Emphasising the Need for a National Fragility Fracture Network for Pakistan (FFN-Pak)

By Hamna Siddiqui, Hafsa Majid, Aysha Habib Khan

Affiliations

1. Department of Pathology and Laboratory Medicine, The Aga Khan University Hospital, Karachi, Pakistan

doi: 10.29271/jcpsp.2023.12.1469

Sir,

Osteoporosis, a worldwide epidemic, is characterised by low bone mass and fragility fractures causing pain, disability, and dependence with high morbidity and mortality. Hip fractures have a 6% fatality rate in the hospital and a 30% fatality rate after one year.¹ It is estimated that there would be 36,524 hip fractures per year in Pakistan among those 50 and older, with 12,902 in males and 23,622 in females. Hip fractures are anticipated to rise steadily each year, rising by 214% by 2050.²

Despite significant advancements in osteoporosis detection and treatment, there are reports of inadequate levels of evaluation and management of osteoporosis, observed in individuals experiencing fragility fractures.³ Cost of treatment, limited centres with resources and expertise for diagnosis, and a lack of awareness amongst the healthcare fraternity are some of the factors in late diagnosis and treatment in Pakistan. Epidemiological data is also unavailable; there are no national clinical practice guidelines or national fracture registries.

In the current scenario, there is a dire need for an organisation to focus on efforts to enhance the management of fragility fractures, rehabilitation, and secondary fracture prevention in Pakistan along with national alliances to facilitate resource development and implement high-quality low-cost solutions. Policy-makers must devise and put into action plans that ensure older people have the chance to live healthy, happy, and productive life in response to this issue. These tactics must reduce the financial, social, and psychological impact that chronic illness puts on society as a whole. In addition to causing discomfort and loss of mobility, fragility fractures pose an extreme risk to older people's quality of life by limiting their ability to live freely and comfortably on their own.

A multidisciplinary network of experts, FFN-Pak was launched in January 2023 with the goal to enhance secondary fracture prevention and improve the treatment of fragility fractures across the country.⁴ The “Call to Action” of FFN-Pak comprises four ‘Pillars’ of activity in line with the Global-FFN. This includes:

• Prompt multidisciplinary treatment for patients with fragility fractures;

• Rehabilitation and continued post-acute care for patients whose capacity to function has been compromised by  fragility  fractures;

• Immediate secondary fracture prevention following the first incidence of all fragility fractures;

• The development of cross-national coalitions with pertinent professional  organisations.

The goal of this network is to break silos and create partnerships and synergies with concrete steps that can be implemented within tight timeframes. It is anticipated that with this launch and aligning with the “Call to Action” of Global FFN, the efforts will have a multiplier synergistic effect in enhancing the standard of care for those who have fragility fractures and ultimately lead to policy-change. With meticulous planning and well-coordinated policy engagement efforts, significant improvements can be made in fragility fracture prevention and treatment at the national level. The FFN-Pak needs to address the issues of the long-term effects of fragility fracture burden on our healthcare system and the lack of national recognition of its importance.

COMPETING INTEREST:
The authors declared no competing interest.

AUTHORS’ CONTRIBUTION:
HS: Involved in writing the initial draft, data collection, and final review.
HM: Critically reviewed for intellectual content.
AHK: Conceived the idea and reviewed the final letter.
All authors approved the final version of the manuscript to be published.

REFERENCES

1. Dang DY, Zetumer S, Zhang AL. Recurrent fragility fractures: A cross-sectional analysis. J Am Acad Orthop Surg 2019; 27(2):e85-91. doi: 10.5435/JAAOS-D-17-00103.
2. Naureen G, Johansson H, Iqbal R, Jafri L, Khan AH, Umer M, et al. A surrogate FRAX model for Pakistan. Arch Osteo-poros 2021; 16:1-6. doi: 10.1007/s11657-021-00 894-w.
3. Khan AH, Jafri L, Ahmed S, Noordin S. Osteoporosis and its perspective in Pakistan: A review of evidence and issues for addressing fragility fractures. Ann Med Surg 2018; 29: 19-25.  doi: 10.1016/j.amsu.2018.03.019.
4. Fragility Fracture Network. Available from; https://fragility fracturenet work.org/middle-east-pakistan/ (Accessed on 6/23/2023).