Chandran Manju, Ebeling Peter R, Mitchell Paul J, Nguyen Tuan V
Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, Singapore, Singapore.
Duke-National University of Singapore (NUS) School of Medicine, Singapore, Singapore.
J Bone Miner Res. 2022 Apr;37(4):608-615. doi: 10.1002/jbmr.4544. Epub 2022 Apr 3.
In the Asia Pacific (AP) region, osteoporosis and its consequence of fragility fractures are not widely recognized as a major public health problem. Several challenges including underdiagnosis and undertreatment exist. The Asia Pacific Consortium on Osteoporosis (APCO) is a nonpartisan and apolitical organization comprising musculoskeletal experts and stakeholders from both private and public sectors who have united to develop tangible solutions for these substantive challenges. APCO's vision is to reduce the burden of osteoporosis and fragility fractures in the AP region. Heterogeneity in both scope and recommendations among the available clinical practice guidelines (CPGs) contribute to the large osteoporosis treatment gap in the Asia Pacific. APCO has therefore developed a pan Asia-Oceania harmonized set of standards of care (The Framework), for the screening, diagnosis, and management of osteoporosis. First, a structured analysis of the 18 extant AP CPGs was completed. Subsequently, a prioritization of themes and agreement on fundamental principles in osteoporosis management were made through a Delphi process of consensus building. This approach, ensuring the opinions of all participating members were equally considered, was especially useful for a geographically diverse group such as APCO. It is hoped that the Framework will serve as a platform upon which new AP national CPGs can be developed and existing ones be revised. APCO is currently embarking on country-specific engagement plans to embed the Framework in clinical practice in the AP region. This is through partnering with regulatory bodies and national guidelines development authorities, through peer-to-peer health care professional education and by conducting path finder audits to benchmark current osteoporosis services against the Framework standards. The principles underpinning the harmonization of guidelines in the AP region can also be utilized in other parts of the world that have similar socioeconomic diversity and heterogeneity of healthcare resources. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
在亚太地区，骨质疏松症及其导致的脆性骨折并未被广泛视为一个主要的公共卫生问题。存在包括诊断不足和治疗不足在内的若干挑战。亚太骨质疏松症联盟（APCO）是一个无党派、非政治性组织，由肌肉骨骼专家以及来自私营和公共部门的利益相关者组成，他们联合起来为这些重大挑战制定切实可行的解决方案。APCO的愿景是减轻亚太地区骨质疏松症和脆性骨折的负担。现有临床实践指南（CPG）在范围和建议方面的异质性导致了亚太地区巨大的骨质疏松症治疗差距。因此，APCO制定了一套泛亚 - 大洋洲统一的骨质疏松症筛查、诊断和管理护理标准（《框架》）。首先，完成了对18份现存亚太CPG的结构化分析。随后，通过德尔菲共识构建过程对骨质疏松症管理中的主题进行了优先级排序并就基本原则达成了一致。这种方法确保了所有参与成员的意见都得到平等考虑，对于像APCO这样地域多样的组织尤其有用。希望该《框架》将成为一个平台，在此基础上可以制定新的亚太国家CPG并修订现有CPG。APCO目前正在开展针对特定国家的参与计划，以将《框架》纳入亚太地区的临床实践。这是通过与监管机构和国家指南制定当局合作、通过同行间的医疗保健专业教育以及通过进行探索性审核来对照《框架》标准对当前骨质疏松症服务进行基准评估来实现的。在亚太地区协调指南所依据的原则也可用于世界上其他具有类似社会经济多样性和医疗资源异质性的地区。© 2022作者。《骨与矿物质研究杂志》由威利期刊有限责任公司代表美国骨与矿物质研究学会（ASBMR）出版。
