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

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.