Fragility fractures, which commonly affects the hip, spine and wrist, are crippling to the lives of patients
A ground-breaking multi-stakeholder alliance charged with countering fragility fractures threatening the world’s most populated and fastest ageing region, will be unveiled in Sydney, Australia.
Formation of the Asia Pacific Fragility Fracture Alliance coincides with an article published in MJA Insight calling for an urgent, cross-disciplinary, multi-sector response to the mounting medical emergency facing Asia’s 4.5 billion inhabitants (comprising 60 per cent of the global population). The article appeals for the swift implementation of mobility-maintaining strategies to enable older people to live well, and independently, for as long as possible.
The Alliance’s four regional and three global representatives drawn from the osteoporosis, geriatrics, orthopaedics and rehabilitation sectors, will focus on three pillars – improving acute care for those who sustain bone fragility fractures (due to osteoporosis), subsequent patient rehabilitation, and secondary fracture prevention. Members of the umbrella organisation have signed a Memorandum of Understanding (MoU) which underscores their commitment to work collaboratively throughout the Asia Pacific region to improve outcomes for people who sustain fragility fractures.
According to Dato’ Dr Joon-Kiong Lee, an orthopaedic surgeon from Malaysia, MJA Insight co-author, and Asia Pacific Fragility Fracture Alliance Co-Chair, a fragility fracture, which currently occurs every three seconds across the globe, compromises quality of life and puts the affected individual at twice the risk for further fracture and loss of independence.
“Fragility fractures, which commonly affects the hip, spine and wrist, are crippling to the lives of patients, their carers’, families and communities alike. They also pose a significant resource and cost burden on health systems and economies, equating to an average 19 per cent of GDP per capita.
“Given our global population is rapidly ageing, with a projected 310 per cent increase in hip fractures for men and a 240 per cent increase in hip fractures for women by 2050. These alarming statistics demonstrate the need for systematic management of fragility fractures,” said Dr Lee.
“The Asia Pacific Fragility Fracture Alliance will act as a catalyst for systematic change, by driving policy, increasing awareness and influencing political and professional frameworks across the region.” Estimates suggest that between 2015 and 2030, the global population aged 60 years and above, will increase by 56 per cent, from 901 million, to more than 1.4 billion respectively. Moreover, by 2050, the Asian population aged 65 years and above will number 936 million, 4.5 – 6.3 million hip fractures are predicted to occur worldwide by 2050, half of which will occur in Asia. The direct medical cost associated with the total number of hip fractures in China, Hong Kong, India, Japan, Korea, Malaysia, Singapore, Taiwan and Thailand collectively is projected to increase from USD 9.5 billion in 2018, to USD 15 billion by 2050.
The article highlights the 2018 Global Call to Action to improve the care of people who sustain fragility fractures, by improving acute multidisciplinary care, rapid secondary fracture prevention and ongoing post-acute fragility fracture care. “One-in-four patients who sustain a hip fracture die within a year, and less than half of those who survive regain their previous level of function,” said Professor Sanjay Kumar Bhadada, Professor of Endocrinology, Secretary, Indian Society for Bone and Mineral Research, India.
“According to The Asian Federation of Osteoporosis Societies (AFOS) study on hip fractures, almost 1.1 million hip fractures are estimated to occur this year in nine countries/regions of Asia Pacific [China, Hong Kong, India, Japan, Korea, Malaysia, Singapore, Taiwan and Thailand] – an alarming, yet conservative figure projected to rise to more than 2.6 million by 2050. China (45 per cent), India (31 per cent) and Japan (9 per cent) will experience the majority of these hip fractures.
“In order to substantially reduce the rate of further fractures and their associated healthcare costs, health systems must appropriately assess and treat individuals who have already sustained a bone fracture,” Prof Bhadada said. Yet, secondary fracture prevention is far from routine in Asia Pacific. Just a quarter of hip fracture patients are on osteoporosis-specific medication when discharged from hospital in Australia, with significant variation between Australian hospitals, ranging from 0 to 73 per cent.
“The proportion of hip fracture patients assessed and/or treated for osteoporosis, ranges from less than one percent in some centres in China, up to (34 per cent) in Korea. For other countries/regions throughout Asia Pacific including Hong Kong (23 per cent), Japan (17 per cent) and Malaysia (30 per cent), the proportion of hip fracture patients who have been assessed or received treatment, is comparable,” said Prof Bhadada. Examples of best practice are, however, emerging throughout the region. National alliances have been established in several countries, including the Stop Osteoporotic Secondary (SOS) Fracture Alliance in Australia; the Live Stronger for Longer coalition in New Zealand and national FFNs in China, India, Japan, Korea, Malaysia and Thailand. Significantly, Taiwan has implemented 23 Fracture Liaison Services (FLS), or secondary fracture prevention programs, since 2015, 15 of which have secured International Osteoporosis Foundation (IOF) best practice accreditation.
According to Professor Jacqui Close, Orthogeriatrician and representative, International Fragility Fracture Network, Australia, there is a growing body of evidence to support the implementation of FLS.
“A FLS aims to ensure all patients aged 50 years or over, who present to healthcare services with a fragility fracture, undergo a risk assessment, and receive appropriate treatment and follow-up.“This collaborative, multi-stakeholder approach represents the most clinically and cost-effective secondary preventative model of care currently available.”
At the initial Asia Pacific Fragility Fracture Summit meeting held in Singapore in May 2018, IOF C.E.O, Dr Philippe Halbout then extended his support for the initiative, moving forward. The IOF is hosting the meeting today, to launch the Asia Pacific Fragility Fracture Alliance.
“The burden of fragility fractures in Asia Pacific is deserving of an innovative initiative that mobilises representatives across disciplines, into swift, collaborative and effective action.
“The IOF is delighted to support this regional initiative through the sharing of our knowledge, vision, skills and influence to significantly improve the outcomes for those who sustain fragility fractures,” said Dr Halbout.
The Alliance meeting is convening immediately prior to the IOF Regional 7th Asia-Pacific Osteoporosis Conference at Sydney’s International Convention Centre, from November 30 to December 1, 2018.
Members of the Asia Pacific Fragility Fracture Alliance include the Asian Federation of Osteoporosis Societies (AFOS), Asia-Oceanian Society of Physical and Rehabilitation Medicine (AOSPRM), Asia Pacific Geriatric Medicine Network (APGMN), Asia Pacific Orthopaedic Association (APOA), Fragility Fracture Network (FFN), International Osteoporosis Foundation (IOF), and The International Society for Clinical Densitometry (ISCD).