The development of Taiwan Fracture Liaison Service network

Abstract

Osteoporosis and its associated fragility fractures are becoming a severe burden in the healthcare system globally. In the Asian-Pacific (AP) region, the rapidly increasing in aging population is the main reason accounting for the burden. Moreover, the paucity of quality care for osteoporosis continues to be an ongoing challenge. The Fracture Liaison Service (FLS) is a program promoted by International Osteoporosis Foundation (IOF) with a goal to improve quality of postfracture care and prevention of secondary fractures. In this review article, we would like to introduce the Taiwan FLS network. The first 2 programs were initiated in 2014 at the National Taiwan University Hospital and its affiliated Bei-Hu branch. Since then, the Taiwan FLS program has continued to grow exponentially. Through FLS workshops promoted by the Taiwanese Osteoporosis Association (TOA), program mentors have been able to share their valuable knowledge and clinical experience in order to promote establishments of additional programs. With 22 FLS sites including 11 successfully accredited on the best practice map, Taiwan remains as one of the highest FLS coverage countries in the AP region, and was also granted the IOF Best Secondary Fracture Prevention Promotion award in 2017. Despite challenges faced by the TOA, we strive to promote more FLS sites in Taiwan with a main goal of ameliorating further health burden in managing osteoporotic patients.

Secondary prevention of fragility fractures: instrumental role of a fracture liaison service to tackle the risk of imminent fracture

“…25 In Taiwan, 22 FLS programmes have already been established, of which 11 are accredited by the IOF. 26 Taiwan has some of the best FLS coverage in the Asia-Pacific region. Randomised controlled trials are being conducted to assess outcomes in Taiwan.…”

Current Status of Long-term Care in Taiwan: Transition of Long-term Care Plan From 1.0 to 2.0

“…In order to build a continuum of care which is personcentered and community-based, Taiwan government planned to gradually establish an accessible, affordable, good-quality and universal service system that could provide diversified continuous services, including family support services, home and community-based, and institutional-based programs. Furthermore, it is a system that upstream prevention to delay disability, 5,6 and downstream preparedness to provide discharge plan and home-based medical care. This system will accomplish the goal of "aging in place" for older adults and give them the opportunity to age in a community with disability and give them a place they are familiar with.…”

Fragility Fracture Prevention—Implementing a Fracture Liaison Service in a High Volume Orthopedic Hospital

“…In the United States, 10.2 million people are affected by osteoporosis and 43.4 million by low bone mass, equaling a quarter of the whole adult population [4]. The impact is similar in Canada, Europe, and Asia [5][6][7]. In Italy, 90.000 hip fractures affect 50-years old patients each year [8].…”

“…In Italy, the direct hospitalization costs for the treatment of patients with fragility fractures over the age of 65 were almost 400 € million in 2002, with a 15% increase in the following three years [11]. The socio-economic burden of fragility fractures is not unique to Europe, but affects all countries with an aging population, such as Australia [12], Canada [13], China [14], and Taiwan [7]. On average, patients suffering from osteoporotic fractures increase their risk of exposure to a second fracture by 86%.…”

“…The IOF created a Best Practice framework to standardize and support its spread (Capture the Fracture), introducing a FLS algorithm which can be adapted to the organizational needs and resources of the local provider, healthcare system, and workforce composition [18]. With a considerable increase in protocols, which have been recently published in the literature, original evidence from empirical data is still recommended by systematic and narrative reviews [6,7,19].…”