Osteoporosis, a silent disease characterised by a diminished bone mineral density and compromised bone microarchitecture, is an important public health problem. Globally, it affects about 21.2% of women and 6.3% of men over the age of 50 years old, with prevalence increasing with age.

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Osteoporosis contributes to an increased risk of fragility fractures – low-trauma fractures occurring mainly in the hip, spine, distal forearm, and proximal humerus. A prior fragility fracture increases the risk of subsequent fractures by up to 86%.

Hip fractures in particular, are associated with high morbidity and a 20-24% mortality rate within the first year after a hip fracture. A 10% loss of bone mass as measured by the DEXA, can increase hip fracture risk by 2.5 times.

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Orthopaedic surgeons frequently encounter patients with bone fragility, complicating elective procedures. Poor bone health increases the risk of intraoperative fractures, screw fixation failure, periprosthetic fractures, implant subsidence, and aseptic loosening, often necessitating revision surgeries. These complications lead to prolonged hospitalisation, decreased function, and higher mortality.

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Early diagnosis, treatment, and preoperative bone health optimisation, can mitigate these risks. Despite the availability of effective treatments, osteoporosis remains underdiagnosed and undertreated, creating a significant care gap. This discrepancy between at-risk individuals and those receiving treatment is termed the osteoporosis care gap. For example, a study done in a Malaysian tertiary care hospital revealed that only 17.1% of patients with fragility fractures were initiated on anti-osteoporotic medication, with just half adhering to treatment after 1 year.

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To address this treatment gap, it is important to equip clinicians with the knowledge and skills needed to accurately diagnose and treat osteoporosis. It is with this aim that the ISCD Orthopaedic Osteoporosis and Densitometry Course is created.

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This course equips participants with the latest evidence-based knowledge on bone health assessment and optimisation. Key learning objectives include:

• Methods for fracture risk assessment

• Principles of DEXA, including indications, interpretation, and pitfalls

• Impact of osteoporosis on elective orthopaedic surgical outcomes

• Clinical components of fragility fracture care and bone health optimisation

• Pharmacological treatments and treatment algorithms for osteoporosis

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In 2024, this course was held as a workshop on the last day of the 2nd Asia Pacific Regional Congress in Connexion Conference and Event Centre, Kuala Lumpur:

Associate Professor Chanika Sritara (Thailand) covered densitometry fundamentals, emphasising the importance of avoiding T-score or BMD comparisons across machines, and prioritising BMD readings over T-scores for fracture risk assessment.

Associate Professor Julie Li Yu (Philippines), discussed tools like FRAX, trabecular bone score (TBS), and bone turnover markers (BTMs) to enhance fracture risk assessment, noting that most fractures occur in non-osteoporotic BMD ranges.

Dr Lim Wan Chieh (Malaysia), highlighted the role of Fracture Liaison Services (FLS) in secondary fracture prevention, highlighting how fragility fracture, falls, frailty, and sarcopaenia compound the risks of future fractures, necessitating a multidisciplinary, coordinated approach.

Dato’ Dr Joon Kiong Lee (Malaysia) underscored the link between bone health and surgical outcomes, advocating for preoperative bone health evaluation and intraoperative bone quality documentation.

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We hope participants gained valuable insights to apply in their practice. The ISCD Orthopaedic Osteoporosis and Densitometry course will return in 2025, held alongside the 1st Asian Falls Network and 4th Fragility Fracture Network of Malaysia Annual Scientific Meeting on the 12th and 13th of September 2025. It will be held at the Vertical, Connexion Conference and Event Centre, Kuala Lumpur. 

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Those interested to participate may register for the event at the following website: https://www.afnffnm.com and gain access to an array of plenaries and symposiums featuring distinguished local and international speakers covering various topics related to falls and fragility fractures. We look forward to welcoming you!

 

Dr Lim Wan Chieh
Geriatrician and Internal Medicine Physician
Representing the Fragility Fracture Network of Malaysia

 

References:

1. Epidemiology of osteoporosis and fragility fractures | International Osteoporosis Foundation [Internet]. 2024. Available from: https://www.osteoporosis.foundation/facts-statistics/epidemiology-of-osteoporosis-and-fragility-fractures

2. Chang E, Nickel B, Binkley N, Bernatz J, Krueger D, Winzenried A, et al. A Novel Osteoporosis Screening Protocol to Identify Orthopedic Surgery Patients for Preoperative Bone Health Optimization. Geriatric Orthopaedic Surgery & Rehabilitation. 2022 Jan 13

3. Lee JK. Lee’s TRIAD—osteoporosis, fragility fracture, and bone health optimization. Archives of Osteoporosis. 2025 Jan 23;20(1).

4. Min Hui Cheah, Siew P, Hui Min Khor, Jeyakantha Ratnasingam, Kumar S, Singh S, et al. Fragility fracture care gap at a tertiary teaching hospital in Malaysia. Archives of osteoporosis. 2023 May 6;18(1)