Browsing by Author "Li-Yu J."

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    Asia–Pacific consensus for the management of osteoporosis in men
    (2025-01-01) Huang C.F.; Ho C.J.; Lin S.Y.; Hwang J.S.; Tai T.W.; Chen J.F.; Tu S.T.; Chan D.C.; Yang R.S.; Chen H.Y.; Tsai K.S.; Cheng T.T.; Chen F.P.; Hung W.C.; Chang Y.F.; Han D.S.; Chandran M.; Bin A.S.; Lee J.K.; Yeap S.S.; Chung Y.S.; Kim K.K.; Ebeling P.; Jaisamrarn U.; Pandey D.; Ferrari S.; McCloskey E.; Charatcharoenwitthaya N.; Taguchi A.; Lekamwasam S.; Van Nguyen T.; Lewiecki E.M.; Saag K.G.; Tsai C.C.; Marín F.; Mori S.; Hwang K.R.; Li-Yu J.; Carey J.J.; Kendler D.; Cheung C.L.; Huang H.K.; Kuptniratsaikul V.; Chan W.P.; Chan S.P.; Ho-Pham L.T.; Hew F.L.; Shi H.; Reid I.; Kanis J.A.; Chen C.H.; Wu C.H.; Huang C.F.; Mahidol University
    Summary: Osteoporosis in men is an underdiagnosed and undertreated condition that leads to significant morbidity and mortality, particularly in the aging population. This consensus report provides tailored guidelines for diagnosing, preventing, and treating male osteoporosis in the Asia–Pacific region by integrating global best practices with regional adaptations. Purpose: To establish evidence-based, region-specific guidelines for the management of male osteoporosis in the Asia–Pacific region, addressing demographic and lifestyle factors. Methods: Expert feedback was gathered through premeeting reviews, consensus conferences, and collaborative discussions. A life-course approach was employed to align international best practices with Asia–Pacific-specific needs, emphasizing continuous monitoring and intervention from middle age onward. Results: The 12 consensus strategies systematically approach male osteoporosis management, addressing screening, diagnosis, treatment, and long-term follow-up. Recommendations include the assessment of fracture risk for men aged 50 years and above, use of dual-energy X-ray absorptiometry (DXA) testing for men aged 70 years and above, lifestyle modifications, and pharmacological interventions such as bisphosphonates, denosumab, and anabolic agents for high-risk patients. Secondary causes of osteoporosis were highlighted, along with the establishment of fracture liaison services (FLSs) to improve long-term care. A life-course approach was proposed to optimize bone health throughout men’s lives. Conclusion: This consensus provides a comprehensive framework tailored to the Asia–Pacific region for diagnosing, preventing, and managing osteoporosis in men. By addressing region-specific challenges and promoting evidence-based interventions, the latest guidelines incorporating the consensus may depict the conceptual direction in reducing fracture risk and improving long-term bone health outcomes for osteoporosis in men.
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    Bone turnover markers reference database in five Southeast Asian countries
    (2024-10-01) Lee J.K.; Khor H.M.; Chotiyarnwong P.; Unnanuntana A.; Amphansap T.; Li-Yu J.; Cating-Cabral M.T.; Luceño V.; Cao N.; Tran T.; Ang S.B.; Puvanendran R.; Mat S.; Lee J.K.; Mahidol University
    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. We established a healthy reference population of 746 healthy premenopausal women aged 20 to 44 years old. Serum Procollagen 1 N-Terminal Propeptide (P1NP), Osteocalcin (OC), and Beta-Crosslaps (CTX) concentrations were measured using an automated immunoassay analyzer system, the cobas® modular analyzer systems (Roche Diagnostic Gmbh). The reference interval was defined as the central 95 % range. The estimated reference interval for CTX was 128 to 811 ng/L, OC was 9.0 to 33.0 μg/L, and for P1NP, the range was 22.8 to 96.5 μg/L. Comparison across countries showed that Singaporeans had the highest levels of median CTX along with Thais and Filipinos, who had significantly higher levels of P1NP and OC. Exploratory analysis on the associations with age showed that BTMs decreased with increasing age at 20 to 29 years old and plateaued after 30 years old. When excluding participants in their 20s, the reference interval estimated were CTX: 117–678 ng/L, P1NP: 21.6–85.8 μg/L and OC: 3.5–27.0 μg/L respectively. To the best of our knowledge, this is the first study to report BTMs reference intervals based on a healthy premenopausal Southeast Asian population which will contribute to the appropriate assessment and monitoring of bone turnover rate in the evaluation and management of osteoporosis in the Southeast Asian region. Lay summary: Osteoporosis is a common health issue, especially in developing countries. However, there is a lack of information on bone health markers specific to the Southeast Asian population. This study aimed to fill this gap by creating a reference database for bone turnover markers (BTMs) in Southeast Asian countries, including Malaysia, the Philippines, Singapore, Thailand, and Vietnam. The researchers studied 746 healthy women aged 20 to 44 years and measured blood markers related to bone health. The reference interval, representing the normal range, was determined. For example, the normal range for CTX was found to be 128 to 811 ng/L, for Osteocalcin was 9.0 to 33.0 μg/L, and for P1NP, the range was 22.8 to 96.5 μg/L. When excluding participants in their 20s, the reference intervals estimated were CTX: 117–678 ng/L, P1NP: 21.6–85.8 μg/L and OC: 3.5–27.0 μg/L respectively. Comparing the results across countries, Singaporeans, Thais, and Filipinos showed variations in their biochemical bone marker levels. Additionally, the study observed changes in the levels with age, with a decrease in BTMs observed after the age of 30. This groundbreaking study provides the first-ever reference intervals for BTMs in a healthy premenopausal Southeast Asian population. These findings will help in the proper assessment and monitoring of bone health, contributing to the management of osteoporosis in the Southeast Asian region.
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    Consensus statement on the application of artificial intelligence in osteoporosis screening and management: perspectives from the Asia-Pacific region
    (2026-01-01) Huang C.F.; Fang W.H.; Chen K.H.; Lin S.Y.; Ho C.J.; Hwang J.S.; Tai T.W.; Liu Y.F.; Shih C.A.; Chen J.F.; Tu S.T.; Chan D.C.; Yang R.S.; Fu S.H.; Chen H.Y.; Tsai K.S.; Cheng T.T.; Chen F.P.; Hung W.C.; Chang Y.F.; Han D.S.; Chandran M.; Bin A.S.; Lee J.K.; Yeap S.S.; Chung Y.S.; Kim K.K.; Ebeling P.R.; Jaisamrarn U.; Pandey D.; Ferrari S.; Yang T.H.; Charatcharoenwitthaya N.; Taguchi A.; Lekamwasam S.; Van Nguyen T.; Lewiecki E.M.; Saag K.G.; Tsai C.C.; Marín F.; Mori S.; Hwang K.R.; Li-Yu J.; Carey J.J.; Kendler D.; Cheung C.L.; Huang H.K.; Kuptniratsaikul V.; Chan W.P.; Chan S.P.; Ho-Pham L.T.; Hew F.L.; Shi H.; Rhee Y.; McCloskey E.; Tanaka S.; Hans D.; Kanis J.A.; Chen C.H.; Wu C.H.; Huang C.F.; Mahidol University
    Summary: Osteoporosis is a major and growing health concern in the Asia-Pacific region, y et it remains widely underdiagnosed and undertreated due to limited access to dual-energy X-ray absorptiometry (DXA) in many areas. Artificial intelligence (AI) offers new opportunities to improve osteoporosis screening and management, but unvalidated tools pose risks of inconsistent care. This consensus was developed to provide regionally harmonized guidance on the safe, effective, and equitable use of AI in osteoporosis care. Purpose: The aim of this work was to establish expert consensus recommendations on the role of AI in osteoporosis screening and management in the Asia-Pacific region. Key objectives were to define appropriate applications of AI (e.g., imaging-based bone assessment and fracture risk prediction) and specify minimum standards for validation and reporting, addressing region-specific implementation challenges and ensuring that AI use aligns with clinical guidelines and ethical principles. Methods: This consensus was developed through multidisciplinary collaboration among experts across the Asia-Pacific region. Each participant reviewed draft statements, contributed feedback during virtual meetings, and provided insights based on clinical experience and current evidence. Consensus was reached iteratively until full agreement was achieved for all statements. The process integrated global best practices and regional adaptations, drawing from peer-reviewed studies, international AI guidelines, and local fracture registry data. The final recommendations emphasize the validation, transparency, and ethical implementation of AI within regional healthcare systems, ensuring compatibility with local regulations. Ultimately, twelve consensus statements were established to guide the responsible use of AI for osteoporosis screening and management in the Asia-Pacific region. Results: The panel produced 12 consensus statements covering the role of AI as an adjunct for opportunistic osteoporosis screening rather than a diagnostic tool, requirements for imaging quality and AI model transparency, standards for validation and performance reporting, integration of AI with clinical risk stratification, demonstration of clinical utility in real-world settings, adherence to data protection laws and ethical AI principles, training of clinicians in AI use, strategies for implementation and monitoring (including post-market surveillance and feedback loops), and recognition of technical, clinical, and equity limitations of AI. All 12 statements give extensive recommendations for using AI to improve osteoporosis management while ensuring patient safety, accuracy, and equity. Conclusion: This first Asia-Pacific consensus on AI in osteoporosis concludes that AI, when appropriately validated and implemented, can help bridge the osteoporosis care gap by identifying high-risk patients who would otherwise remain undiagnosed, thus facilitating earlier intervention. It emphasizes that AI should complement—not replace—standard diagnostic methods and clinical judgment. The guidance emphasizes validation, transparency, and ethical oversight to facilitate early intervention while minimizing risks associated with unvalidated or premature AI adoption.