Taiwanese experts highlight fracture epidemic amid rapidly ageing population
In the face of a super-aging society, Taiwan is seeing a surge in the number of fragility fractures, with increases of 170% projected between 2010 and 2035. The fracture epidemic will significantly impact not only patients and their families but also place a heavy strain on the healthcare system. With this scenario in mind, a new report 'Solutions for Fracture Prevention in Taiwan' was issued by the International Osteoporosis Foundation (IOF) Capture the Fracture® programme in collaboration with leading Taiwanese experts. The report aims to stimulate health policy change that will help to reduce the impending burden, including by addressing the extreme osteoporosis treatment gap.
Super aged society will drive enormous and costly rise in fragility fractures
Dr. Ding-Cheng Chan, Director of the Department of Geriatrics and Gerontology National Taiwan University Hospital in Taipei, stated: “Taiwan's rapidly aging population is driving a significant rise in fragility fractures. Taiwan is expected to become a "super-aged" society - by 2025 over 20% of its population will be aged 65 or older, and projections indicate this figure will surpass 40% by 2060. This demographic shift will greatly increase the incidence and societal burden of fragility fractures. As well the hip fracture age-standardized rate in Taiwan is among the highest in the world, estimated at 208 and 167 per 1000,000 person-years among women and men, respectively.”
Aside from the societal implications, the costs to the healthcare system will be enormous. The projected costs of hip fractures alone are expected to rise by 170% between 2018 and 2050, reaching 700 million USD.
Undertreatment of osteoporosis is a major challenge
Currently, more than 1.5 million Taiwanese who are at high risk of fracture remain untreated for osteoporosis despite the availability of effective and safe medications.
Dr. Wei-Chieh Hung, Director, Division of Preventive Medicine, Department of Family Medicine, E-Da Hospital, added: “Around 75% of patients at risk of fragility fractures do not receive any treatment for osteoporosis, the underlying cause of fragility fractures. Poor treatment initiation is especially marked in high-risk patients, with only 30% of patients adherent to medication one year after having sustained a fracture, despite their imminent risk of subsequent fractures. This is a tragedy given the serious consequences of fractures, which cause pain, disability, loss of independence, and significantly impact on quality of life. Fractures are also life-threatening, with the 12-month mortality at approximately 14% following hip and 6% following vertebral fractures.”
Studies have shown that fracture patients who adhere to osteoporosis medications have better outcomes, with a significantly lower re-fracture risk and lower mortality. One way to help ensure that fracture patients do not fall through the ‘treatment gap’ is through the broader implementation of coordinated systems of post-fracture care known as Fracture Liaison Services (FLS). An FLS serves to identify, treat, and monitor patients who have sustained a first fracture and who are at the highest risk of sustaining further fractures, especially within the first two years. In Taiwan, the number of FLS programmes has been growing rapidly over the past few years – and currently, 33 Taiwanese hospitals have such a service. Ideally, all fracture patients should have access to these important services.
Policy recommendations that would help tackle the epidemic of fractures
The report identifies five key recommendations that could address the rising tide of fragility fractures:
- Prioritize fragility fractures within the healthcare agenda, including providing additional financial resources for post-fracture care. Specific needs include more funding and reimbursements for Fracture Liaison Services and better coverage of diagnostic testing by DXA.
- Expand coverage of osteoporosis treatment to include primary prevention for those at risk.
- Increase deployment of Fracture Liaison Services (FLS) to increase post-fracture screening, diagnosis and rates of osteoporosis treatment.
- Promote public education to raise awareness of bone health in both the healthcare and public spheres. For osteoporosis to be prioritized and effective treatment regimens delivered, further training for clinicians is imperative. At the same time, patients need to become aware of risk factors and the importance of timely diagnosis, treatment, and adherence.
- Robust data collection, derived from more studies and national statistics, would help create a true picture of the burden of fractures and osteoporosis, and the potential cost-effectiveness of interventions including the implementation of FLS.
Dr. Philippe Halbout, CEO of the International Osteoporosis Foundation concluded: “We thank the leading Taiwanese experts who have worked with the IOF Capture the Fracture® Policy Group to publish this policy reports and succinct recommendations. The report is a unique resource which provides a roadmap of effective solutions that, in synergy, would lead to the reduction of osteoporosis-related fractures in the Taiwanese population.”
“If all stakeholders dedicated to patient care work together on essential actions, the results will include fewer fractures, better patient outcomes, reduced healthcare costs, and most importantly, saved lives."
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About the Report
‘Solutions for Fracture Prevention in Taiwan’ is authored by the following experts from Taiwan: Dr. Ding-Cheng Chan (National Taiwan University); Dr. Wei-Chieh Hung (E-Da hospital); Dr. Chun Sheng Ho (Lutong Poh-Ai Hospital); Dr. Yu-Pin Chen (Wan Fang Hospital), in collaboration with the IOF-Capture the Fracture® Policy Group.
About Capture the Fracture®
Capture the Fracture® (CTF) is a multi-stakeholder initiative, led by the International Osteoporosis Foundation (IOF), to facilitate the implementation of Post-Fracture Care Coordination Programs, such as Fracture Liaison Services (FLS), for secondary fracture prevention. The CTF initiative, which celebrated its 10th anniversary in 2022, aims to drive local and regional change to prioritize secondary fracture prevention. It sets global best practice standards and provides recognition to FLS through its Best Practice Framework (BPF). The CTF programme also provides mentoring, resources, and essential documentation to promote the prioritization of secondary fracture prevention and support the implementation and quality improvement of FLS. Since 2020, the growth of the CTF Network has been accelerated by the collaboration and support of industry partners Amgen and UCB, which have provided sponsorship through the Capture the Fracture® Partnership. Currently, the CTF network includes more than 1050 FLS in 60 countries worldwide. FLS are invited to apply for free evaluation and recognition through the online application platform available on the CTF website. www.capturethefracture.org #CaptureTheFracture
About IOF
The International Osteoporosis Foundation (IOF) is the world’s largest non-governmental organization dedicated to the prevention, diagnosis, and treatment of osteoporosis and related musculoskeletal diseases. IOF members, including scientific research committees and over 335 patient, medical, and research organizations, work together to make fracture prevention and healthy mobility a worldwide healthcare priority. www.osteoporosis.foundation.org