures relating to this work. Professor Cyrus Cooper has received consulting fees and honoraria from Amgen, Danone, Eli Lilly, GSK, Medtronic, Merck, Nestle, Novartis, Pfizer, Roche, Servier, Shire, Takeda and UCB. Dr. Philippe Halbout is the Chief Executive Officer of the International Osteoporosis Foundation and has no disclosures relating to this work. Professor Robert Daniel Blank: Consulting, Bristol Myers Squibb; advisory board, Amgen; ownership, Abbott Labs, Abbvie, Amgen, JangoBio, Procter & Gamble; editorial stipend, Elsevier; authorship royalties, Wolters Kluwer. Dr. Yanling Zhao reports no conflicts of interest. Professor Jae-Young Lim reports no disclosures relating to this work. Associate Professor Irewin Tabu reports no disclosures relating to this work. Professor Maoyi Tian reports no conflicts of interest. Professor Aasis Unnanuntana has no disclosures relating to this work. Assistant Professor Ronald Man Yeung Wong has no disclosures relating to this work. Professor Noriaki Yamamoto has no disclosures relating to this work. Professor Ding-Chen (Derrick) Chan reports personal fees (consulting fees) from Amgen, Lotus, Eli-Lilly and Harvester Trading Co, Ltd. Dato’ Dr. Joon Kiong Lee has received honoraria from Amgen, Mylan, and Zuellig Pharma for speaking at symposia, as member of advisory board and educational programmes and workshops.

Figures

**Fig. 1**
Old-age dependency ratio for Thailand for the period 1950 to 2100. From World Population Prospects: Volume II: Demographic Profiles 2017 Revision. ST/ESA/SER.A/400, by Department of Economic and Social Affairs, Population Division, ©2017 United Nations. Reprinted with the permission of the United Nations

**Fig. 2**
A systematic approach to fragility fracture care and prevention for New Zealand [117]. Reproduced with kind permission of Osteoporosis New Zealand

See this image and copyright information in PMC

References

1. Wikipedia (2022) World population. https://en.wikipedia.org/wiki/World_population. Accessed 16 Aug 2022
1. Adam D. How far will global population rise? Researchers can't agree. Nature. 2021;597:462–465. doi: 10.1038/d41586-021-02522-6. - DOI - PubMed
1. World Health Organization (2020) The decade of healthy ageing: a new UN-wide initiative. https://www.who.int/news/item/14-12-2020-decade-of-healthy-ageing-a-new-.... Accessed 16 Aug 2022
1. Worldometers.info (2022) Current world population. https://www.worldometers.info/world-population/. Accessed 16 Aug 2022
1. Wikipedia (2022) List of countries and dependencies by population. https://en.wikipedia.org/wiki/List_of_countries_and_dependencies_by_popu.... Accessed 16 Aug 2022

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

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