New alliance tackles fragility fractures

Wednesday, 05 December, 2018

New alliance tackles fragility fractures

A new alliance has been formed to counter the growing ‘tsunami’ of fractures happening among the elderly within the Asia Pacific region.

The new Asia Pacific Fragility Fracture Alliance was launched to coincide with an article published in MJA Insight calling for an urgent, cross-disciplinary, multisector response to the mounting medical fracture emergency facing Asia’s 4.5 billion inhabitants (comprising 60% of the global population).1 The article calls 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 consists of four regional and three global representatives from the osteoporosis, geriatrics, orthopaedics and rehabilitation sectors. They 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.

Alliance members have signed a memorandum of understanding (MoU) underscoring their commitment to work collaboratively throughout the Asia Pacific region to improve outcomes for people who sustain fragility fractures.

According to Dato’s 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% of GDP per capita.7

“Given our global population is rapidly ageing, with a projected 310% increase in hip fractures for men and a 240% 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%, 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 and 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 US$9.5 billion in 2018 to US$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 healthcare 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 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%.19


1. United Nations Department of Economic and Social Affairs Population Division (2017) World Population Prospects: Volume I 2017 Revision. New York.

2. Joon-Kiong, L. & Chan, D.C. (2018) Osteoporosis: Improving care of fragility fracture patients in Asia Pacific: A multidisciplinary, multisector approach. MJA Insight. Available at: [last accessed Nov, 2018].

3. International Osteoporosis Foundation. Capture the fracture – About. Available at [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.

5. International osteoporosis foundation. What is Osteoporosis. Available at: [last accessed Nov, 2018]

6. Office of the Surgeon General (US). Bone Health and Osteoporosis: A Report of the Surgeon General. Rockville (MD): Office of the Surgeon General (US); 2004. 5, The Burden of Bone Disease. Available from:

7. Mohd-Tahir, N.A & Li, S.C. 2017. Economic burden of osteoporosis-related hip fracture in Asia: a systematic review. Osteoporosis International. 28 (7), 2035-2044.

8. International Osteoporosis Foundation. Osteoporosis Facts and Statistics. Available at: [last accessed Nov, 2018].

9. United Nations Department of Economic and Social Affairs Population Division. World population ageing 2015 - highlights (ST/ESA/SER.A/368). New York. 2015.

10. United Nations, Department of Economic and Social Affairs, Population Division (2017). World Population Prospects: The 2017 Revision, Volume I: Comprehensive Tables (ST/ESA/SER.A/399).

11. Ching-Lung Cheung, Seng Bin Ang, Manoj Chadha, Eddie Siu-Lun Chow, Yoon-Sok Chung, Fen Lee Hew, Unnop Jaisamrarn, Hou Ng, Yasuhiro Takeuchi, Chih-Hsing Wu, Weibo Xia, Julie Yu, Saeko Fujiwara, (2018) An updated hip fracture projection in Asia: The Asian Federation of Osteoporosis Societies study, Osteoporosis and Sarcopenia, (4), (1),16-21.

12. Adler, R.A. (2012) Secondary fracture prevention. Curr Osteoporosis Reports. Vol 10: 22. Available at: [last accessed Oct 2018].

13. Australian and New Zealand Bone and Mineral Society Position Paper on Secondary Fracture Prevention. Available at: [last accessed, Oct 2018].

14. Akesson K, Marsh D, Mitchell PJ, McLellan AR, Stenmark J, Pierroz DD, Kyer C, Cooper C, Group IOFFW (2013) Capture the Fracture: a Best Practice Framework and global campaign to break the fragility fracture cycle. Osteoporosis Int 24:2135-2152.

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. Accessed 14 October 2018.

17. Keene GS, Parker MJ, Pryor GA (1993) Mortality and morbidity after hip fractures. BMJ 307:1248.

18. Dreinhofer KE, Mitchell PJ, Begue T, et al. (2018) A global call to action to improve the care of people with fragility fractures. Injury 49:1393-1397.

19. Australian and New Zealand Hip Fracture Registry (2018) Annual Report 2018. Sydney

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