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Secondary prevention of fragility fractures in Asia Pacific: an educational initiative

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Abstract

The Asia -Pacific Bone Academy (APBA) Fracture Liaison Service (FLS) Focus Group educational initiative has stimulated activity across the Asia -Pacific region with the intention of supporting widespread implementation of new FLS. In 2017, the APBA FLS Focus Group developed a suite of tools to support implementation of FLS across the Asia-Pacific region as a component of a multi-faceted educational initiative. This article puts this initiative into context with a narrative review describing the burden of fragility fractures in the region, the current secondary fracture prevention care gap and a summary of emerging best practice. The results of a survey to evaluate the impact of the APBA educational initiative is presented, in addition to commentary on recent activities intended to improve the care of individuals who sustain fragility fractures across the Asia -Pacific. A FLS Toolbox for Asia-Pacific was developed which included the following sections:

1. The burden of fragility fractures in the Asia-Pacific region.

2. A summary of evidence for FLS in the Asia-Pacific.

3. A generic, fully referenced FLS business plan template.

4. Potential cost savings accrued by each country, based on a country-specific FLS Benefits Calculator.

5. How to start and expand FLS programmes in the Asia-Pacific context.

6. A step-by-step guide to setting up FLS in countries in the Asia-Pacific region.

7. Other practical tools to support FLS establishment.

8. FLS online resources and publications.

The FLS Toolbox was provided as a resource to support FLS workshops immediately following the 5th Scientific Meeting of the Asian Federation of Osteoporosis Societies (AFOS) held in Kuala Lumpur in October 2017. The FLS workshops addressed three key themes:

• The FLS business case.

• Planning the FLS patient pathway.

• The role of the FLS coordinator in fragility fracture care management.

A follow-up survey of 142 FLS workshop participants was conducted in August–September 2018. The survey included questions regarding how FLS were developed, funded, the scope of service provision and the support provided by the educational initiative. Almost one-third (30.3%) of FLS workshop participants completed the survey. Survey responses were reported for those who had established a FLS at the time the survey was conducted and, separately, for those who had not established a FLS. Findings for those who had established a FLS included:

• 78.3% of respondents established a multidisciplinary team to develop the business case for their FLS.

• 87.0% of respondents stated that a multidisciplinary team was established to design the patient pathway for their FLS.

• 26.1% of respondents stated that their FLS has sustainable funding.

• The primary source of funding for FLS was from public hospitals (83.3%) as compared with private hospitals (16.7%).

Most hospitals that had not established a FLS at the time the survey was conducted were either in the process of setting-up a FLS (47%) or had plans in place to establish a FLS for which approval is being sought (29%). The primary barrier to establishing a new FLS was lack of sustainable funding. The APBA FLS Focus Group educational initiative has stimulated activity across the Asia-Pacific region with the intention of supporting widespread implementation of new FLS. A second edition of the FLS Toolbox is in development which is intended to complement ongoing efforts throughout the region to expedite widespread implementation of FLS.

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Acknowledgements

The Asia Pacific Bone Academy (ABPA) Fracture Liaison Service (FLS) Focus Group has been supported by unrestricted grants from Amgen Asia Holding Limited. The approach taken to organising the content of the FLS Toolbox was inspired by Osteoporosis Canada’s FLS implementation initiative, “Make the FIRST Break the LAST with Fracture Liaison Services”.

The work of the International Osteoporosis Foundation (IOF) has proved invaluable in the development of this initiative. The IOF Capture the Fracture® programme has developed globally endorsed standards of care for FLS, and the IOF World Osteoporosis Day reports provide a global perspective on the impact of osteoporosis and solutions to mitigate that impact. The 2013 IOF Asia Pacific Regional Audit has provided a wealth of information on all aspects of fragility fracture care and prevention in the region.

The Fragility Fracture Network (FFN) has articulated key steps in the implementation of systematic approaches, with a particular focus on the importance of national multisector, multidisciplinary alliances.

From the USA, Kaiser Permanente, the National Osteoporosis Foundation and the National Bone Health Alliance very generously shared a comprehensive suite of practical resources incorporated into the FLS Toolbox which will save FLS champions in Asia Pacific an enormous amount of time and energy.

The ABPA FLS Focus Group would also like to thank the following individuals and organisations: Paul Mitchell of Synthesis Medical NZ Limited for support with development of this educational initiative and medical writing support with this manuscript; AsiaCare Group in Hong Kong for development of the FLS Benefits Calculator and FLS workshops across the region; Amiculum Singapore for development of artwork for all materials; and Amgen Asia for the provision of unrestricted educational grants to make this work possible.

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Authors and Affiliations

  1. Department of Medicine, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash Health, Translational Research Facility, Level 7, 246 Clayton Rd, Clayton, VIC, 3168, Australia

    P.R. Ebeling

  2. Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan

    D.-C. Chan

  3. Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan

    D.-C. Chan

  4. Superintendent Office, Chutung Branch, National Taiwan University Hospital, Hsinchu, Taiwan

    D.-C. Chan

  5. Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    T.C. Lau

  6. Department of Orthopedic Surgery, Beacon International Specialist Centre, Petaling Jaya, Selangor, Malaysia

    J.K. Lee

  7. Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand

    T. Songpatanasilp

  8. Department of Orthopaedics, International Medical Centre, Central, Hong Kong

    S.H. Wong

  9. Puchong Medical Specialist Centre, Puchong, Selangor, Malaysia

    F.L. Hew

  10. Sime Darby Medical Centre, Subang Jaya, Selangor, Malaysia

    F.L. Hew

  11. Amgen Asia Holding Limited, Hong Kong, Hong Kong

    R. Sethi

  12. Servier, Suresnes, France

    M. Williams

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  1. P.R. Ebeling
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Corresponding author

Correspondence to P.R. Ebeling.

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Conflicts of interest

Professor Peter Ebeling has research funding from Amgen, Eli-Lilly, Novartis and Alexion and has received honoraria from Amgen and Alexion. Dr. Derrick Chan is a consultant for Amgen. Mr. Ravdeep Sethi is an employee of Amgen Asia Holding Limited. Dr. Manette Williams was a previous employee of Amgen Asia Holding Limited during the development and initial implementation of the educational initiative. The Asia Pacific Bone Academy (APBA) FLS Focus Group and development of the multi-faceted educational initiative relating to FLS implementation has been supported by unrestricted educational grants from Amgen Asia.

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Ebeling, P., Chan, DC., Lau, T. et al. Secondary prevention of fragility fractures in Asia Pacific: an educational initiative. Osteoporos Int 31, 805–826 (2020). https://doi.org/10.1007/s00198-019-05197-y

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