Development of the Asia Pacific Consortium on Osteoporosis (APCO) Framework: clinical standards of care for the screening, diagnosis, and management of osteoporosis in the Asia-Pacific region

Abstract

Guidelines for doctors managing osteoporosis in the Asia-Pacific region vary widely. We compared 18 guidelines for similarities and differences in five key areas. We then used a structured consensus process to develop clinical standards of care for the diagnosis and management of osteoporosis and for improving the quality of care. Purpose Minimum clinical standards for assessment and management of osteoporosis are needed in the Asia-Pacific (AP) region to inform clinical practice guidelines (CPGs) and to improve osteoporosis care. We present the framework of these clinical standards and describe its development. Methods We conducted a structured comparative analysis of existing CPGs in the AP region using a "5IQ" model (identification, investigation, information, intervention, integration, and quality). One-hundred data elements were extracted from each guideline. We then employed a four-round Delphi consensus process to structure the framework, identify key components of guidance, and develop clinical care standards. Results Eighteen guidelines were included. The 5IQ analysis demonstrated marked heterogeneity, notably in guidance on risk factors, the use of biochemical markers, self-care information for patients, indications for osteoporosis treatment, use of fracture risk assessment tools, and protocols for monitoring treatment. There was minimal guidance on long-term management plans or on strategies and systems for clinical quality improvement. Twenty-nine APCO members participated in the Delphi process, resulting in consensus on 16 clinical standards, with levels of attainment defined for those on identification and investigation of fragility fractures, vertebral fracture assessment, and inclusion of quality metrics in guidelines. Conclusion The 5IQ analysis confirmed previous anecdotal observations of marked heterogeneity of osteoporosis clinical guidelines in the AP region. The Framework provides practical, clear, and feasible recommendations for osteoporosis care and can be adapted for use in other such vastly diverse regions. Implementation of the standards is expected to significantly lessen the global burden of osteoporosis.

Adherence to dosing schedule of denosumab therapy for osteoporosis during COVID-19 lockdown: an electronic medical record and pharmacy claims database study from Asia

“…Though several medications are currently available for osteoporosis treatment, poor adherence to such therapy is often seen. Non-adherence limits the benefits of therapy and is of potential economic significance and international osteoporosis guidelines emphasize the importance of adherence to anti-osteoporosis therapy [ 2 ]. Denosumab is a human monoclonal antibody that is approved for the treatment of both post-menopausal and male osteoporosis.…”

APCO Framework of Clinical Standards of Care

“…In line with the guiding principle, APCO has developed a Pan Asia-Pacific Framework of Clinical Standards of Care for the screening, diagnosis, and management of osteoporosis. [ 14 ] The drafting of the framework involved a two-step process: a comparative analysis of the existing osteoporosis guidelines in the Asia-Pacific region followed by a Delphi process for developing the clinical care standards framework.…”

“…A four-round Delphi process that employed a series of questionnaires sent to the APCO members was then used to establish a consensus and develop the standards of care. [ 14 ]…”

Harmonization of Osteoporosis Guidelines: Paving the Way for Disrupting the Status Quo in Osteoporosis Management in the Asia Pacific

“…(16)(17)(18) It was with this goal in mind that APCO embarked on developing a pan Asia Oceania Framework of minimum standards of care for the screening, diagnosis, and management of osteoporosis. (19) Previous attempts to develop regionwide osteoporosis guidelines have employed a process of interpretation of available evidence on osteoporosis management by a small, ad hoc working group of experts from within just a few societies/organizations (20) or have focused on developing recommendations exclusively for secondary fracture prevention specifically targeted to clinical situations in a particular country, eg the United States. (21) Though a few osteoporosis guidelines were reviewed in the process of developing the standards of care for the latter consensus, no systematic analysis of all the individual elements in the guidelines was undertaken.…”

“…A broad range of indications for treatment were cited in the various guidelines, with each guideline typically featuring three or four of a total of 14 indications identified. (19) A four-round Delphi process in which the then current APCO members participated was subsequently used to develop the standards of care for assessment, diagnosis, and management of osteoporosis for the AP region. For this, APCO members were invited to determine which aspects of care required clinical standards to be developed, based on a list informed by the findings of the 5IQ comparative analysis.…”