Jung-Fu Chen

Clinical practice guidelines for the prevention and treatment of osteoporosis in Taiwan: summary

Osteoporosis is recognized as a major public health problem worldwide and in Taiwan. However, many patients with osteoporotic fractures do not receive appropriate assessments or treatments. This guideline, proposed by the Taiwanese Osteoporosis Association, is to serve as a quick reference for healthcare providers to improve the assessment of osteoporosis and development of optimal strategies for osteoporotic management in Taiwan. To review and update osteoporosis management, the guideline is constituted with Taiwan-specific osteoporosis epidemiological data, medication protocols, and the 10-year FRAX®. The guideline is based on evidence-based medicine and public health considerations. Recommendations are not limited to the reimbursement regulations permitted by the National Health Insurance of Taiwan.

Consensus of Official Position of IOF/ISCD FRAX Initiatives in Asia-Pacific Region

The fracture risk assessment tool (FRAX(®)) has been developed for the identification of individuals with high risk of fracture in whom treatment to prevent fractures would be appropriate. FRAX models are not yet available for all countries or ethnicities, but surrogate models can be used within regions with similar fracture risk. The International Society for Clinical Densitometry (ISCD) and International Osteoporosis Foundation (IOF) are nonprofit multidisciplinary international professional organizations. Their visions are to advance the awareness, education, prevention, and treatment of osteoporosis. In November 2010, the IOF/ISCD FRAX initiative was held in Bucharest, bringing together international experts to review and create evidence-based official positions guiding clinicians for the practical use of FRAX. A consensus meeting of the Asia-Pacific (AP) Panel of the ISCD recently reviewed the most current Official Positions of the Joint Official Positions of ISCD and IOF on FRAX in view of the different population characteristics and health standards in the AP regions. The reviewed position statements included not only the key spectrum of positions but also unique concerns in AP regions.

Final Declaration of the Asian Metaforum on the Role of Vitamin D and the Management of Osteoporosis

BACKGROUND Vitamin D is essential for Ca absorption, prevention of falls and fracture, and maintenance of muscle strength and balance. Lack of awareness of the importance of vitamin D in bone health is common in Asia. OBJECTIVE To define key statements, objectives and actions for improving osteoporosis management and vitamin D inadequacy in Asia. RESULTS AND CONCLUSION This declaration was jointly produced by specialists at the Asia Metaforum on the Role of Vitamin D and the Management of Osteoporosis, held in September 2006 in Hong Kong, to define actions to prevent vitamin D insufficiency in Asia. Although developed specifically for Asia, some or all of these statements may be applicable to other regions of the world.

Long-term use of acarbose and CV Event: confusing finding from mega data bank

For the four years from 2009–2010 to 2012–2013 the number of people with Type 2 diabetes receiving the care process of recording the urine albumin-to-creatinine ratio variedbetween 73.9% and 77.5%. The number increased in 2013–2014 to 84.4%, but decreased significantly in 2014–2015 to 74.6%. The QOF indicator incentivizing the recording of albumin-tocreatinine ratio was retired from 1 April 2014.

Correction to: Consensus on best practice standards for Fracture Liaison Service in the Asia-Pacific region

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.

FRI0197 Time Lag of Improvement in Synovial Hypertrophy Compared To Rapid Response in Power Doppler Synovial Vascularity in Post-Adalimumab Rheumatoid Arthritis

Background In previous studies, the patients achieved greater disease control by adalimumab at 24 weeks, this response was maintained over the next 24 weeks1, however, we could not found the characteristic in image to confirm the clinical presentations. Objectives This study aimed to validate the use of power Doppler ultrasonography (PDUS) for evaluating synovial vascularity and synovial hypertrophy for synovitis in patients with rheumatoid arthritis (RA) treated with adalimumab. Methods The synovial disease activity and vascularity of RA on both wrists (radio-carpal joint) were assessed using GS and PDUS to derive the composite US scores based on abnormal counts and severity. The relationship between each measure was determined. Results The 71 patients who received adalimumab therapy had significantly decreased DAS28, ESR, and CRP. After one month, PD score decreased and then remained low for 12 months. Synovial hypertrophy did not change until 3–6 months after, when it started to improve (p=0.017). By multivariate analysis, sex, age, BMI, and DAS28 did not lead to any difference between synovial hypertrophy and PDUS changes (p=0.498). Conclusions Composite US markers of synovial hypertrophy correlate significantly to the DAS28 score and ESR/CRP in adult RA. The time needed for synovial hypertrophy to decrease may be up to 3–6 months after adalimumab therapy. Using ultrasound Doppler measurements predict success of treatment with anti-TNF-alpha has been a trend in monitoring biological therapy in patients with RA References Keystone EC, et al. Arthritis and rheumatism. May 2004;50(5):1400–1411. Disclosure of Interest None declared

Who Can Pass the ISCD Professional Certification Course? The 8-Yr Experience in Taiwan

The International Society for Clinical Densitometry (ISCD) launched the professional certification course in early 1996 and was introduced to Taiwan by the Taiwanese Osteoporosis Association in 2002. Disclosing the associated factors of passing the certification examination would be valuable to advance the teaching skill of faculties and clinical excellence of professionals. From June 2002 to July 2009, 732 attendees (male/female=621/111) of 12 professional certification courses (11 courses delivered in Chinese) were enrolled for analysis. All subjects were asked to complete a questionnaire including demographics and professional experience at the time of course registration. After certification examination, subjects were dichotomized as either pass or fail group for analyzing the determinants of pass rate statistically. The average pass rate of the 12 examinations was 75.3% (n=551). In univariate analysis, the age (p<0.001) and hospital level (p<0.001) showed significant differences between the pass and fail groups. However, in the multivariate logistic analysis, only the age (odds ratio [OR]=0.907, 95% confidence interval [CI]: 0.867-0.949, p<0.001) and clinical experience (attending physician vs resident: OR=3.210, 95% CI: 1.215-8.485, p=0.019) were the independent determinants for passing the course. Professionals who are relatively younger or attending physicians have higher pass rate of ISCD course in Taiwan. The fact that only limited predisposing factors might influence the pass rate reflects the efficient design of course delivering. For any knowledge level of professionals who have interest in the excellence of osteoporosis diagnosis and management, the ISCD course is recommended.