The impact of aging population is great to society. In Hong Kong, the aged population (age >=65) will increase from 20.5% in 2021 to 36% in 2046. Osteoporosis, as one of the major chronic diseases, should be treated in a more systematic approach. Attention only to the related complication, ie the fragility fractures (hip fracture, vertebral compression, and other fractures) is not adequate. The management should be a multidisciplinary holistic approach, including Acute, Rehabilitation and Community phases, with timely input from different disciplines. The challenges are great, especially in the era of preventive medicine and under the concept of chronic disease model of Hospital Authority nowadays.
Acute phase is aiming at treating the fragility fractures timely, to reduce morbidity and mortality, and to enhance the outcome. The challenges will be the standardization of clinical pathway, the availability of ortho-geriatric co-care, protected operation list and the use of advanced surgical implants for immediate full weight bearing.
Rehabilitation phase is aiming at early and continuous rehabilitation during hospitalization, to facilitate the return to community. The challenges will be the availability of rehabilitation bed and in-patient allied health.
Community phase is aiming at continuous rehabilitation after discharge, to achieve the pre-injury quality of life as much as possible, secondary prevention including bone health management, fracture and fall prevention. The challenges will be the availability of out-patient allied health, DXA scan, bone health medication, management on sarcopenia, frailty, and fall prevention.
Some measures had been started in the Hospital Authority to cope with the challenges, including additional resources for trauma list, surgical implants, and bone health medications. Fracture Liaison Service, Orthopaedic Day Rehabilitation and Telehealth had also been implemented. Our way forwards may include: 1) Collaboration with District Health Center, targeting Osteoporosis as a chronic disease model, with continuous quality care in the community. 2) Enhancement of e-platform on fragility fracture, with the concept of big data. 3) Early identification and treatment of osteoporosis by artificial intelligence detection of occult spine collapse or by community screening etc.
Treating osteoporosis and fragility fracture patient better, is more cost-effective than treating them badly. This group of patients is worth receiving more attention and resources and intervening earlier.
