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 today.

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).¹ 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.²

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,³ compromises quality of life, and puts the affected individual at twice the risk for further fracture and loss of independence. ⁴

“Fragility fractures, which commonly affect the hip, spine and wrist,⁵ are crippling to the lives of patients, their carers’, families and communities alike.⁶ 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. ⁷

“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 2050,⁸ 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.⁹ Moreover, by 2050, the Asian population aged 65 years and above will number 936 million.¹⁰ Between 4.5 – 6.3 million hip fractures are predicted to occur worldwide by 2050, half of which will occur in Asia.¹¹ 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 2050.¹¹

Worryingly, despite the availability of generally effective and well-tolerated therapies, only a minority of people who sustain fragility fractures are evaluated and treated for underlying osteoporosis.¹² Therefore, many people experience further, debilitating secondary fractures, creating a substantial, but avoidable burden on already strained health care systems.¹³

The MJA Insight article outlines various global and regional strategies to date, designed to systematically manage and prevent fragility fractures, with a common focus on secondary fracture prevention.^14,15,16 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.²

“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,”³ said Associate Prof Derrick Chan, geriatrician and gerontologist, article co-author, and Co-Chair, Asia Pacific Fragility Fracture Alliance, Taiwan.

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 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).

References

1. United Nations Department of Economic and Social Affairs Population Division (2017) World Population Prospects: Volume I 2017 Revision. New York.
2. Joon-Kion, L. & Chan, D.C. Improving care of fragility fracture patients in Asia Pacific: A multidisciplinary, multisector approach. MJA Insight.
3. International Osteoporosis Foundation. Capture the fracture – About. Available at https://www.capturethefracture.org/about. [Last accessed Oct, 2018].
4. Madureira, M. M., Ciconelli, R. M., & Pereira, R. M. (2012). Quality of life measurements in patients with osteoporosis and fractures. Clinics (Sao Paulo, Brazil), 67(11), 1315-20.
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15. Eisman JA, Bogoch ER, Dell R, et al. (2012) Making the first fracture the last fracture: ASBMR task force report on secondary fracture prevention. J Bone Miner Res 27:2039-2046.
16. Fragility Fracture Network (2018) Fragility Fracture Network website. http://fragilityfracturenetwork.org/ Accessed 14 October 2018.