Taipei Municipal Wanfang Hospital (Managed by Taipei Medical University)

Taipei Municipal Wanfang Hospital is a medical center located in Taipei, Taiwan, serving at least 300,000 local residents. The elderly constitute the main ethnic group, accounting for 20% of all residents. Every year, more than 600 geriatric patients attended to our hospital for management of fragile fractures including hip, vertebral and wrist fractures. However, only less than 35% of these geriatric victims with fragile fractures received anti-osteoporotic treatment, accounting for high refracture risk among them.

With the increasing number of geriatric population and associated fragile fracture, our Fracture Liaison Service (FLS) was initiated since 2017 in order to decrease the refracture risk and mortality among these older victims. Our FLS team was composed of orthopedic surgeons, geriatricians, physiatrists, emergency physicians, dietitians, physical therapists, hospital and home nurses as well as social workers. Geriatric hip fracture patients were the main population served in our FLS program, followed by patients with vertebral fracture and other fragile fractures. All the patients followed in our FLS received comprehensive assessments for nutritional status, falling risk, FRAX, osteoporosis and sarcopenia, cognitive function and pre-fracture functional stats and lifer quality. Individualized treatment for osteosarcopenia and rehabilitation program would be offered for each patient based on the teamwork among the FLS members. In addition, patients with high falling risk would receive a home visit to check the environment in danger for falling accident. Functional recovery, adherence for anti-osteoporotic treatment and anti-osteoporotic drugs related complications were our follow-up targets following fragile fractures.

With our efforts on FLS, we have already increased the rates of post-injury assessment for bone mineral density from 23% to 85%, osteoporosis treatment rates from 44% to 72%. It’s worth to mention that the post-fracture one-year mortality rate was also decreased from 20% to around 10% in our geriatric hip fracture patients. Severe articles focusing on the characteristics and outcomes of the geriatric hip fracture patients were published as the below list based on our FLS databank.

1.        Chen YP, Wong PK, Tsai MJ, Chang WC, Hsieh TS, Leu TH, et al. The high prevalence of sarcopenia and its associated outcomes following hip surgery in Taiwanese geriatric patients with a hip fracture. J Formos Med Assoc. 2020;119(12):1807-16.

2.        Cheng SH, Kuo YJ, Lin JC, Chang WC, Wu CC, Chu YL, et al. Fat distribution may predict intra- or extra-capsular hip fracture in geriatric patients after falling. Injury. 2020;51(2):414-9.

       3.        Chang W-T, Kuo Y-J, Huang Y-Y, Tsai M-J, Chen Y-P. Poor Activities of Daily Living Function Reflect Poor Quality of Life after Hip Fracture Surgery for Geriatric Patients. Social Health and Behavior. 2019;2(2):41-6