The Fragility Fracture Network Malaysia (FFNM) organised its first annual congress on 3 Dec 2022 in Kuala Lumpur, Malaysia. This was attended by 93 delegates from multidisciplinary backgrounds ranging from geriatric medicine, nursing, orthopaedic surgery and rehabilitation medicine.

Delegates had the opportunity to hear talks on the evidence base for multidisciplinary fragility fracture care, pain management for the older people, operative and non-operative indications for hip fracture, acute vertebral fragility fracture management, maximising recovery after hip fracture surgery, fracture liaison services (FLS), the role of primary care in falls and fracture prevention, and the effectiveness of osteoporosis treatment for older people. There were also interactive panel discussions on challenging pre-operative cases, barriers and facilitators in setting up FLS services, and bone health optimisation in orthopaedic surgery. FFNM would like to express its gratitude to all the chairpersons, speakers and moderators who contributed to such a successful program.

During the annual congress, FFNM also launched its FLS framework. This document highlighted the fragility fracture burden in Malaysia and wider adoption of FLS will address our existing secondary fracture prevention care gap. The FFNM FLS framework writing group are grateful to the peer-reviewers who reviewed the framework and endorsements from 12 local and international societies. The framework details steps on how to implement FLS services and the use of a minimum common dataset (MCD) to performance manage.

A successful event with lots of learning, networking and sharing. FFNM, not one to rest on its laurels, is now moving on to plan its 2023 annual congress.

Dato’ Dr Joon-Kiong Lee (consultant orthopaedic surgeon and president of FFN Malaysia) delivering his speech during the launch of FFN Malaysia Fracture Liaison Service (FLS) Framework
Council members of FFN Malaysia after the launch of FFNM Fracture Liaison Service (FLS) Framework


People sustaining fragility fractures often do not have access to appropriate refracture prevention treatments. In efforts to understand why, and to report on how these services are delivered in recent years, Akesson and colleagues undertook a literature review of current Post Fracture Service (PFS) provided in countries around the world. The evaluated the programs including types, effectiveness, economy and geography with the program types being Fracture Liaison Service, Orthogeriatric Service, other and Remote/virtual. It was found that fracture liaison services and geriatric/orthogeriatric services were the most common models of PFC programs, and both were cost-effective. However, while the number of publications reporting on these services has increased in recent years, many countries are still not reporting on their efforts even when numbers of fragility fractures are high. The authors concluded that coordinated services continue to be cost-effective with positive patient outcomes. However, they urge for expansion and refinement of the services models with more reporting on quality improvement studies to inform efforts to deliver more equitable and improved interventions to prevent further fractures.  

Dr. Krisina Akesson, lead author in the study reflected that “It is known that coordinated multidisciplinary services for secondary prevention of fragility fractures are effective and acceptable by patients, their families and carers, as well as being cost-effective. These outcomes have been reported repeatedly by numerous services across the globe over the past decades and yet many people are still not offered care. Our study provides context to help understand what services work in different setting however more research is required.”

For further information about secondary fragility fracture prevention contact the FFN Secondary Fragility Fracture Prevention SIG lead Robyn Speerin @RehabRobyn

Dr. Sandra Iuliano is a senior research fellow in the department of medicine, University of Melbourne who undertakes research on nutrition and exercise across the lifespan specifically to improve musculoskeletal health. Dr. Iuliano presented at the FFN Congress on her recent work which involved over 7000 older adults from 60 residential aged-care homes in Australia. Research shows that in Australia 6 % of people are in care homes however these account for 30% of all the hip fractures. This is a result of the 5 times greater risk of falling than older adults in the community with 1 in 10 residents hospitalised annual due to a fall-related injury half of which are fractures. She notes that many individuals may not necessarily receive secondary prevention and rehabilitation following their fracture which can result in greater likelihood of mortality.

Dr. Iuliano’s work increased the intake of milk, yoghurt, and cheese provided to residents in care home, achieving 3.5 servings daily in older adults increasing calcium intake to over 1100mg per day and protein to 1.1g per kg body weight. The research team worked with the food service staff to increase the amount of these foods on their menus in a way that considered the preferences of the residents.

After 2 years the results found:

Dr. Iuliano noted that some consider the decline in nutritional status to be a normal result of aging, however this is not accurate. Changing the nutritional intake for individuals in care home for 2 years, including enhancing the intake of calcium and protein helps prevent falls and fractures, and reduces the risk of malnutrition.

A report has been launched by the Australian and New Zealand Falls Prevention Society (ANZFPS) that proposes a plan for urgent and coordinated action that could reduce falls by 30% and turn the tide on a $2.3 billion healthcare burden.

The report makes the following recommendations:

  1. Establish a National Falls Prevention Coordination Group.
  2. Develop and implement a 5-year national plan for preventing falls that is funded.
  3. Engage all levels of government and a broad range of sectors.
  4. Include falls prevention strategies for people across the lifespan in all settings.
  5. Greater investment in research.

A report was developed to address the following key points and is backed by researchers, academics, clinicians and consumer groups:

 “Falls can cause people to lose their independence, and in many cases their lives. Fall injuries often result in fear of future falls and leads to social isolation and impacts on quality of life. Falls are the leading cause of hospitalised injuries and injury deaths in people aged 65 years and above, and should be looked at as an urgent public health concern.

“Strong evidence suggests that coordinated government action on falls prevention reduces falls by 30% in just one year resulting in long-term benefits for health, quality of life and independence” said Professor Kim Delbaere, report co-author, President of the ANZFPS.

Professor Cathie Sherrington, report co-author and Lead Chief Investigator of the NHMRC Centre of Research Excellence – Prevention of Falls Injuries: The University of Sydney, added: “International guidelines recommend a tailored approach with support for exercise to maximise physical function throughout life and health care to address other risk factors. Investment in fall prevention programs can be cost-effective.”

Aging demographics and the resulting increased rate of falls are an issue around the world and require coordinated action across all sectors.

A copy of the full report can be accessed here: ANZFPS_Why investing in falls prevention across Australia can’t wait

Join the FFN

To help make the FFN vision a reality in your country, join the FFN – for free – today
Join FFN Today