In response to a rapidly aging population and the rising burden of fall-related injuries, Thailand has launched a National Model Initiative for Integrated Surveillance, Prevention, and Management of Falls, Hip Fractures, and Recurrent Fractures in its elderly population. The initiative aims to enhance the monitoring and prevention of fractures among older adults, leveraging technology and data-driven strategies.

Addressing a Growing Public Health Crisis

As of 2022, Thailand's elderly population (aged 60 and above) reached 12.1 million, comprising 18.3% of the total population. By 2028, this figure is expected to surge to 40%, heightening concerns over osteoporosis-related falls and fractures. Statistics indicate that individuals with osteoporosis are five times more likely to sustain fall-induced fractures than those without the condition. Alarmingly, falls account for over 90% of hip fractures, with recurrent fallers facing a fourfold increased risk.

The urgency of the issue is underscored by mortality rates, with 1,255 elderly individuals succumbing to fall-related injuries in 2022 alone. Recognizing the need for systemic intervention, Thailand’s Ministry of Public Health has prioritized the implementation of targeted strategies to identify, monitor, and mitigate fall-related risks.

National Model Initiative for Integrated Surveillance, Prevention, and Management of Falls, Hip Fractures, and Recurrent Fractures 

The pilot project, known as the "Nan Model," laid the groundwork for this initiative with the following dual objectives:

• Risk Stratification: Deployment of the Fracture Risk Assessment Tool (FRAX) via digital platforms, for scalable, cost-effective screening of high-risk elderly individuals – thus reducing the need for labor-intensive home assessments
• Comprehensive Risk Management: A centralized data system to enhance interagency coordination, and to enable real-time surveillance, personalized interventions, and longitudinal tracking of at-risk seniors within community settings.

The National Model Initiative for Integrated Surveillance, Prevention, and Management of Falls, Hip Fractures, and Recurrent Fractures in Thailand’s Elderly Population serves as a cornerstone of Thailand’s strategic response, institutionalizing systematic data aggregation, analysis, and dissemination to underpin evidence-based policymaking. This initiative aligns with the Ministry of Public Health’s mandate to reduce morbidity, mortality, and healthcare expenditures associated with hip fractures, particularly within the context of rapid population aging. By integrating technological innovations and data-driven frameworks championed by the Nan Model, the registry exemplifies Thailand’s commitment to advancing proactive, equitable, and sustainable healthcare solutions for its aging populace. This measure further supports national health security objectives, ensuring alignment with global best practices in geriatric care and injury prevention.

Challenges faced, Stakeholder Collaboration

Aligning diverse stakeholders before developing the registry was a significant challenge. The Thai Orthopedic Association and Siriraj Health Policy co-led a year-long effort to establish a national model for fall and fracture prevention in Thailand’s elderly population. Securing funding from the Health Promotion Fund (HPF) was a major hurdle, requiring alignment of multi-sectoral priorities and proof of long-term financial sustainability.

HPF played a crucial role by:

• Providing academic, policy, and public engagement support to ensure alignment with integrated health surveillance and prevention protocols.
• Facilitating interagency communication to enhance health monitoring, care coordination, and evidence-based interventions.

This collaboration highlights Thailand’s commitment to cross-sectoral healthcare solutions under the Universal Health Coverage (UHC) framework. The registry remains in development, with ongoing efforts to address implementation challenges.

Innovative Features, Success Stories and Long-term Outcomes 

The Initiative incorporates several innovative features and has demonstrated measurable success through its pilot initiatives. Key notable features of the registry include:

• Integrated Care Coordination: Advanced information systems provide personalized self-care guidelines and risk specific interventions for elderly individuals. It enables targeted home-based rehabilitation plans aligned with population needs.
• Holistic Risk Surveillance: The registry bridges gaps in Thailand’s existing data infrastructure by systematically capturing information on fall prevention, health promotion, and rehabilitation outcomes for hip fracture patients.
• Pilot Expansion Success: Implemented across 11 provinces and one district over two years, the project established a replicable framework for fall and fracture surveillance with five core objectives
  • Objective 1: Development of a screening system to diagnose and monitor osteoporosis patients at risk of falls/hip fractures.
  • Objective 2: Creation of a unified hip fracture patient registry to integrate treatment data across facilities, enable care coordination, and support home rehabilitation.
  • Objective 3: Identification of modifiable risk factors (e.g., environmental hazards, comorbidities) and evaluation of intervention efficacy.
  • Objective 4: Formulation of context-specific guidelines for nationwide scalability.
  • Objective 5: Analysis of economic impacts and fiscal burdens associated with hip fracture care. 

The "Nan Model" has emerged as a pioneering success, demonstrating the registry’s capacity to reduce fall-related morbidity and mortality while enhancing patient quality of life. By leveraging digital tools like FRAX, the project achieved:

• Efficient Resource Allocation: Elimination of labor-intensive door-to-door screenings through digital risk stratification, optimizing time and budgetary resources.
• Proactive Rehabilitation: Enhanced post-fracture care coordination reduced complications and recurrent fractures during home recovery.
• Policy Impact: Evidence generated from the registry informed national guidelines for fall prevention and geriatric care, aligning with Thailand’s Universal Health Coverage goals.

The initiative underscores the Ministry of Public Health’s commitment to advancing integrated, technology-enabled solutions for aging populations, ensuring alignment with global health security and sustainable development priorities.

Professor Thanut Valleenukul, MD, Executive Committee of the Royal College of Orthopaedic Surgeons of Thailand (RCOST), and Vice Chairman of the Thai Orthopaedics Association stated:

“The registry is projected to deliver long-term reductions in healthcare expenses, fewer cases of hip fractures, and lower mortality rates. By effectively coordinating data across all levels of healthcare and using evidence to guide policy decisions, it serves as a blueprint for equitable, adaptable elderly care systems in Thailand and other countries.”

Contributions and Roles of Key Collaborators

The development of Thailand’s National Hip Fracture Registry has been a collaborative endeavour involving the following stakeholders:  

Siriraj Health Policy (Faculty of Medicine, Siriraj Hospital, Mahidol University): Led research and system design - conducting comprehensive research and analysis; collaborating with multidisciplinary teams to establish protocols for monitoring elderly individuals at risk; deployed specialized personnel, tools and resources to facilitate the development of the registry.

Thai Orthopedic Association (TOA): Provided policy and operational coordination; clinical expertise and advisory support including clinical knowledge, data-driven insights and technical guidance on fall prevention, fracture management, and rehabilitation; led capacity training for healthcare professionals on registry use and patient care.

Royal College of Orthopedic Surgeons of Thailand (RCOST):  Facilitated cross-sectoral collaboration at policy, provincial and interagency levels to establish operational mechanisms for the registry’s national implementation; strengthened partnerships; coordinated training programs to equip healthcare professionals with specialized knowledge; promoted standardized protocols from monitoring.

Krungthai Bank Public Company Limited (KTB): Supported the adoption of advanced technologies and digital innovations to enhance health surveillance systems for elderly populations at risk of falls and fractures. Key contributions include the development of secure electronic platforms to integrate identity verification, health rights validation, and service accessibility via the bank’s digital channels; enabled Health Information System (HIS) Connectivity – i.e. data exchange between the registry and participating healthcare facilities, ensuring seamless integration of health data (e.g., patient records, treatment histories) across systems, while prioritizing data security and privacy; and collaborated with project stakeholders to expand system connectivity with external agencies, fostering a unified ecosystem for elderly care management.

Multi-sectoral partnerships

This multi-sectoral partnership exemplifies Thailand’s commitment to integrating academic rigor, clinical excellence, financial innovation, and policy advocacy. Together, these stakeholders have positioned the registry as a transformative model for addressing aging-related public health challenges, ensuring equitable, technology-driven care for elderly populations while aligning with national health security and sustainable development objectives.

Future Plans and Strategic Vision

The future of the National Model Initiative for Integrated Surveillance, Prevention, and Management of Falls, Hip Fractures, and Recurrent Fractures in Thailand’s elderly population will be driven by strategic collaborations with key stakeholders. The Thailand Center of Excellence for Life Sciences (TCELS) will focus on fostering innovation in health management for at-risk elderly populations emphasizing scalable commercial and societal applications and a robust innovation ecosystem to accelerate advancements in technologies, digital platforms, and preventive care services. Additionally, TCELS will provide academic advisory support to align initiatives with the registry’s objectives. The National Health Security Office (NHSO) will mobilize affiliated agencies to implement the registry’s health surveillance framework, integrating policies across policy, provincial and interagency levels. It will optimize the national health reimbursement data system to enhance fiscal efficiency and transparency in public health service delivery. Additionally, NHSO will embed collaborative outcomes into long-term policies to ensure equitable access and systemic resilience. It will also provide expertise in data governance, cybersecurity, and system interoperability to safeguard sensitive health information and streamline processing.

These partnerships will enhance the registry’s capabilities through technical sustainability, policy harmonization, and global benchmarking. By uniting academic, clinical, technological, and policy stakeholders, the project will become a sustainable, future-ready platform, reducing healthcare disparities and improving quality of life for its aging population, reinforcing the nation’s commitment to innovation and health security.

A Milestone in Elderly Healthcare Reform

This initiative aligns with Thailand’s 20-Year National Strategy (2018–2037) and the Second National Plan for the Elderly (2023–2027), reflecting the country’s commitment to proactive, technology-driven healthcare solutions for its aging population.

Through continued collaboration and innovation, a National Model Initiative for Integrated Surveillance, Prevention and Management of Falls, Hip Fractures, and Recurrent Fractures is set to play a transformative role in reducing fall-related morbidity and improving quality of life for its elderly citizens.