Publications by authors named "Joon-Kiong Lee"

Unlabelled: This position paper aims to establish and standardise Bone Health Optimization (BHO) strategies for older patients undergoing elective orthopaedic surgeries in Malaysia. It emphasises pre-, intra-, and post-operative assessments and tailored management. Adopting the "5IQ" approach, it proposes clinical standards and a registry to improve surgical outcomes and patient care.

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Osteoporosis is highly prevalent, particularly in developing countries. However, bone turnover marker reference ranges for management of osteoporosis in Asian population are yet to be explored and established. Thus, this study aims to develop a regional bone turnover markers (BTMs) reference database by combining country-specific reference database from five ASEAN countries: Malaysia, the Philippines, Singapore, Thailand, and Vietnam.

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Article Synopsis
  • - The study aims to create a consensus in the Asia-Pacific region on long-term management and sequential therapy for osteoporosis, focusing on effective fracture prevention through individualized treatment strategies.
  • - A panel of experts analyzed current literature and expert opinions, resulting in 12 key recommendations, such as using anabolic agents for high fracture risk patients and switching to antiresorptive agents post-anabolic therapy if needed.
  • - The findings offer a cost-effective framework for osteoporosis management, emphasizing shared decision-making and integration of local healthcare systems to enhance patient care in the Asia-Pacific region.
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Unlabelled: A survey of awareness and attitudes to the management of fragility fractures among the membership of the Asia Pacific Orthopaedic Association conducted in 2022 found considerable variation in care across the region. A Call to Action is proposed to improve acute care, rehabilitation and secondary fracture prevention across Asia Pacific.

Purpose: Fragility fractures impose a substantial burden on older people and their families, healthcare systems and national economies.

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Aims: The aim of this study was to describe the current pathways of care for patients with a fracture of the hip in five low- and middle-income countries (LMIC) in South Asia (Nepal and Sri Lanka) and Southeast Asia (Malaysia, Thailand, and the Philippines).

Methods: The World Health Organization Service Availability and Readiness Assessment tool was used to collect data on the care of hip fractures in Malaysia, Thailand, the Philippines, Sri Lanka, and Nepal. Respondents were asked to provide details about the current pathway of care for patients with hip fracture, including pre-hospital transport, time to admission, time to surgery, and time to weightbearing, along with healthcare professionals involved at different stages of care, information on discharge, and patient follow-up.

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Article Synopsis
  • The Clinical Practice Guidelines aim to provide evidence-based recommendations for healthcare providers dealing with postmenopausal osteoporosis (OP) screening, diagnosis, and management.
  • A comprehensive literature review from 2014 onwards helped update the guidelines by formulating key clinical questions and evaluating relevant studies.
  • Recommended management includes assessing fracture risk, implementing non-pharmacological measures (like calcium intake and exercise), and choosing pharmacological treatments based on the patient's risk level, with regular assessments to adjust treatment as necessary.
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Purpose: Vitamin D deficiency and insufficiency is common among populations globally, and in Asia and Malaysia. The purpose of this Position Paper is to propose recommendations for both clinicians and non-clinicians to promote vitamin D sufficiency in Malaysian adults. Formation of a national multisector, multidisciplinary alliance is also proposed to progress initiatives relating to safe sun exposure, adequate vitamin D intake through food fortification, and vitamin D supplementation for high-risk groups.

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Osteoarthritis (OA) contributes to significant medical and socioeconomic burden in many populations. Its prevalence is expected to rise continuously owing to the combined effects of aging and increase in risk factors, including obesity, physical inactivity, and joint injuries. Pain is a hallmark presentation of OA.

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Postmenopausal women are at significant risk for osteoporotic fractures due to their rapid bone loss. Half of all postmenopausal women will get an osteoporosis-related fracture over their lifetime, with 25% developing a spine deformity and 15% developing a hip fracture. By 2050, more than half of all osteoporotic fractures will occur in Asia, with postmenopausal women being the most susceptible.

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Article Synopsis
  • The review highlights the growing impact of fragility fractures on individuals and healthcare systems, with an expected increase as populations age.
  • Key topics addressed include the human and economic consequences of these fractures, risk factors involved, and current management practices.
  • It calls for systematic improvements in acute care and prevention strategies to better address fragility fractures globally, particularly during the "Decade of Healthy Ageing" initiative by the UN and WHO.
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Unlabelled: This narrative review summarises ongoing challenges and progress in the care and prevention of fragility fractures across the Asia Pacific region since mid-2019. The approaches taken could inform development of national bone health improvement Road Maps to be implemented at scale during the United Nations 'Decade of Healthy Ageing'.

Purpose: This narrative review summarises recent studies that characterise the burden of fragility fractures, current care gaps and quality improvement initiatives intended to improve the care and prevention of fragility fractures across the Asia Pacific region.

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Background: The 2013 Malaysian Clinical Practice Guidelines on the Management of Osteoarthritis (OA) recommend a linear step-up approach to manage knee OA. However, patients with knee OA often require a multimodal approach to address OA-related pain symptoms and functional limitations. This consensus aimed to provide doctors with an updated set of evidence-based, clinical experience-guided recommendations to manage knee OA.

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Article Synopsis
  • The ESCEO algorithm for knee osteoarthritis management, first introduced in 2014, underwent updates in 2019, prompting a Southeast Asia Working Group (SEAWG) to evaluate its reception and application among local experts.* -
  • The recommended treatment steps emphasize a combination of non-pharmacological and pharmacological approaches, starting with symptomatic slow-acting drugs, followed by oral NSAIDs or alternatives like intra-articular injections, since patient safety varies.* -
  • The findings highlight the importance of the ESCEO algorithm for local health systems in Southeast Asia, acknowledging that reimbursement policies significantly influence its implementation in clinical practice.*
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Purpose Of Review: This review sought to describe quality improvement initiatives in fragility fracture care and prevention.

Recent Findings: A major care gap persists throughout the world in the secondary prevention of fragility fractures. Systematic reviews have confirmed that the Fracture Liaison Service (FLS) model of care is associated with significant improvements in rates of bone mineral density testing, initiation of osteoporosis treatment and adherence with treatment for individuals who sustain fragility fractures.

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Osteoporosis is a major health issue. By 2050, a greater than 2-fold increase in patients number with hip fractures will occur in Asia representing 50% of all hip fractures worldwide. For the Asia-Pacific (AP) region, more efforts on controlling osteoporosis and the subsequent fractures are crucial.

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In this article the name of the sixth author, E. Michael Lewiecki was rendered incorrectly. The publisher regrets this error and apologizes for the inconvenience caused.

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Article Synopsis
  • The Fracture Liaison Service (FLS) Consensus Meeting, held on October 14, 2017, in Taiwan, aimed to review and establish best practices for fracture prevention and management in the Asia-Pacific region, supported by international organizations.
  • Experts concluded that the 13 Best Practice Framework (BPF) standards were mostly relevant for the region, needing only minor adjustments to suit local healthcare settings.
  • Key recommendations included enhancing patient education and increasing public communication about FLSs to improve their effectiveness and accessibility in the area.
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  • This Clinical Guidance focuses on helping practitioners assess and manage glucocorticoid-induced osteoporosis (GIO) by utilizing evidence-based recommendations.
  • A systematic literature review was conducted to update treatment guidelines from 2012, emphasizing early intervention for patients starting glucocorticoids, especially within the first 3-6 months when fracture risk rises.
  • Bisphosphonates are recommended as the primary treatment for GIO, particularly in post-menopausal women and older men, while younger individuals should only receive them if they have existing fractures or are at very high risk.
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Article Synopsis
  • Dual-energy X-ray absorptiometry (DXA) is a crucial technology for diagnosing osteoporosis and evaluating fracture risk by measuring bone mineral density (BMD).
  • The accuracy of DXA scans heavily relies on proper acquisition, analysis, and interpretation; any shortcomings can lead to mismanagement of patient care.
  • The International Society for Clinical Densitometry outlines quality standards for DXA testing to ensure reliable results, ultimately improving treatment decisions and patient outcomes.
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Article Synopsis
  • The Clinical Guidance aims to assist healthcare practitioners in effectively assessing, diagnosing, and managing osteoporosis (OP) based on the best available evidence.
  • A comprehensive literature review, updating information from 2012, focused on identifying effective diagnostic and treatment strategies for both postmenopausal and male OP, highlighting the importance of using fracture risk assessment tools alongside bone density measurements.
  • Key recommendations include maintaining adequate calcium and vitamin D intake while emphasizing that pharmacological therapies, particularly anti-resorptives, are essential for confirmed OP, requiring regular assessment and adjustment of treatment plans for patients.
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Article Synopsis
  • The FRAX tool is designed to identify individuals at high risk for fractures and guide treatment decisions to prevent them.
  • While not all countries have specific FRAX models, similar regions can utilize surrogate models to assess fracture risk.
  • The IOF and ISCD are organizations that work to enhance osteoporosis awareness and treatment, and they held a conference in 2010 to establish guidelines for using FRAX, including adapting recommendations for the Asia-Pacific region based on local characteristics.
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Background: A vast amount of literature describes the incidence of fracture as a risk for recurrent osteoporotic fractures in western and Asian countries. Osteoporosis evaluation and treatment after a low-trauma fracture, however, has not been well characterized in postmenopausal women in Asia. The purpose of this study was to characterize patient and health system characteristics associated with the diagnosis and management of osteoporosis among postmenopausal women hospitalized with a fragility fracture in Asia.

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The International Society for Clinical Densitometry (lSCD) is a nonprofit multidisciplinary international professional organization. The ISCD mission is to advance excellence in the assessment of skeletal health. To achieve this mission, the ISCD has conducted a number of Position Development Conferences over the past 10yr, bringing together international experts to review and create evidence-based position statements guiding clinicians involved in the area.

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