Capture the Fracture Welcomes 100th FLS/OLS from Japan to its Network
On September 24th, Fracture Liaison Service (FLS) experts and Capture the Fracture® (CTF) Mentors gathered for a virtual roundtable, celebrating the significant milestone of reaching over 100 FLS/OLS on the International Osteoporosis Foundation's (IOF) CTF Map of Best Practice.
This landmark achievement highlights the country’s commitment to improving osteoporosis management and fracture prevention, driven by many factors, including increased public support for FLS/OLS, the nationwide mentorship programme and steadfast support from multiple stakeholders.
At the Roundtable, opening remarks were made by Prof. Nicholas Harvey, IOF President. On the roundtable panel were the following CTF Mentors, who each shared their insights and discussed the various factors which have led to successes in FLS/OLS implementation:
Prof. Hiroshi Hagino, Sanin Rosai Hospital
Prof. Atsushi Suzuki, Fujita Health University
Dr. Satoshi Ikeda, Ken-Ai Memorial Hospital
Prof. Noriaki Yamamoto, Niigata Rehabilitation Hospital
Dr. Naohide Takigawa, Nishinomiya Kyoritsu Neurosurgical Hospital
Dr. Masahiro Tanaka, Rinku Nagayama Hospital
Dr. Hiroki Yasuoka, Tokorozawa Hakushoukai Hospital
The Origins of CTF involvement in Japan
Dr. Yamamoto, recounted the origins of Japan’s involvement in CTF. "My journey began in 2013 when I established the FLS at our hospital, and I took on the challenge of raising the flag of the CTF programme by applying for CTF recognition in 2016. At that time, CTF certification was almost unknown in Japan, and I took on the challenge by Dr. Hagino by introducing international trends,” Dr. Yamamoto shared. He stated that this certification, which enhances care quality and motivates healthcare providers, quickly became a goal for many Japanese hospitals as of 2018, when he introduced it at academic conferences.
Dr. Hagino, President of the Japanese Osteoporosis Society (JOS), further elaborated on the historical context, describing how the JOS was instrumental in the selection of mentors and development of CTF in Japan. "When the CTF Programme was originally launched, I was approached to spread the word. The Japan Fragility Fracture Network (FFN-J) were also promoting the prevention of secondary fractures. JOS has translated the instructions for applying for CTF. Digital translation tools were limited at the time, so I remember the academic society translated it by hand," he explained. He added, “in 2021, with the mentorship programme, I presented it at an academic conference and the JOS Osteoporosis Liaison Service (OLS) committee undertook it. It has progressed so far and I think it went well”.
The Role of National Support and CTF Recognition for Quality Improvement
Dr. Suzuki emphasized the role of official support. "Receiving JOS endorsement has made it very reassuring for new facilities to participate in the CTF programme," Dr. Suzuki noted. "In addition, I think it was very important that the Best Practice Framework required for the CTF application was translated into Japanese at a very early stage "
Dr. Yasuoka recalled his journey toward obtaining certification and getting to gold. His facility achieved Silver CTF certification in 2019, a milestone that transformed internal operations and made FLS activities more visible. "Being certified gave our activities credibility and enabled smoother operations and recognition within and outside the hospital," Dr. Yasuoka said.
Dr. Ikeda, whose hospital serves as a central treatment facility, shared his experience in tackling challenges associated with certification. “We initiated our Osteoporosis Liaison Service in 2012 but registered for CTF certification in 2020. We expected a Gold level, but we received Silver. CTF evaluates the whole facility, not an individual, so I remember thinking I would not be able to achieve gold without cooperation from the whole team.” Dr. Ikeda’s hospital ultimately achieved Gold after re-submitting the questionnaire. “I have always felt that CTF enhances a hospital’s reputation. Also, with the revision of medical fees in 2022, hospitals in areas that have not been practicing FLS have started to work on FLS, so I would like to encourage those facilities to register for CTF in the future,” Dr. Ikeda added.
Dr. Tanaka recounted his experience in applying for CTF recognition and the importance of planning ahead with evaluation in mind. “By registering, it became very easy to do activities in the hospital. The management side began to understand that we were doing this kind of thing with an objective evaluation, and they began to cooperate with us a lot. It is probably important to be aware of this IOF certification when building a team, including at the beginning.”
Dr. Takigawa added, “We started our FLS in 2015. I got a silver in 2018. We thought that we could definitely get gold, so it was like the fact that it was silver ignited a fire, and all the members began to think about what went wrong. The staff voluntarily moved to expand the activities and two years later, I reapplied and obtained gold.”
Success factors for the 100 FLS/OLS milestone
Japan’s progress in fracture prevention and osteoporosis care has been fueled by significant policy changes and the efforts of dedicated stakeholders. In 2022, medical fee revisions supported FLS activities for hip fractures. Dr. Yamamoto credited this policy shift with amplifying interest across Japan. “We started our activities in accordance with the IOF mentorship programme, and the major changes in Japan's healthcare policy had a synergistic effect,” he observed.
Dr. Hagino added, “JOS now has more than 12’000 members, half of whom are medical staff, and many of them are working on OLS. I believe that supporting the activities of such people will lead to the development of the society, and at the same time, it will be a great contribution to society.”
Applying for CTF and working according to Clinical Standards
Dr. Tanaka shared his experience with completing the BPF Questionnaire, making the link with “There are quite a few people who do not know that BPF can be viewed in Japanese,” Dr. Tanaka noted. “The requirements are not so difficult if we manage patients properly according to clinical standards, it's not that different from your daily work, and it's an evaluation of whether the basics are done properly.” Dr. Suzuki echoed the sentiment, stating, “in other words, it is easier to organize the work according to the clinical standards and then collect the numbers”.
Improving Quality and Getting to Gold in Japan
The increased awareness around FLS/OLS also led to a rise in interest in quality metrics. Dr. Tanaka presented the mentors’ plans for developing Japan-specific Key Performance Indicators (KPIs). He noted, “We decided to consider our KPIs based on the original KPIs presented by IOF, but in Japan, medical fees are tied to standards of care, so it’s essential that KPIs are aligned with these standards to avoid overburdening healthcare staff. This approach allows for effective patient tracking and progress measurement without straining resources.”
Metrics allow for tracking quality and at the core of quality of care are the daily activities and organization of care. Dr. Yasuoka highlighted some of the ways he and his team improved their score to gold – notably, including patients with fractures treated on an outpatient basis. “I had already done all the proximal femur fractures and vertebral fractures that were admitted, so I had to do distal radius fractures and humeral proximal fractures. As a result, I made a strict list of these on an outpatient basis, and as a result, we received an evaluation of achievement. I got a very good score and got gold. It was difficult to pick up patients in an outpatient setting, so the doctor, nurse, and medical clerk in charge worked together in a scrum and made a list to identify them.”
Dr. Ikeda outlined some strategies used by his FLS to identify all patients and improve assessment and treatment rates to get to Gold. “At our hospital, all patients with fractures undergo rehabilitation, so the osteoporosis manager who is a physical therapist manages and registers them, notifies each department, and evaluates and intervenes. Outpatient fractures are identified and tabulated based on the disease name on the medical fee statement,” he explained. “As a result, orthopedic surgeons other than myself prescribe therapeutic drugs for patients with inpatient and outpatient fractures, which I think is a major factor in the transition from silver to gold”.
Future Goals and the Impact on Japanese Society
Japan’s commitment to achieving CTF certification for 100 facilities is a crucial step in a larger vision for osteoporosis and fracture prevention. Many initiatives, including the KPIs for FLS/OLS, are under development. One such initiative is the update to the Japanese Guidelines for the Prevention and Treatment of Osteoporosis. As President of JOS, Dr. Hagino highlighted the impact of osteoporosis management on public health, noting that "preventing fragility fractures is a national priority to improve healthy life expectancy and reduce social security costs.”
Dr. Suzuki shared reflections on the next steps, stating, “more than 100 facilities have registered on the Map of Best Practice. Approximately 2,000 hospitals are involved in the surgical treatment of proximal femur fractures, so it is expected that the number of facilities participating in this program will continue to increase”. He further added, “I think there is a need for further discussion on improving the quality.”
The roundtable discussion closed with the mentors’ continued commitment to contributing to medical care, medicine, and social welfare. This achievement is a testament to the country’s dedication to healthier aging and sets the stage for broader healthcare improvements in the years to come.
Prof. Nicholas Harvey, IOF President, said, “This achievement would not have been possible without the dedication of our CTF mentors… through their efforts, the number of FLS/OLS has more than doubled in two years to achieve this goal. As we reflect on this success, let it also inspire us to continue advancing osteoporosis care.”