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The current situation in the approach to osteoporosis in older adults in Turkey: areas in need of improvement with a model for other populations

Primary Author(s)

Gulistan Bahat, MD

Prof.
Istanbul University, Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics

Contributing Author(s)

NC

Nezahat M. Catikkas, MD

Istanbul University, Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics
DG

Dilek Gogas Yavuz, MD

Marmara University, Marmara Medical School, Department of Internal Medicine, Division of Endocrinology and Metabolism
PB

Pinar Borman, MD

Hacettepe University, Hacettepe Medical School, Department of Physical Medicine and Rehabilitation
RG

Rengin Guzel, MD

Cukurova University, Cukurova Medical School, Department of Physical Medicine and Rehabilitation
MB

Meris E. Bozkurt, MD

Istanbul University, Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics
JR

Jean-Yves Reginster, MD

University of Liège, Liège Medical School, Department of Public Health, Epidemiology and Health Economics

Introduction: The total number of older adults in Turkey is striking, amounting to around 8 million, and this translates into considerably higher numbers of cases of osteoporosis (OP) and fractures in older adults.

Objectives: We aimed to outline the current situation of OP in older adults in Turkey and investigate the differences between Turkey and a representative developed European country (Belgium), in terms of the screening, diagnosis, and treatment of OP. Our intention in this regard was to identify areas in need of improvement and subsequently to make a clear call for action to address these issues.

Methods: Herein, considering the steps related to the OP approach, we made a complete review of the studies conducted in Turkey and compared with the literature recommendations.

Results: There is a need for a national osteoporotic fracture registry; measures should be taken to improve the screening and treatment of OP in older males, such as educational activities; technicians involved in dual-energy X-ray absorptiometry (DXA) scanning should undergo routine periodic training; all DXA centers should identify center-specific least significant change values; all older adults should be considered for routine lateral dorsolumbar X-ray imaging for the screening of vertebral fractures while ordering DXA scans; the inclusion of vertebral fracture assessment (VFA) software in DXA assessments should be considered; screening using a fracture risk assessment tool (FRAX) algorithm that is specific to Turkey should be integrated; the fortification of foods with vitamin D is required; the high fracture risk by country-specific FRAX algorithm and the presence of falls/high fall risk should be integrated in reimbursement terms; and finally, more "fracture liaison services" should be established.

Conclusions: We suggest that the practical consideration of our suggestions will provide considerable support to the efforts for combating with the adverse consequences of OP in society. This approach can be subsequently modeled for other populations to improve the management of OP globally.