Hip Fracture Registry (HFR) Toolbox
Media Kit

Regional media release                                                 EMBARGOED: 12:01AM AEST, TUESDAY, JUNE 15, 2021


World-first Hip Fracture Registry Toolbox striving to improve care for the 1 million+ who fracture a hip in Asia Pacific each year


An innovative world-first Hip Fracture Registry Toolbox has been launched today (Tuesday, June 15, 2021) to address the alarming death and disability caused by the more than 1 million hip fractures sustained in the Asia Pacific each year.1

Developed by the Asia Pacific Fragility Fracture Alliance (APFFA) in collaboration with the Fragility Fracture Network (FFN), the practical and informative resource explains the fundamental need, and how to best advocate for, the establishment of a national hip fracture registry. Tailored to clinicians, hospital administrators, healthcare systems and governments alike, the Toolbox covers pertinent topics, including stakeholder engagement and consolidation, building a case for change, planning and funding a registry, to setting up a pilot registry, and navigating governance and ethics approval. Examples of current registries and other useful resources also feature in the Toolbox.

Concerningly, one-in-four patients who sustain a hip fracture die within a year, and less than half of those who survive, regain their previous level of function.2-5 The expected direct incurred cost associated with the more than 1.1 million hip fractures estimated to have occurred in nine countries and regions in APAC, including China, Chinese Taipei, Hong Kong SAR, India, Japan, Malaysia, Singapore, South Korea and Thailand in 2018, amounts to USD 7.5 billion. This cost  is projected to increase to almost USD 13 billion by 2050.1

According to Consultant Ortho-Geriatrician, Clinical Director of the Falls, Balance and Injury Research Centre at Neuroscience Research Australia (NeuRA), and APFFA Hip Fracture Registry Working Group Co-Chair, Professor Jacqui Close, Australia, widescale implementation of hip fracture registries worldwide, can facilitate vast improvements in care for the millions of people who sustain a hip fracture each year.6,7

“Hospitals can utilise hip fracture registries to benchmark their provision of care against best practice clinical standards for acute care, rehabilitation, and secondary fracture prevention.6,8

“Furthermore, hip fracture registries can transform patient-level data into information that both equips and empowers  hospital teams to identify, and develop solutions for key challenges within their respective institutions, and to strive for ongoing improvement in care,”8 said Prof Close.

By 2050, one in four people in APAC will be aged over 60. This portion of the population is expected to triple between 2010 and 2050, reaching close to 1.3 billion people.9 Within the same timeframe, between 4.5 to 6.3 million hip fractures are predicted to occur worldwide, half of which will occur in Asia.10

Given the exponential increase in both the incidence and costs associated with hip fractures to date, and those anticipated globally,11 hip fracture registries serve as a vital tool underpinning quality improvement initiatives8 in the Asia Pacific region, and globally, argues Consultant Geriatrician and Medical Director, Fiona Stanley Fremantle Hospitals Group, and APFFA Hip Fracture Registry Working Group Co-Chair, Dr Hannah Seymour, Australia.

“As of April 2021, 18 countries across Asia Pacific, Europe, Latin America and North America had established a hip fracture registry, at different stages of maturation, participation and development.12-28 Notably, only three registries are currently operating in the Asia Pacific.

“The Hip Fracture Registry Toolbox explains how timely, reliable and constructive feedback to clinical teams, coupled with the engagement and participation of key stakeholders, improves the impact of hip fracture registries,” Dr Seymour said.

With adequate operational efficiency and funding, registries can improve healthcare, and are likely to prove significantly cost-effective.29

Registries can contribute to government initiatives designed to manage rapidly aging populations, and can further help governments to promote the equitable provision of care.30

According to Orthopaedic Surgeon and APFFA co-Chair, Dato’ Dr. Joon-Kiong Lee, Malaysia, today’s release of the Toolbox also coincides with the launch of APFFA’s YouTube channel.

“The APFFA YouTube channel will house a series of educational videos featuring interviews with leading clinicians from the Asia Pacific bone arena, reflecting on important considerations for each of the seven key steps involved in establishing a hip fracture registry.

“We trust our APFFA and FFN Toolbox, and supporting videos, will arm our colleagues throughout Asia Pacific, and the rest of the world, with the necessary inspiration, knowledge and guidance on how to successfully establish a national hip fracture registry in their respective countries,” said Dato’ Dr Lee.


Formed in November 2018, APFFA comprises seven global and regional member organisations from the geriatrics, orthopaedics, osteoporosis and rehabilitation sectors, with the primary purpose of driving policy change, improving awareness and changing political and professional mindsets, to facilitate optimal fragility fracture management across Asia Pacific.

About the APFFA HFR Working Group

The APFFA Hip Fracture Registry Working Group is a principal action group within APFFA, comprising global experts in hip fracture treatment and management, charged with driving the development of the HFR Toolbox.

In addition, the HFRWG report on hip fracture epidemiology and outcomes across Asia Pacific aims to frame the problems facing the region, and outline APFFA-related projects capable of providing a part solution to these issues.

The HFRWG is also responsible for a feasibility study examining the costs and practicalities of establishing new hip fracture registries in specific countries throughout Asia Pacific.

About the Fragility Fracture Network (FFN)

The FFN is a global organisation comprising a multidisciplinary network of experts charged with improving the treatment and secondary prevention of fragility fractures. The organisation strives to optimise multidisciplinary management of a patient with a fragility fracture, to ensure maximum recovery, quality of life, and no further fractures, worldwide.

The Hip Fracture Audit Special Interest Group (HFA SIG) comprises a multidisciplinary network of clinicians
well-versed in hip fracture audits, striving for global adoption of a Minimum Common Dataset (MCD), and a worldwide platform to share HFA knowledge, learning and research.

To learn more about APFFA, and to download the Hip Fracture Registry Toolbox, head to www.apfracturealliance.org/HFR-toolbox/ 

Follow APFFA on LinkedIn asia-pacific-fragility-fracture-alliance

For more information, contact:
Kirsten Bruce or Mel Kheradi, VIVA! Communications, Sydney, AUSTRALIA
T. +61 401 717 566 / +61 2 421 551 257
kirstenbruce@vivacommunications.com.au / melorin@vivacommunications.com.au

Experts available for interview

  • Dato’ Dr. Joon-Kiong Lee - Deputy Medical Director, Head of Department of Orthopedic Surgery and Consultant Orthopedic Surgeon, Beacon Hospital, MALAYSIA
  • Prof. Ding-Chen (Derrick) Chan - Vice Superintendent, National Taiwan University Hospital, Hsin-Chu Branch, Executive Director, National Taiwan University Hsin-Chu Hospital and attending physician, Department of Geriatrics & Gerontology, TAIWAN
  • Dr Edward Leung - Director, Geriatric Medicine (Healthy Ageing) & Hon. Consultant in Geriatric Medicine, Hong Kong Sanatorium & Hospital, President, Hong Kong Association of Gerontology & President, Osteoporosis Foundation Hong KongHONG KONG
  • Prof. Jacqui Close - Consultant Orthogeriatrician and Co-Chair,  Asia Pacific Fragility Fracture Alliance (APFFA) Hip Fracture Registry Working Group, AUSTRALIA
  • Dr Hannah Seymour - Consultant Geriatrician and Medical Director, Fiona Stanley Fremantle Hospitals Group and Co-Chair, Asia Pacific Fragility Fracture Alliance (APFFA) Hip Fracture Registry Working Group, AUSTRALIA
  • Adj. A/Prof. Paul Mitchell - School of Medicine, University of Notre Dame, Australia &  Project Manager, Asia Pacific Fragility Fracture Alliance (APFFA), NEW ZEALAND
  1. Cheung, C.-L., et al., An updated hip fracture projection in Asia: The Asian Federation of Osteoporosis Societies study. Osteoporosis and sarcopenia, 2018. 4(1): p. 16-21.
  2. National Osteoporosis Foundation, NOF's Clinician's Guide to Prevention and Treatment of Osteoporosis.
  3. Australian Institute of Health and Welfare. Musculoskeletal fact sheet. Osteoporosis. [cited Jan, 2020]; Available from: https://www.aihw.gov.au/getmedia/61866386-568b-41fa-93e4-090ad201ab2b/phe187-osteoporosis-factsheet.pdf.aspx
  4. Cosman, F., et al., Clinician's Guide to Prevention and Treatment of Osteoporosis. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2014. 25(10): p. 2359-2381.
  5. Downey, C., M. Kelly, and J.F. Quinlan, Changing trends in the mortality rate at 1-year post hip fracture - a systematic review. World journal of orthopedics, 2019. 10(3): p. 166-175.
  6. Currie, C., Hip fracture audit: Creating a 'critical mass of expertise and enthusiasm for hip fracture care'? Injury, 2018. 49(8): p. 1418-1423.
  7. Wise, J., Hip fracture audit may have saved 1000 lives since 2007. BMJ : British Medical Journal, 2015. 351: p. h3854.
  8. Johansen, A., et al., Using national hip fracture registries and audit databases to develop an international perspective. Injury, 2017. 48(10): p. 2174-2179.
  9. United Nation Population Fund (UNFPA) Asia & the Pacific. Ageing. [cited May]; Available from: https://asiapacific.unfpa.org/en/node/15208.
  10. Cheung, C.L., et al., An updated hip fracture projection in Asia: The Asian Federation of Osteoporosis Societies study. Osteoporos Sarcopenia, 2018. 4(1): p. 16-21.
  11. Baker, P.N., et al., Evolution of the hip fracture population: time to consider the future? A retrospective observational analysis. BMJ Open, 2014. 4(4): p. e004405.
  12. Asia Pacific Fragility Fracture Alliance. Hip Fracture Registry Toolbox. 2021 [cited May, 2021]; Available from: www.apfracturealliance.org/HFR-toolbox/
  13. Australia and New Zealand Hip Fracture Registry. Australia and New Zealand Hip Fracture Registry. [cited May, 2021]; Available from: https://anzhfr.org.
  14. Yamamoto, N., H.E. Takahashi, and N. Endo, Chapter 6 - The Challenge of Secondary Prevention of Hip Fracture in Japan, in Secondary Fracture Prevention, M.J. Seibel and P.J. Mitchell, Editors. 2019, Academic Press. p. 109-115.
  15. Kim, J.W., et al., Reoperation rate, mortality and ambulatory ability after internal fixation versus hemiarthroplasty for unstable intertrochanteric fractures in elderly patients: a study on Korean Hip Fracture Registry. Arch Orthop Trauma Surg, 2020. 140(11): p. 1611-1618.
  16. Schoeneberg, C., et al., Effect of time-to-surgery on in-house mortality during orthogeriatric treatment following hip fracture: A retrospective analysis of prospectively collected data from 16,236 patients of the AltersTraumaRegister DGU®. Injury, 2021. 52(3): p. 554-561.
  17. Kristensen, P.K., et al., The Danish Multidisciplinary Hip Fracture Registry 13-Year Results from a Population-Based Cohort of Hip Fracture Patients. Clin Epidemiol, 2020. 12: p. 9-21.
  18. Sund, R., et al., Monitoring the performance of hip fracture treatment in Finland. Annals of Medicine, 2011. 43(sup1): p. S39-S46.
  19. Yli-Kyyny, T.T., et al., Risk factors for early readmission due to surgical complications after treatment of proximal femoral fractures – A Finnish National Database study of 68,800 patients. Injury, 2019. 50(2): p. 403-408.
  20. Walsh, M.E., et al., Trends in hip fracture care in the Republic of Ireland from 2013 to 2018: results from the Irish Hip Fracture Database. Osteoporos Int, 2021. 32(4): p. 727-736.
  21. Finnish Intitute for health and welfare. PERFECT Hip Fracture Registry Available from: https://thl.fi/fi/tutkimus-ja-kehittaminen/tutkimukset-ja-hankkeet/perfect/osahankkeet/lonkkamurtuma/perusraportit.
  22. Ferrara, M.C., et al., Three-year National report from the Gruppo Italiano di Ortogeriatria (GIOG) in the management of hip-fractured patients. Aging Clin Exp Res, 2020. 32(7): p. 1245-1253.
  23. van Voorden, T.A.J., et al., Effect of the Dutch Hip Fracture Audit implementation on mortality, length of hospital stay and time until surgery in elderly hip fracture patients; a multi-center cohort study. Injury, 2020. 51(4): p. 1038-1044.
  24. Kristoffersen, M.H., et al., Cognitive impairment influences the risk of reoperation after hip fracture surgery: results of 87,573 operations reported to the Norwegian Hip Fracture Register. Acta Orthop, 2020. 91(2): p. 146-151.
  25. The Scottish Hip Fracture Audit. The Scottish Hip Fracture Audit. [cited May, 2021]; Available from: https://www.shfa.scot.nhs.uk.
  26. Ojeda-Thies, C., et al., Spanish National Hip Fracture Registry (RNFC): analysis of its first annual report and international comparison with other established registries. Osteoporos Int, 2019. 30(6): p. 1243-1254.
  27. Jc, V., et al., Mexican Hip Fracture Audit (ReMexFC): objectives and methodology. MOJ Orthopedics & Rheumatology, 2019. 11: p. 115-118.
  28. Arshi, A., et al., Standardized Hospital-Based Care Programs Improve Geriatric Hip Fracture Outcomes: An Analysis of the ACS NSQIP Targeted Hip Fracture Series. J Orthop Trauma, 2019. 33(6): p. e223-e228.
  29. Australian Commission on Safety and Quality in Health Care, Economic evaluation of clinical quality registries. 2016.
  30. Australian Government, National Clinical Quality Registry and Virtual Registry Strategy - A National Strategy for Clinical Quality Registries and Virtual Registries 2020-2030. 2020.
Files available for download
  • Regional media release
  • 200-word summary
  • Backgrounder – The Hip Fracture Registry Toolbox
  • Infographic
  • PROFILE - Dato' Dr. Joon-Kiong Lee, MALAYSIA
  • PROFILE - Professor Derrick Chan, TAIWAN
  • PROFILE - Dr Edward Leung, HONG KONG
  • PROFILE - Professor Jacqui Close, AUSTRALIA
  • PROFILE - Dr Hannah Seymour AUSTRALIA
  • PROFILE - Adjunct Associate Professor Paul Mitchell, NEW ZEALAND

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