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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

Chandran M 1 , Mitchell PJ 2 , Amphansap T 3 , Bhadada SK 4 , Chadha M 5 , Chan DC 6 Show all authors , Chung YS 7 , Ebeling P 8 , Gilchrist N 9 , Habib Khan A 10 , Halbout P 11 , Hew FL 12 , Lan HT 13 , Lau TC 14 , Lee JK 15 , Lekamwasam S 16 , Lyubomirsky G 17 , Mercado-Asis LB 18 , Mithal A 19 , Nguyen TV 20 , Pandey D 21 , Reid IR 22 , Suzuki A 23 , Chit TT 24 , Tiu KL 25 , Valleenukul T 26 , Yung CK 27 , Zhao YL 28 , Asia Pacific Consortium on Osteoporosis (APCO)

Affiliations 

  • 1 Department of Endocrinology, Osteoporosis and Bone Metabolism Unit, Singapore General Hospital, 20, College Road, Academia, Singapore, 169856, Singapore. manju.chandran@singhealth.com.sg
  • 2 Synthesis Medical NZ Limited, Pukekohe, Auckland, New Zealand
  • 3 Department of Orthopedics, Police General Hospital, Bangkok, Thailand
  • 4 Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
  • 5 Department of Endocrinology, Hinduja Hospital and Research Centre, Mumbai, India
  • 6 Internal Medicine, National University Hospital Chu-Tung Branch, Chinese Taipei, Taiwan
  • 7 Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, South Korea
  • 8 Department of Medicine in the School of Clinical Sciences, Monash Health, Melbourne, Australia
  • 9 Canterbury District Health Board, Christchurch, New Zealand
  • 10 Section of Chemical Pathology, Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
  • 11 International Osteoporosis Foundation, Nyon, Switzerland
  • 12 Department of Medicine, Subang Jaya Medical Centre, Subang Jaya, Malaysia
  • 13 Musculoskeletal and Metabolic Unit, Biomedical Research Center, Pham Ngoc Thach University of Medicine, Bone and Muscle Research Group, Ton Duc Thang University, Ho Chi Minh City, Vietnam
  • 14 Division of Rheumatology, Department of Medicine, National University Hospital, Singapore, Singapore
  • 15 Department of Orthopedics, Beacon International Specialist Centre, Petaling Jaya, Malaysia
  • 16 Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
  • 17 Osteoporosis Australia, Sydney, Australia
  • 18 Faculty of Medicine and Surgery, University of Santo Tomas, Manila, Philippines
  • 19 Endocrinology, Diabetes Division, Mithal, M. Max Healthcare - Pan-Max, Gurgaon, India
  • 20 Genetics and Epidemiology of Osteoporosis Laboratory, Bone Biology Division, Garvan Institute of Medical Reseach, Sydney, Australia
  • 21 Department of Orthopaedics, National Trauma Centre, Kathmandu, Nepal
  • 22 Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
  • 23 Department of Endocrinology, School of Medicine, Fujita Health University, Toyoake, Japan
  • 24 East Yangon General Hospital, Yangon, Myanmar
  • 25 Polytrauma and Fragility Fracture team, Department of Orthopaedics and Traumatology, Queen Elizabeth Hospital, Hong Kong, SAR, China
  • 26 Department of Orthopedics, Bhumibol Adulyadej Hospital, Bangkok, Thailand
  • 27 Department of Endocrinology and Patient Safety Unit, Raja Isteri Pengiran Anak Saleha Hospital, Bandar Seri Begawan, Brunei Darussalam
  • 28 Department of Obstetrics and Gynecology, Beijing United Family Hospital, Beijing, China
Osteoporos Int, 2021 Jul;32(7):1249-1275.
PMID: 33502559 DOI: 10.1007/s00198-020-05742-0

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.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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