​Headed by Associate Professor Manju Chandran of Singapore General Hospital, APCO’s new framework  is the first in the world to set out minimal standards ranging from identifying at-risk patients and treatment indications to patient education and monitoring.

It comes as no surprise that osteoporosis is fast becoming a major public health threat in Asia Pacific, no thanks to the region’s fast-greying population.

It is estimated that in 2018, over 1.1 million hip fractures happened across China, Taiwan, Hong Kong, India, Japan, Malaysia, Singapore, South Korea and Thailand – and this number is projected to increase by more than two times by 2050.

Despite the grim outlook, a new set of benchmark guidelines put forth by the Asia Pacific Consortium on Osteoporosis (APCO) may help to turn the numbers around.

Published in the peer-reviewed journal Osteoporosis International in January 2021, the APCO Framework comprises 16 minimum clinical standards for screening, diagnosis and management of osteoporosis in the region and beyond.

The Framework comes at a crucial time, with one fragility fracture happening every three seconds worldwide. Such injuries cause patients to lose quality of life and independence – and about a quarter of hip fracture patients die within a year. 

In addition, osteoporosis is often underdiagnosed. As many as five out of six patients with a fragility fracture may not be assessed and diagnosed for it, according to a 2017 study by the Royal Australian College of General Practitioners & Osteoporosis Australia.

“Implementation of The APCO Framework, or a similar set of standards of care informed by the Framework, is expected to significantly reduce the burden of osteoporosis not only in the Asia Pacific region, but also worldwide,” said Assoc Prof Manju Chandran, inaugural APCO Chairperson, who is also a Senior Consultant in the Department of Endocrinology and Director of the Osteoporosis and Bone Metabolism Unit at Singapore General Hospital .

Overview of the APCO Framework
Developed by Osteoporosis Experts from 19 countries and regions, the framework provides clinicians with a structured and clear set of guidelines that define:

  • Patients and at-risk individuals who should be assessed for osteoporosis, such as those with a history of fragility fractures or pre-existing medical conditions and patients on medications linked to bone loss
  • Require investigations
  • Indications for treatment including patient history, bone mineral density T-Scores and fracture risk
  • The appropriate selection of interventions including pharmacological treatments and lifestyle changes
  • Self-care guidance for patients
  • Integration of healthcare systems for optimal care
  • Methods for monitoring and improving the quality of osteoporosis care in the long term

The APCO Framework was the result of a detailed 5IQ analysis and the Delphi Consensus process that was employed on the 18 clinical practice guidelines that are extant in APAC.

The 5IQ exercise assessed the extent of disparity between national guidelines whilst the Delphi technique was used to survey APCO members on aspects of care that needed specific standards and to help members arrive at a consensus for the final framework.

Development of The APCO Framework not only led to the formation of new relevant clinical guidelines; it also brought to light the ongoing disparities and inconsistencies in osteoporosis clinical practice in the region. This has resulted in widely varying recommendations from physicians.

“Implementation of the minimum clinical standards proposed by The APCO Framework, and reform of existing guidelines, will support clinical improvement initiatives, while also paving the way for a more holistic approach to osteoporosis care, and ultimately, greater consistency across all national and regional clinical practice guidelines in the region,” said Dr Philippe Halbout, CEO of the International Osteoporosis Foundation (IOF) and APCO Executive Committee member.

APCO – a catalyst for change
The framework is APCO’s first major undertaking since its founding in Singapore in May 2019.

The consortium comprises osteoporosis experts in APAC, representatives who have been tasked to develop tangible solutions to the challenges posed by osteoporosis and improve fracture prevention efforts.

“Developing The APCO Framework has been a challenging, yet highly fulfilling task. It was heartening to see our APCO members, who represent 19 countries and regions in the Asia Pacific, working together, voluntarily, over many months, to achieve this common goal. We hope that the Framework can serve as a stimulus for harmonisation of guidelines in other regions that have similar socio-economic diversity and heterogeneity of health care resources,” said Assoc Prof Chandran.

She added, “The Framework will be instrumental in setting a new and enhanced benchmark for the provision of quality care across the region.”

Click here to download or access The APCO Framework. Visit www.apcobonehealth.org to learn more.