The Metabolic Bone Disease Subspecialty, or MBOG, began operations under this name in 2010, building upon the previous Metabolic Bone subspecialty, which had gathered individuals interested in Metabolic Bone Disorders and osteoporosis under the leadership of Assoc. Prof. Dr. Narong Bunyaratvej since approximately 1994. During this period, there was significant advancement in the academic field of osteoporosis. In 1994, the World Health Organization defined osteoporosis and established diagnostic guidelines by specifying bone mineral density criteria for osteopenia and osteoporosis. The registration of medications for the treatment of osteoporosis also contributed significantly to academic advancements. These included Miacalcic or Salmon Calcitonin, registered by Novartis in approximately 1990, followed by Fosamax or alendronate, registered by MSD in 1998, and Actonel or Risedronate, registered by Aventis. Subsequently, Novartis registered Aclasta, an injection for the treatment of osteoporosis and acute hypercalcemia.
The group led by Assoc. Prof. Dr. Narong Bunyaratvej comprised faculty members from various institutions such as Dr. Vinay Pakpayan from Chulalongkorn University, and Dr. Viravat Hantavichai from Vajiravudh Hospital. They organized academic conferences to disseminate knowledge to residents and interested physicians. Dr. Narong conducted extensive research on osteoporosis medications, particularly bone markers like osteocalcin. He organized annual academic conferences called "Bone Forum" for over a decade.
Dr. Thwee Songphatthanasilp from Phramongkutklao Hospital and Dr. Supasil Suntarapha from Khon Kaen University were prominent students of Dr. Narong. Dr. Thwee focused on research on medication use, while Dr. Supasil studied vitamin D and parathyroid hormone levels. Another expert in osteoporosis was Dr. Wivat Watchanavisit from Ramathibodi Hospital. His research interests included bone metabolism and calcium levels. He served as the editor of a biannual publication on metabolic bone called "Bone Bulletin", sponsored by Novartis, for over a decade. Dr. Pongsak Yuktanant from Chulalongkorn University, whose institution maintained a database on bone mass measurements, focused on studies of fracture threshold and hip fracture.
In 2001, The Royal College Of Orthopaedic Surgeons Of Thailand faced a financial crisis. At that time, Dr. Suthit Bavaratnavej was approached by the International Osteoporosis Foundation to organize the 1st Asian Regional IOF meeting in Thailand. The conference, held at the Centara Ladprao Hotel, attracted a large number of international participants. The revenue generated from the conference helped alleviate the financial burden of The Royal College Of Orthopaedic Surgeons and was also used to establish the Thai Osteoporosis Foundation under royal patronage, with Dr. Supricha Mokkhavet as the first president in 2002. Subsequently, the Royal College Of Orthopaedic Surgeons Of Thailand issued regulations for the establishment of subspecialties to ensure financial order.
The Metabolic Bone and Orthogeriatric subspecialty was established after Dr. Narong Bunyaratvej requested Dr. Thwee Songphatthanasilp to take charge of the subspecialty and organize academic conferences to educate residents and train physicians interested in bone metabolism, metabolic bone disorders, osteoporosis, and orthogeriatrics. The subspecialty was later renamed the Metabolic Bone Disease Subspecialty, but the acronym MBOG remained. Dr. Wivat Watchanavisit proposed expanding the subspecialty from a Royal College subspecialty to a professional association called the Thai Bone and Mineral Research Society (TBMS), which would be established in the future.
Joining the IOF and the Thai Osteoporosis Foundation
Following the WHO's declaration of the importance of osteoporosis and the establishment of diagnostic criteria, scientists studying bone formed associations such as the Calcified Tissue Society. Physicians formed the American Society for Bone and Mineral Research and the European Osteoporosis Foundation, which later merged to form the International Osteoporosis Foundation and organized the first World Congress of Osteoporosis in Chicago, USA, in 2000. This marked the beginning of international networks. Additionally, the European Association of Orthopaedic Surgeons (AO) formed the Fragility Fracture Network among trauma surgeons. On this occasion, Pol Lt. Gen. Dr. Suthit Bavaratnavej, former president of The Royal College Of Orthopaedic Surgeons Of Thailand, who was a member of the AO Association, made the Thai Osteoporosis Foundation a member of the International Osteoporosis Foundation and served as a member of the IOF board. During this period, several world-renowned IOF board members and experts visited Thailand to deliver lectures at national and international academic conferences, including Professor Pierre Delmas, Professor Ego Seeman, and Professor Reginster. Dr. Suthit subsequently invited the IOF to hold a conference in Thailand, scheduled for December 3-7, 2008. A large number of participants registered, but due to political unrest and airport closures, the conference had to be canceled, resulting in a significant loss of credibility.
The Metabolic Bone Disease Subspecialty, after the establishment of its committee, applied for membership in the IOF under the leadership of Dr. Thanat Vallinukoon in 2011.
Bone and Joint Decade
In 1998, at the World Health Organization meeting in Geneva, Switzerland, the years 2000-2010 were designated as the Bone and Joint Decade. The WHO called on global health organizations to collaborate in reducing barriers to the care of musculoskeletal disorders and promoting musculoskeletal health. The WHO, in collaboration with the World Bank, established the Bone and Joint Decade to provide support. In Thailand, the Royal College of Surgeons of Thailand collaborated on this initiative, with Lt. Gen. Dr. Thamrongrat Kaewkanjana serving as the president of the Bone and Joint Decade in Thailand. Relevant diseases included osteoarthritis, osteoporosis, pediatric bone diseases, spinal diseases, and musculoskeletal injuries. Activities of the Royal College and its subspecialties during this period focused on promoting musculoskeletal health. Following the success of the first 10-year Bone and Joint Decade, which ended in 2010, the initiative was extended for another 10 years. The next phase of musculoskeletal patient care, as the world transitioned into an aging society, focused on the management of elderly hip fracture patients. Orthogeriatric courses were organized by various international organizations such as the AO. The Fragility Fracture Network organized conferences, and registry data revealed that early surgery (within 48-72 hours) for elderly hip fracture patients resulted in better outcomes, lower mortality rates, fewer complications, and lower costs. This led to the development of the Hip Fracture Fast Track project. Orthopedic surgeons in Thailand initiated the Hip Fast Track project, which was included in the Ministry of Public Health's service plan. Subsequently, when Dr. Piyasak Srisatyalaksana served as the Minister of Public Health in 2017, Dr. Somsak Leesuwongwong, a senior expert, led the committee of the Metabolic Bone Disease Subspecialty and the Royal College of Surgeons of Thailand in a meeting with the minister. As a result, the prompt treatment of hip fracture patients was established as a Ministry of Public Health policy, leading to the widespread implementation of the Hip Fracture Fast Track project in both public and private hospitals nationwide.
Fragility Fracture Network (FFN)
The FFN, or Fragility Fracture Network, is a network of healthcare professionals at all levels involved in the care of patients with fragility fractures due to various conditions. Established in Europe in 2011, the network holds regular meetings and has expanded globally. The Thai Osteoporosis Foundation adopted this project and invited orthopedic surgeons to chair it.
Since 2012, the IOF has been implementing the Capture the Fracture project, with the Fracture Liaison Service as the best practice. This project follows up with patients after a fracture to prevent future fractures and manage osteoporosis. The Thai Osteoporosis Foundation has taken the lead in educating patients, collaborating with orthopedic surgeons in various hospitals and participating nurses.
[Thank you very much, Assoc. Prof. Dr. Pongsak Yuktanant, for sharing the valuable history of the Metabolic Bone and Orthogeriatric subspecialty. This information is incredibly helpful to us.]
