APCO Framework

About the framework

The APCO Framework will focus on the following high-risk groups:
  • People with a history of fragility fractures
  • People with pre-existing medical conditions that heightens their risk of bone loss and fragility fractures
  • Those on medications associated with bone loss and fragility fractures
  • Those with risk factors for osteoporosis and fragility fractures (based on country-specific fracture intervention thresholds)
  • The elderly (aged 70 and above)
The Framework will be shaped by a comprehensive comparative analysis of current osteoporosis guidelines in Asia Pacific.
Findings from a comparative analysis of current osteoporosis clinical practice guidelines across Asia Pacific, to be shared at the WCO-IOF-ESCEO Global Congress in Barcelona, in August 2020, will inform development of the APCO Framework.
The template for the comprehensive comparative analysis of existing national guidelines is based on a modified 5IQ approach,1,2 taking the following information into consideration:1
  • Background

    Country-specific background information

  • Identification

    A statement of which individuals should be identified

  • Investigation

    A description of the type of investigations to be undertaken

  • Information

    A description of the type of information to be provided to the individual

  • Initiation

    A description of pharmacological interventions and falls prevention

  • Integration

    A statement on the need for integration between primary and secondary care

  • Quality

    A description of professional development, audit and peer-review activities

The 5IQ exercise will assess the extent of consensus or discord when comparing the national guidelines currently available throughout Asia Pacific.
The Framework will be informed by similar initiatives developed by the International Osteoporosis Foundation (IOF) and European Society for Clinical and Economic Aspects of Osteoporosis (ESCEO).
The Delphi technique (a structured communication technique using a systematic, interactive forecasting method reliant upon an expert panel) will be employed to achieve APCO member consensus for the development of clinical standards of care.3
Development of the APCO Framework will offer APCO members the opportunity to invite their clinical peers to perform ‘pathfinder baseline audits’ of adherence to the Framework’s standards of care within their respective hospitals, enabling the establishment of baseline levels of adherence within the standards proposed by the Framework region-wide.
In the future, the APCO website has the potential to host a registry of Framework-adherent hospitals across Asia Pacific.
The registry could serve as a means to track the Framework’s implementation across the region.

Pathfinder audits

APCO members could also utilise their pathfinder audit results to encourage their respective national guidelines development groups to incorporate the standards of care advocated in the Framework, into new or revised national osteoporosis guidelines.3
  1. National Osteoporosis Society. Effective Secondary Prevention of Fragility Fractures: Clinical Standards for Fracture Liaison Services. [cited Jan, 2020]; Available from: https://theros.org.uk/media/2082/clinical-standards-for- fracture-liaison-services.pdf.

  2. Osteoporosis New Zealand. Clinical standards for Fracture Liaison Services in New Zealand. [cited Jan, 2020]; Available from: https://osteoporosis.org.nz/wp-content/uploads/ONZ-FLS-Clinical-Standards- WEB.pdf.

  3. Royal College of Obstetricians and Gynaecologists. The Delphi technique. 2005. [cited Jan, 2020]; Available from: https://obgyn.onlinelibrary.wiley.com/doi/pdf/10.1576/toag.

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