Cracking Osteoporosis 

Singapore, Oct 26: More than 50 per cent of the world’s hip fractures are expected to occur in the Asia Pacific by the year 2050.
The survival of those who sustain an osteoporotic fragility fracture is significantly compromised for up to six years, with patients facing twice the risk of death within the first year.
A prior fracture at any site doubles a person’s risk of refracture.
More than 80 per cent of fragility fracture patients are neither assessed, nor treated, placing a substantial, but importantly, preventable burden on already strained healthcare systems.
This is despite the extensive availability of safe and effective osteoporosis management strategies.
Minimum clinical standards for the assessment and management of osteoporosis are therefore urgently required in the Asia Pacific, to inform clinical practice guidelines, and improve osteoporosis care.
In conjunction with the World Osteoporosis Day on October 20 the Asia Pacific Consortium on Osteoporosis (APCO) launched a world-first, interactive, educational osteoporosis resource – the APCO Health Care Professional (HCP) Peer to Peer Educational Modules.
The APCO HCP Peer to Peer Education Modules will offer physicians a comprehensive, evidence-based resource encouraging wide scale implementation of the minimum clinical standards of care for osteoporosis advocated in The APCO Framework.
This will enable the delivery of best practice osteoporosis care throughout the Asia Pacific – the world’s fastest ageing region.
According to APCO Chairperson, and Director of the Osteoporosis and Bone Metabolism Unit, Singapore General Hospital Dr Manju Chandran there are significant inconsistencies in clinical practice guidelines in the Asia Pacific for the management and prevention of osteoporosis and fragility fractures.
She said these guidelines vary extensively in scope and recommendations.
There is also a lack of information available on adherence to national guidelines in daily clinical practice.

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“It is to address this care gap, that APCO has developed an interactive, 17-module educational series today, to arm osteoporosis champions in the Asia Pacific, with information, supporting data, topical literature summaries, and best practice examples that support and emphasise each of The APCO Framework’s 16 minimum clinical standards and emerging themes in osteoporosis care.
“Increasing awareness and education among healthcare professionals in the Asia Pacific is imperative to bringing change to the real-world clinical practice of osteoporosis care and fracture prevention,” Dr Chandran said.
“The Asia Pacific is home to 4.5 billion people, rapidly ageing populations, and vastly different healthcare systems.
“An overwhelming 319 million people aged 50 years and over from the Asia Pacific are projected to be at high risk of osteoporotic fracture over the next two decades, while more than half of the world’s hip fractures are expected to occur in the region by 2050,” Dr Chandran added.
“Singapore has one of the highest hip fracture rates in the world, with a four-to-five-fold increase in incidence noted over a recent 30-year period.

Cracking Osteoporosis. Supplied.
Cracking Osteoporosis. Image Supplied.

“The incidence of osteoporotic fractures in Singapore is projected to rise from more than 15,000 in 2017, to 24,100 by 2035, an increase of 57.9 per cent.
“The total economic burden (including both direct and indirect costs) associated with these fractures is projected to grow from SGD 183.5 million (USD 214 million) in 2017, to SGD 289.6 million (USD 136 million) by 2035.”
After one year, two in five people who sustain a hip fracture will be unable to walk independently, while two-thirds will encounter difficulty performing at least one essential daily task.
“Economically, the burden of current treatment of a single hip fracture in the Asia Pacific is extremely high, equating to approximately 19 per cent of our region’s per-head gross domestic product (GDP),” said APCO Committee member, Consultant in Endocrinology and Diabetes at Tun Wah Hospital, and Chairperson of the Guideline for the Management of Postmenopausal Osteoporosis in Hong Kong Dr Ip Tai-Pang.
In Hong Kong SAR alone, the direct medical costs of hip fractures were an estimated USD 85 million in 2018, the costs for which are projected to increase to USD 243 million by 2050.
“Given the anticipated exponential growth in fragility fractures due to the region’s rapidly ageing population, mass urbanisation and our increasingly sedentary lifestyles, we must act now,” Dr Ip said.
“Osteoporosis experts can use the new APCO HCP Education Modules either in full, or in part, to inspire and further inform their peers and professional communities on those at high-risk for fracture who require identification and assessment, based on their medical and fracture history, risk factors, co-occurring diseases, country-specific osteoporosis screening tool results, and falls risk.
“Supporting data on the administration, duration, monitoring of, and adherence to, various treatment interventions and their associated side-effects, as well as the critical need for long-term management plans, also feature in the APCO modules,” said Dr Ip.
Osteoporosis is vastly under-diagnosed and under-treated. Disturbingly, millions of people worldwide at high risk of fracture remain unaware of this underlying, silent disease.
Championed by the International Osteoporosis Foundation (IOF), World Osteoporosis Day is dedicated to raising global awareness of the importance of prevention, diagnosis and treatment of osteoporosis and musculoskeletal diseases.
“This World Osteoporosis Day, we encourage healthcare providers, policy makers, patients, members of the public, and the media on a global, regional and national stage, to recognise the monumental human and socio-economic burden of osteoporosis, and the severe impact of fractures on a patient’s independence and quality of life,” IOF Chief Executive Officer, and APCO Executive Committee member, Dr Philippe Halbout said.
“One of the emerging osteoporosis themes outlined in the APCO HCP Education Modules, is the importance of Asia Pacific-wide systemic integration of case identification and management at all levels of health systems, including acute care services, when patients present with fractures through Post Fracture Care Coordination Programs, such as Fracture Liaison Services (FLS).
“These coordinated systems of care aim to identify, treat and monitor patients presenting with a fragility fracture. Intervention can reduce fractures by up to 50 per cent, deliver substantial financial savings, and ultimately, save lives,” said Dr Halbout.

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