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Fracture liaison services for osteoporosis in the Asia-Pacific region: current unmet needs and systematic literature review

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Abstract

The analysis aimed to identify the treatment gaps in current fracture liaison services (FLS) and to provide recommendations for best practice establishment of future FLS across the Asia-Pacific region. The findings emphasize the unmet need for the implementation of new programs and provide recommendations for the refinement of existing ones. The study’s objectives were to evaluate fracture liaison service (FLS) programs in the Asia-Pacific region and provide recommendations for establishment of future FLS programs. A systematic literature review (SLR) of Medline, PubMed, EMBASE, and Cochrane Library (2000–2017 inclusive) was performed using the following keywords: osteoporosis, fractures, liaison, and service. Inclusion criteria included the following: patients ≥ 50 years with osteoporosis-related fractures; randomized controlled trials or observational studies with control groups (prospective or retrospective), pre–post, cross-sectional and economic evaluation studies. Success of direct or indirect interventions was assessed based on patients’ understanding of risk, bone mineral density assessment, calcium intake, osteoporosis treatment, re-fracture rates, adherence, and mortality, in addition to cost-effectiveness. Overall, 5663 unique citations were identified and the SLR identified 159 publications, reporting 37 studies in Asia-Pacific. These studies revealed the unmet need for public health education, adequate funding, and staff resourcing, along with greater cooperation between departments and physicians. These actions can help to overcome therapeutic inertia with sufficient follow-up to ensure adherence to recommendations and compliance with treatment. The findings also emphasize the importance of primary care physicians continuing to prescribe treatment and ensure service remains convenient. These findings highlight the limited evidence supporting FLS across the Asia-Pacific region, emphasizing the unmet need for new programs and/or refinement of existing ones to improve outcomes. With the continued increase in burden of fractures in Asia-Pacific, establishment of new FLS and assessment of existing services are warranted to determine the impact of FLS for healthcare professionals, patients, family/caregivers, and society.

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Acknowledgments

The authors would like to thank Dr. Zhongyun Zhao for facilitating this research and author collaborations.

Funding

This work was supported by Amgen Inc. Writing and editorial assistance was provided by ApotheCom and funded by Amgen Inc. and grant from NCKUH (NCKUH-10609007, 10605021).

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Authors and Affiliations

  1. Department of Family Medicine, National Cheng Kung University College of Medicine and Hospital, 138 Sheng-Li Road, Tainan, 70428, Taiwan

    Y. -F. Chang & C. -H. Wu

  2. Department of Family Medicine, National Yang-Ming University Hospital, Yilan, Taiwan

    C. -F. Huang

  3. Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan

    J. -S. Hwang

  4. Division of Endocrinology and Metabolism, Changhua Christian Hospital, Changhua, Taiwan

    J. -F. Kuo

  5. Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Chiayi, Taiwan

    K. -M. Lin

  6. Department of Orthopaedics, Tainan Municipal Hospital, Tainan, Taiwan

    H. -C. Huang

  7. Complete HEOR Solutions LLC, 1046 Knapp Road, North Wales, PA, 19454, USA

    S. Bagga & A. Kumar

  8. Keelung Chang Gung Memorial Hospital, Chang Gung University, Keelung, Taiwan

    F. -P. Chen

  9. Institute of Gerontology, National Cheng Kung University College of Medicine, Tainan, Taiwan

    C. -H. Wu

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  1. Y. -F. Chang
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  4. J. -F. Kuo
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  5. K. -M. Lin
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  6. H. -C. Huang
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  7. S. Bagga
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  8. A. Kumar
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  9. F. -P. Chen
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  10. C. -H. Wu
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Correspondence to C. -H. Wu.

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Conflicts of interest

Yin-Fan Chang, Chun-Feng Huang, Jawl-Shan Hwang, Jeng-Fu Kuo, Ko-Ming Lin, Hui-Cheng Huang, Ankita Kumar, Fang-Ping Chen, Chih-Hsing Wu declare that they have no conflict of interest.

Shalini Bagga has ownership or partnership in Complete HEOR Solutions LLC.

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Chang, Y.F., Huang, C.F., Hwang, J.S. et al. Fracture liaison services for osteoporosis in the Asia-Pacific region: current unmet needs and systematic literature review. Osteoporos Int 29, 779–792 (2018). https://doi.org/10.1007/s00198-017-4347-y

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