International Osteoporosis Foundation Research Articles

Impact of osteoporosis and osteoporosis medications on fracture healing: a narrative review.

Fracture healing is a complex process. Uncertainty exists over the influence of osteoporosis and the medications used to treat it on fracture healing. Narrative review authored by the members of the Fracture Working Group of the Committee of Scientific Advisors of the International Osteoporosis Foundation (IOF), on behalf of the IOF and the Société Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT). Fracture healing is a multistep process. Most fractures heal through a combination of intramembranous and endochondral ossification. Radiographic imaging is important for evaluating fracture healing and for detecting delayed or non-union. The presence of callus formation, bridging trabeculae, and a decrease in the size of the fracture line over time are indicative of healing. Imaging must be combined with clinical parameters and patient-reported outcomes. Animal data support a negative effect of osteoporosis on fracture healing; however, clinical data do not appear to corroborate with this. Evidence does not support a delay in the initiation of antiresorptive therapy following acute fragility fractures. There is no reason for suspension of osteoporosis medication at the time of fracture if the person is already on treatment. Teriparatide treatment may shorten fracture healing time at certain sites such as distal radius; however, it does not prevent non-union or influence union rate. The positive effect on fracture healing that romosozumab has demonstrated in animals has not been observed in humans. Overall, there appears to be no deleterious effect of osteoporosis medications on fracture healing. The benefit of treating osteoporosis and the urgent necessity to mitigate imminent refracture risk after a fracture should be given prime consideration. It is imperative that new radiological and biological markers of fracture healing be identified. It is also important to synthesize clinical and basic science methodologies to assess fracture healing, so that a convergence of the two frameworks can be achieved.

Development and Comparison of Treatment Decision Tools for Glucocorticoid-Induced Osteoporosis.

Long-term Glucocorticoid (GC) use results in compromised bone strength and fractures, and several treatment recommendations have been developed to prevent fractures, but none have been validated in a real-world setting. This study aims to create a treatment decision tool and compares this tool to the treatment suggestions from the American College of Rheumatology (ACR), International Osteoporosis Foundation and European Calcified Tissue Society (IOF-ECTS), and GC-adjusted Fracture Risk Assessment Tool (GC-FRAX), above the intervention threshold. We utilized registry data gathered at Chang Gung Memorial Hospital at Kaohsiung, Taiwan, between September 2014 and April 2021. This research is a single-center, observational, and case-controlled study. We recruited participants using prednisone for at least 2.5 mg/day or the equivalent dose for over 3 months, excluding those younger than 40, those with malignancies, or those currently undergoing anti-osteoporosis therapy. The primary endpoint was new fragility fractures within 3 years, including morphometric vertebral fractures detected at baseline and with a follow-up thoracic-lumbar spine X-ray. Participants were randomly allocated into derivation and validation sets. We developed the Steroid-Associated Fracture Evaluation (SAFE) tool in the derivation cohort by assessing the weights of exploratory variables via logistic regression. Prediction performance was compared in the validation set by the receiver operating characteristic (ROC) curve, the area under the curve (AUC), and sensitivity and specificity. A total of 424 treatment-naïve subjects were enrolled, and 83 (19.6%) experienced new fractures within 3 years. The final formula of the SAFE tool includes osteoporosis (1 point), an accumulated GC dose ≥ 750 mg within 6 months (or equivalent prednisolone of ≥4.5 mg/day for 6 months) (1 point), a BMI ≥ 23.5 (1 point), previous fractures (1 point), and elderliness of ≥70 years (2 points). In the validation set, a treatment decision based on the SAFE ≥ 2 points demonstrated an AUC of 0.65, with a sensitivity/specificity/accuracy of 75.9/54.0/58.9, with an ACR of 0.56 (100.0/11.0/31.0), IOF-ECTS 0.61 (75.9/46.0/52.7), and GC-FRAX 0.62 (82.8/42.0/51.2). Among current GIOP recommendations, the SAFE score serves as an appropriate treatment decision tool with increased accuracy and specificity.

Expert opinions on the prevalence, diagnosis and treatment choice for osteoarthritis management in Indian settings

Studies have reported the capability of bisphosphonates to delay the progression of structural deterioration associated with osteoarthritis (OA). Limited studies exist regarding OA management in India and the determinants influencing patients' decisions regarding surgical interventions. So, this study aimed to assess the prevalence, diagnostic practices, and treatment options available for OA management in Indian clinical practice with a special focus on alendronate, a bisphosphonate medication for OA pain management. The cross-sectional, multiple-response questionnaire-based study collected a survey response using a 25-item questionnaire from 276 clinicians across India. Additionally, the survey focused on determining the diagnostic practices helpful in determining osteoporosis and the preference of treatment options for OA management. Based on the responses of 276 participants, 43% indicated that the diagnosis of OA was predominant in both genders. Moreover, about 51% of the respondents suggested that mass screening for osteoporosis in Indian patients should be conducted using the one-minute risk test developed by the International Osteoporosis Foundation. Additionally, 47% of the respondents highlighted hip fractures as the most common type of bone fracture observed in these patients. Furthermore, around 51% of the study participants emphasized that adequate calcium consumption during childhood can potentially reduce the incidence of osteoporosis. For the effective management of OA, alendronate was preferred by 49% of respondents over the other bisphosphonates.As per the expert consensus,patients who have osteoporosis risk factors and osteopenia without fragility fractures were recommended to adhere to dietary and lifestyle modifications, coupled with calcium and vitamin D supplementation, and bisphosphonate therapy. Alendronate was preferred over other bisphosphonates for the effective management of OA.

Building a Multidisciplinary Care Pathway Supported by a Surgical Approach to Local Bone Formation.

Osteoporosis is the most common disease of bone mineral metabolism. In Spain, it affects approximately 3 million people, of whom 80% are females and 20% are males. Despite the advances that have been made in this field, we continue to witness alarming levels of fragility hip fractures. In 2010, the cost of osteoporosis in the European Union was estimated to be 37,000 million euros, which included the costs for the treatment of incident fractures (66%), pharmacological prevention (5%), and long-term fracture care (29%). A multidisciplinary care pathway supported by a surgical approach to local bone formation is needed. Recently, the International Osteoporosis Foundation (IOF) and the European Society for Clinical and Economic Aspects of Osteoporosis (ESCEO) included in their treatment guidelines a local osteo-enhancement procedure (LOEP) as a treatment option. In the Ossure™ LOEP technique (AgNovos Healthcare USA, LLC, Rockville, MD), a calcium-based triphasic osteoconductive implant material (AGN1), which has been shown to increase bone mineral density (BMD) and proximal femoral strength, is introduced percutaneously in the femoral neck and intertrochanteric region. Basically, the procedure consists of three percutaneous steps: prepare, clean, and fill the cavity with AGN1. It can be carried out with sedation and local anaesthesia or spinal anaesthesia. This report presents a clinical case and discusses how to select patients who could potentially benefit from this technique.

Osteoporosis: Investigations and Monitoring.

Osteoporosis is characterized by microarchitectural disruption of the bone, decrease in bone mineral density, and increased skeletal fragility and risk of fracture. Osteoporosis occurs due to the decoupling of bone formation and bone resorption, with a significant increase in resorption. This review article focuses on the role of laboratory investigations in the diagnosis and monitoring of treatment in patients with osteoporosis. This review article collected literature from various databases using keywords such as 'Laboratory investigations', 'Osteoporosis', 'Diagnosis', 'Monitoring', and 'Bone turnover markers'. Laboratory investigations, including serum calcium, alkaline phosphatase, vitamin D, and parathormone, are commonly performed tests to exclude secondary causes of osteoporosis and monitor the response to therapy. The biochemical markers of bone turnover are newly emerged tests for monitoring individual patients with osteoporosis. These markers are classified as bone formation and resorption markers, measurable in both serum and urine. The use of these markers is limited by biological and analytical variability. The International Federation of Clinical Chemistry and Laboratory Medicine and the International Osteoporosis Foundation recommend serum procollagen type 1 amino-terminal propeptide as the bone formation marker and β-form of C-terminal cross-linked telopeptide of type I collagen (β-CTx-1/β-CrossLaps) as the marker of choice, using standardized procedures. However, in specific cases, such as patients with chronic renal disease, CTx-1 is replaced by the resorption marker tartrate-resistant acid phosphatase 5b, as its levels are not affected by renal excretion. Bone turnover markers have emerged as tools for the assessment of osteoporosis, using standardized procedures, and are useful in monitoring therapy and treatment compliance.

98 Bone health: managed correctly? A clinical audit

Abstract Background Bone health is as important in the geriatric population as any other clinical system. The International Osteoporosis Foundation states that approximately 75 million people have osteoporosis across Europe, the United States and Asia. Osteoporosis and Fragility Fractures have become a common finding in presentations to general practices and emergency departments. Clinical guidelines exist with key elements to best identify, investigate, treat, and follow up these patients—but are guidelines being followed? Methods A clinical audit and service evaluation of patients attending a geriatric assessment and treatment clinic was compared to the new 2021 United Kingdom National Osteoporosis Guideline Group publication. The comparison between strong recommendations in these guidelines and clinical practice in patients with known osteoporosis and fragility fractures was undertaken using a self-designed matrix. 28 patient files were identified, and findings recorded. Results This study suggests that bone health in geriatric patients is undertreated. Only 25% of identified patients were investigated, treated, and prescribed bone health medication as per the 2021 United Kingdom National Osteoporosis Guideline Group publication. History taking regarding comorbidities, level of mobility and frailty scoring were judiciously completed across the 28-patient sample. Referrals to allied health practitioners was lacking though patient follow up was well documented. Conclusion The key is to identify poor bone health early, act swiftly with relevant investigations and commencing medications and preventing fragility fractures and hospital admissions. Future reviews of bone health management in the geriatric populations are still required to allow full understanding on the topic.

Mind the osteoporosis care gap with timely diagnosis: an executive summary of nationwide osteoporosis Campaigns 2019-2021.

The World Osteoporosis Day inaugurate on October 20 every year by the International Osteoporosis Foundation to initiate bone health and osteoporosis as a global health agenda for policymakers, health care providers, and the public. The reported the campaigns activities in three years 2019, 2020, and 2021. The aim of this campaigns was to promote the osteoporosis awareness to close osteoporosis care and data gaps. World Osteoporosis Day campaigns were held during three consecutive years 2019-2021 through "structuring" and "implantation" phases. The slogan of "early detection and timely diagnosis of osteoporosis" was followed in different public awareness and healthcare professional educational events. Also, a short survey regarding the knowledge of women aged ≥ 50 years of osteoporosis was used in campaigns to gather data for future planning. These nationwide campaigns was supported by the Osteoporosis Research Center in collaboration with the non-communicable diseases management office of Iran's Ministry of Health. All activities stablished to close the "data" and "awareness" gap in osteoporosis care. 1972, 1881, and 2538 women aged ≥ 50 were participated in the world osteoporosis campaigns and educated in 2019, 2020, and 2021, respectively. More than thousands of online and published educational materials were provided and disseminated in group and face-to-face and virtual education via celebration meetings in primary healthcare facilities, parks and shopping malls. The wide-ranging health slogans and massages was distributed by way of SMS, press conferences on television, radio, and other social media platforms. In addition, the in-person and virtual events such as up-date osteoporosis symposiums, national osteoporosis research network meetings, osteoporosis essential courses, and subspecialty one-day seminars provided knowledge for health care teams and policy makers. Closing the osteoporosis treatment gap was approached by nationwide campaigns to make an appropriate intervention to emphasize early diagnosis and awareness of osteoporosis to close the care gap. The online version contains supplementary material available at 10.1007/s40200-023-01257-7.

Validation of JSBMR's CTIBL manual for Japanese men receiving androgen deprivation therapy for prostate cancer.

Androgen deprivation therapy (ADT) for prostate cancer causes cancer treatment-induced bone loss (CTIBL), increases the fracture risk 2-3 times, and worsens life prognoses. The Japan Society of Bone and Mineral Research (JSBMR) created a CTIBL treatment manual in 2020; however, no study has validated its use in patients with ADT/CTIBL prostate cancer. This study classified 124 patients with prostate cancer without bone metastasis who received ADT into high- and low-risk groups using the JSBMR CTIBL algorithm. Comparisons were made with the period to incident vertebral fracture and the existing International Osteoporosis Foundation (IOF) classification. The median age was 74years; the median observation period was 81months. At 1, 3, 5, 7, and 9years, the prevalence of incident vertebral fractures was, respectively, 3.3%, 10.7%, 17.9%, 21.4%, and 31.2% in the entire population; 13%, 27%, 36%, 42%, and 58% in the high-risk group (19%); and 1%, 7%, 14%, 17%, and 25% in the low-risk group (81%). The hazard ratio between the two groups was 3.57 (p = 0.0004). Based on multivariate analysis, age, previous vertebral fracture and femoral neck bone density were significant risk factors for incidental vertebral fracture. The JSBMR had a hazard ratio of 3.26 (p = 0.04) relative to 1.13 (p = 0.84) for the IOF, indicating the JSBMR classification performed better. Taking preventive measures against fractures is necessary, including starting bone-modifying agents early in patients with a high fracture risk. The JSBMR CTIBL manual may be useful for this purpose.

The Capture the Fracture® Partnership: an overview of a global initiative to increase the secondary fracture prevention care for patient benefit

SummaryThe Capture the Fracture® Partnership (CTF-P) is a unique collaboration between the International Osteoporosis Foundation, academic units and industry partners to enhance the implementation of effective, efficient fracture liaison services (FLSs) with a good patient experience. CTF-P has generated valuable resources for the specific countries as well as the broader FLS community to improve the initiation, effectiveness and sustainability of FLS in a wide range of healthcare settings.

Biochemical Markers of Bone Fragility in Patients with Diabetes. A Narrative Review by the IOF and the ECTS.

The risk of fragility fractures is increased in both type 1 and type 2 diabetes. Numerous biochemical markers reflecting bone and/or glucose metabolism have been evaluated in this context. This review summarizes current data on biochemical markers in relation to bone fragility and fracture risk in diabetes. Literature review by a group of experts from the International Osteoporosis Foundation (IOF) and European Calcified Tissue Society (ECTS) focusing on biochemical markers, diabetes, diabetes treatments and bone in adults. Although bone resorption and bone formation markers are low and poorly predictive of fracture risk in diabetes, osteoporosis drugs seem to change bone turnover markers in diabetics similarly to non-diabetics, with similar reductions in fracture risk. Several other biochemical markers related to bone and glucose metabolism have been correlated with BMD and/or fracture risk in diabetes, including osteocyte-related markers such as sclerostin, HbA1c and advanced glycation end products (AGEs), inflammatory markers and adipokines, as well as IGF-1 and calciotropic hormones. Several biochemical markers and hormonal levels related to bone and/or glucose metabolism have been associated with skeletal parameters in diabetes. Currently, only HbA1c levels seem to provide a reliable estimate of fracture risk, while bone turnover markers could be used to monitor the effects of anti-osteoporosis therapy.

Detecting Associations Between Body Mass Index and Bone Mineral Density in Patients with Fractures of Different Localizations

Introduction . Osteoporosis is a multifactorial metabolic disease that increases the risk of bone fracture because of reduced bone mineral density. The International Osteoporosis Foundation estimates that about 200 million people are affected by osteoporosis. Therefore, it is relevant to develop clinical and diagnostic methods that would make it possible to effectively predict fracture risks in different parts of the skeleton and, based on population studies, to accurately predict the course of the disease. Aim . To study the levels of body mass index and bone mineral density in men and women with fractures of different localizations. Materials and methods . 828 postmenopausal women (61.94 ± 7.98 years) and 496 men over 50 years (62.03 ± 10.83 years) were examined. Bone mineral density (BMD) was measured by means of two-phase Dual-energy X-ray absorptiometry (DEXA) using QDR 4500A (Hologic, USA) in standard locations. Body mass index (BMI) was also assessed. Results and discussion . The study has revealed associations between BMI and peripheral bone fractures, BMD of the lumbar vertebrae and fractures of the peripheral bones and spine, BMD of the femoral neck and fractures of this localization in women. In men, associations were revealed between BMI, BMD of the lumbar spine and fractures of all localizations, as well as between BMD of the femoral neck and spinal fractures and concomitant fractures. Conclusion . In women, a decrease in BMD of the femoral neck enhances the risk of fractures in general, BMD of the lumbar spine — only the risk of fractures of this localization. In men, a decline in BMD of both the lumbar spine and the femoral neck increases the risk of fractures of various localizations. Reduced BMI enhances the risk of fractures in general in both men and women.

Comments on the use of Key Performance Indicators in evaluating the Organization of Fracture Liaison Services

In recent years Fracture Liaison Services (FLS) have been established worldwide to reduce the number of fractures due to osteoporosis. Within the framework of the global campaign «Capture the fracture» by International Osteoporosis Foundation (IOF), some questionnaires have been proposed to assess the quality of FLS’ organization. Key Performance Indicators (KPIs) are used to analyze the effectiveness of the FLS working at the patient level. Thanks to their use, it is possible to identify areas that need improvement, evaluate the effectiveness of the changes being made, and compare the quality of work in various FLS at the regional or country level. This article discusses approaches to the use and calculation of each KPI in practical healthcare in the Russian Federation, taking into account epidemiological data, national clinical guidelines, and the specifics of the organization of the healthcare system in our country.

Implementation of a fracture liaison service. Experience with 177 patients

Every year about 9 million fragility fractures (FF) occur worldwide and 80% of these are underdiagnosed or undertreated. Aiming to close the gap of diagnosis and treatment of osteoporosis, Fracture Liaison Services (FLS) were developed. To describe the implementation of the first FLS in Chile, its inclusion criteria, patient enrolment, treatment adherence and referrals during the first year. A FLS was implemented at a health care network composed by two hospitals. The International Osteoporosis Foundation (IOF) guidelines were applied with a nurse practitioner as the coordinator. From May 2020 to April 2021 all patients diagnosed with a FF in the emergency rooms were invited to participate. Patients with pathological fractures and active cancer were excluded. Demographical data, fracture location, previous fractures, treatment and adherence, and mortality were recorded. From 443 patients with a diagnosis of FF, 177 patients (40%) accepted to participate. Their mean age was 74 ± 13 years and 84% (149) were female. Forty eight percent (84) had a lower extremity FF. Hip fractures were the most common (67). Ninety-five patients reported previous FF and 11,2% (20) had received anti-osteoporotic treatment. At four months of follow-up, 62% (50) had received vitamin D and calcium supplementation and 20% (16) of those patients with an indication of anti-osteoporotic drugs, had received them. The implementation of the FLS was successful with a 40% enrolment of patients, receiving certification by the IOF.

A surgical procedure to deliver a triphasic calcium-based implant material to address local bone loss and strengthen an osteoporotic proximal femur: a case report

Bone loss associated with the systemic skeletal disease osteoporosis results in weakened or fragile bone, the most serious consequence of which is fracture. A 67-year-old post-menopausal Caucasian woman presented with a diagnosis of osteoporosis by FRAX and DXA and a history of a fragility hip fracture. The patient was classified according to the latest guidance document for treating patients with post-menopausal osteoporosis from the International Osteoporosis Foundation and European Society for Clinical and Economic Aspects of Osteoporosis. The patient was at very high risk for major osteoporotic fracture, including hip fracture. This case report describes the use of a minimally invasive surgical procedure to address bone loss in the proximal femur associated with osteoporosis. Local osteo-enhancement procedure (LOEP), a minimally invasive surgical procedure, was performed using a triphasic calcium-based implant material, AGN1. LOEP was carried out under general anesthesia and fluoroscopic navigation. The area of bone loss in the proximal femur, the enhancement site, was identified, debrided, and irrigated to prepare it for low-pressure filling with AGN1 implant material. The patient recovered from the procedure without incident and was discharged without activity limitations after an overnight stay. X-ray imaging and DXA scans were used to evaluate implant material resorption and replacement with bone over a 3.25-year follow up. A significant and sustained increase in femoral neck and total hip BMD was observed (pre vs 3.25 years post-procedure: 0.546 vs 1.031 gm/cm2 and 0.628 vs 0.96 gm/cm2, respectively), which corresponded to a change in the patient’s T-score from the osteoporosis range to normal. Based on the use of T-scores to measure the risk of fragility fractures, and acknowledging the well-published limitations of doing so, the hip fracture risk of this patient was reduced from very high to low. This case report documents the use of this minimally invasive, targeted procedure to address hip fragility fracture (the most serious issue in the systemic disease osteoporosis), with AGN1 implant material used to replace bone lost in the proximal femur.

Intertrochanteric fractures and mortality in elderly patients

The aim of the following article was to provide an overview of the medical knowledge on the correlation of intertrochanteric fractures of the femur and mortality in the elderly population. Due to the fact that life expectancy has increased, we can observe an increasing trend of hip fractures. There are about 20,000 fractures of the proximal end of the femur treated in Poland and 300,000 patients in the United States annually. It is estimated that the upward trend of fractures can be traced to 2050 with an increase of +1% per year. There are expected to be 6 million cases per year worldwide according to International Osteoporosis Foundation. The most frequently early mortality related factors are biodemographic factors - age and gender. The majority - 75% of those treated fractures are female. Also, the risk of fracture of the proximal end of the femur in women over 50 years is almost 20%, and by the age of 80 it reaches 30%. Although among women the risk of fracture is higher, mortality is lower than man who experienced the same fracture. Other predictors of poor functional outcomes and early mortality factors for patients with hip fracture besides age and gender, are clinical factors, such as time spent waiting for surgery or comorbidities. Knowing those factors, we can try to avoid some complications. Each surgeon has to remember about a multidisciplinary care protocols, which are made to improve healthcare, shorten length of hospital stay, and decrease mortality in hip‐fracture‐operated patients. Also, it is significant to select proper surgical methods depending on the fracture complexity. This article was written based on analyzing data available in publications in Pubmed and Google Scholar databases.

The need to distinguish intervention thresholds and diagnostic thresholds in the management of osteoporosis.

This position paper of the International Osteoporosis Foundation (IOF) and the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) addresses the rationale for separate diagnostic and intervention thresholds in osteoporosis. We conclude that the current BMD-based diagnostic criteria for osteoporosis be retained whilst clarity is brought to bear on the distinction between diagnostic and intervention thresholds.

Correlation of vitamin D with osteoporosis

Introduction: Osteoporosis is a disease of bone metabolism, which is characterized by the silent and progressive reduction of bone density and is followed by a risk for fractures that can be fatal to the patient. The causes leading to this disease are endogenous and exogenous, but it is mainly related to the decrease in vitamin D level. Aim: Our study is the review and presentation of a more complete picture regarding osteoporosis and the effect of vitamin D on osteoporosis. Material and Method: Is a literary review of studies published in PubMed, Medline, WebMD, on the topic of vitamin D and its correlation with osteoporosis, an essential indicator with a wide range of applications in diagnosis and analysis of this illness. The scientific studies referenced, highlight the effectiveness of diagnosing osteoporosis through a bone density scan with a dual energy X-ray (DEXA), which provides the most accurate assessment to date on bone density. According to ‘International Osteoporosis Foundation’ statistics conducted for EU countries, Switzerland, UK the estimated number of individuals with osteoporosis above 50 years old in 2019 was 32 million, from which 25.5 million were of the gender female and 6.5 millionmale, deriving the conclusion that females are more prone to osteoporosis. Apart from diagnosis of osteoporosis,in the studies referenced,of great importance is the role of vitamin D levels and its correspondence with osteoporosis. In a study by Michael Holick Vitamin D deficiency. N Engl J Med. a vitamin D deficiency is defined by concentration of 25(OH)D less than 10ng/mL and an insufficiency of 20-30 ng/mL. At last, treatments and recommendations for osteoporosis regarding vitamin D deficiency have elaborated to supplementary diets, bisphosphonates treatments and even hormone replacement therapy. Conclusion: 25-OH-Vitamin D is essential for vitamin D status. To prevent the rapid progress of osteoporosis, factors that need immediate attention such as diet, lifestyle and an early diagnosis through DEXA are to be a priority, especially in risk patients.

Efforts of the Russian Association on Osteoporosis in 2021

The Russian Association on Osteoporosis was established in 1995 and by now it has regional branches in 53 cities of the ­Russian Federation with total 116 members. The Association also includes the Society of Patients OSTEORUS (­Chairman — OB ­Ershova). Association and OSTEORUS are full members of the Committee of National Societies of the International ­Osteoporosis Foundation (IOF).At the general meeting of regional branch delegates, held in September 2020, the following members of the presidium were elected: President prof. OM Lesnyak (St. Petersburg), vice-president prof. OB Ershova (Yaroslavl), members of the presidium: dr. AF Akhatov (Kazan), prof. IA Baranova (Moscow), PhD ZE Belaya (Moscow), IG Belenky (St. Petersburg), KYu Belova (­Yaroslavl), LP Evstigneeva (Yekaterinburg), IE Zazerskaya (St. Petersburg), EG Zotkin (Moscow), PhD NA Ibragimova (Omsk), TL Karonova (St. Petersburg), IN Kiseleva (Cheboksary), prof. AYu Kochish (St. Petersburg), fellow of the Russian Academy of Sciences prof. VI Mazurov (St. Petersburg), PhD LA Marchenkova (Moscow), prof. LV Menshikov (Irkutsk), PhD RZ Nurlygayanov (Ufa), prof. EN Otteva (Khabarovsk), prof. SS Rodionova (Moscow), prof. LYa Rozhinskaya (Moscow), IA Skripnikova (Moscow), prof. ON Tkacheva (Moscow), NV Toroptsova (Moscow), prof. SV Yureneva (Moscow). The next meeting of the RAOP Presidium was held on December 18, 2021, at which the results of work in 2021 were summed up and plans for 2022 were outlined.

Quality improvement initiatives in the care and prevention of fragility fractures in the Asia Pacific region.

SummaryThis narrative review summarises ongoing challenges and progress in the care and prevention of fragility fractures across the Asia Pacific region since mid-2019. The approaches taken could inform development of national bone health improvement Road Maps to be implemented at scale during the United Nations ‘Decade of Healthy Ageing’.PurposeThis narrative review summarises recent studies that characterise the burden of fragility fractures, current care gaps and quality improvement initiatives intended to improve the care and prevention of fragility fractures across the Asia Pacific region.MethodsThe review focuses on published studies, reports and quality improvement initiatives undertaken during the period July 2019 to May 2022.ResultsEpidemiological studies conducted in countries and regions throughout Asia Pacific highlight the current and projected increasing burden of fragility fractures. Recent studies and reports document a persistent and pervasive post-fracture care gap among people who have sustained fragility fractures. Global initiatives developed by the Fragility Fracture Network and International Osteoporosis Foundation have gained significant momentum in the Asia Pacific region, despite the disruption caused by the COVID-pandemic. The Asia Pacific Fragility Fracture Alliance has developed educational resources including a Hip Fracture Registry Toolbox and a Primary Care Physician Education Toolkit. The Asia Pacific Osteoporosis and Fragility Fractures Society—a new section of the Asia Pacific Orthopaedic Association—is working to engage orthopaedic surgeons across the region in the care and prevention of fragility fractures. The Asia Pacific Consortium on Osteoporosis developed a framework to support national clinical guidelines development groups. Considerable activity at the national level is evident in many countries across the region.ConclusionDevelopment and implementation of national Road Maps informed by the findings of this review are urgently required to respond to the epidemiological emergency posed by fragility fractures during the United Nations ‘Decade of Healthy Ageing’.

Osteoporosis: An Update on Screening, Diagnosis, Evaluation, and Treatment.

Osteoporosis screening, diagnosis, and treatment have gained much attention in the health care community over the past 2 decades. During this time, creation of multispecialty awareness programs (eg, "Own the Bone," American Orthopedic Association; "Capture the Fracture," International Osteoporosis Foundation) and improvements in diagnostic protocols have been evident. Significant advances in technology have elucidated elements of genetic predisposition for decreased bone mineral density in the aging population. Additionally, several novel drug therapies have entered the market and provide more options for primary care and osteoporosis specialists to medically manage patients at risk for fragility fractures. Despite this, adherence to osteoporosis screening and treatment protocols has been surprisingly low by health care practitioners, including orthopedic surgeons. Continued awareness and education of this skeletal disorder is crucial to effectively care for our aging population. [Orthopedics. 2023;46(1):e20-e26.].