News & Trends - Pharmaceuticals
APCO’s collective voices to foster best practice in osteoporosis care in Asia-Pac

Pharma News: More than 50% of the world’s hip fractures are expected to occur in the Asia Pacific by the year 2050. In a strong effort to stem the tide, and to promote quality care in osteoporosis, the Asia Pacific Consortium on Osteoporosis (APCO) has launched a world-first, interactive, educational osteoporosis resource – the APCO Health Care Professional (HCP) Peer to Peer Educational Modules.
Dr Manju Chandran, Senior Consultant, Department of Endocrinology, Director, Osteoporosis & Bone Metabolism Unit, Singapore General Hospital & APCO Executive Committee Chairperson, spoke to Health Industry Hub about the current osteoporosis landscape in the region, the impact of COVID-19, role of technology in enhancing patient care and the future trends in osteoporosis management.
There are barriers to fostering best practice in osteoporosis care in the Asia Pacific region. According to Dr Chandran, the biggest barrier is osteoporosis awareness. “Although it is slowly increasing in certain countries in the Asia Pacific, it is at a very slow rate. When considering funding for research projects or attention from policymakers, other chronic conditions such as diabetes get the noise and the attention. Osteoporosis tends to get short shrift because maybe it’s not as glamorous as other diseases such as cardiovascular disease and cancer.
“Our goal in the formation of APCO was that by putting together osteoporosis experts from different countries in the Asia Pacific region, we could make an impact through our collective voices. We aim to change the equation so that the voice of osteoporosis is heard more. It’s amazing that we now have 20 countries represented within the Asia Pacific region.”
The rationale for developing the framework for the minimum standards of care for the screening, diagnosis and management of osteoporosis is that the current osteoporosis guidelines in the region do not provide consistent messaging. “Though I firmly believe that guidelines should be individualised to a country’s specific needs, the current ones are too heterogeneous in their scope and recommendations,” she said.
The APCO HCP Peer to Peer Education Modules will offer clinicians a comprehensive, evidence-based resource encouraging widescale implementation of the minimum clinical standards of care for osteoporosis advocated in The APCO Framework. This will enable the delivery of best practice osteoporosis care throughout the Asia Pacific – the world’s fastest ageing region.
The COVID-19 pandemic has disrupted access to timely osteoporosis diagnosis, treatment and care. A couple of months ago, Dr Chandran published a study on medication adherence demonstrating that the odds of being adherent to denosumab was significantly lower during lockdowns than that during the pre-COVID-19 period [OR 0.525 (95% CI 0.430–0.640); p < 0.001], and odds of being adherent were higher if patients were managed by endocrinologists than if they were managed by other specialists [OR 1.765 (95% CI: 1.444–2.158); p < 0.001].
Dr Chandran added “COVID-19 has had a huge impact in the care of chronic diseases, such as osteoporosis. Services have been disrupted, patients are fearful to come to the hospital to get their medications and to consult doctors.
“At the Singapore General Hospital, we run a Fracture Liaison Services (FLS), the first in the Asia Pacific region, and during the lockdowns we noticed a big decrease in recruitment that bridges the gap between the time after a patient has had a fracture and subsequent follow up. We also had to postpone bone mineral density testing during this time.”
The use of technology in healthcare has been accelerated as a result of the pandemic and it will play a big role in patient care during the COVID recovery phase.
Dr Chandran commented “I’m flipping Charles Dicken’s quote on its head when I say ‘It was the worst of times, it was the best of times’. These last two years have been the worst of times as far as humanity is concerned, and the best of times paving the way for a lot of innovations in technology worldwide.
“In addition to the electronic medical records and the virtual consultations which have boomed, technology is being harnessed in multiple ways even within osteoporosis care to facilitate care coordination, improve practice efficiencies and track data over time.
“Currently there are useful physician-patient platforms, but they only provide appointment reminders and opportunities for patients to look at their lab results. Perhaps these existing platforms can be tweaked so more knowledge can be imparted to patients.
“Digital health and other forces are converging now to completely reshape the healthcare ecosystem. Industry with their links to health technology platforms could connect us with the providers.”
Dr Chandran is optimistic about the future of osteoporosis care and the role of technology. “AI and augmented reality are going to be harnessed more and more. There are existing deep learning algorithms and AI tools that assists with the detection of asymptomatic (silent) spine fractures, and screening and diagnosis of osteoporosis.
“For physicians, the application of augmented reality needs to evolve. However, the use of augmented reality is already available and in use for orthopaedic surgeons.
“Pharmacogenomics in which the right medicine is given to the right patient based on the person’s genetic framework is another development we are going to be seeing in osteoporosis care.
“In the future we will be able to combine AI and deep learning algorithms with precision medicine based on pharmacogenomics in the management of osteoporosis,” she concluded.
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