Division of Geriatrics, Department of Internal Medicine, Istanbul Medical School, Istanbul University, Capa, 34093, Istanbul, Turkey.
Division of Endocrinology and Metabolism, Department of Internal Medicine, Marmara Medical School, Marmara University, Istanbul, Turkey.
Arch Osteoporos. 2021 Nov 30;16(1):179. doi: 10.1007/s11657-021-01038-w.
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. In this article, we outlined the current situation of OP in older adults in Turkey and investigated 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.
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.
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.
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.
土耳其的老年人口数量庞大，达到了约 800 万，这意味着土耳其的骨质疏松症（OP）和老年人骨折病例数量相当高。本文概述了土耳其老年人群中 OP 的现状，并比较了土耳其和一个具有代表性的欧洲发达国家（比利时）在 OP 的筛查、诊断和治疗方面的差异。我们旨在确定需要改进的领域，并随后明确呼吁采取行动来解决这些问题。
在此，我们考虑了与 OP 方法相关的步骤，对土耳其进行的研究进行了全面审查，并与文献建议进行了比较。
需要建立一个全国性的骨质疏松性骨折登记处；应采取措施提高老年男性的 OP 筛查和治疗水平，如开展教育活动；参与双能 X 线吸收法（DXA）扫描的技术人员应定期接受常规培训；所有 DXA 中心都应确定特定于中心的最小有意义变化值；所有老年人在进行 DXA 扫描时都应考虑进行常规的侧位腰椎 X 射线成像以筛查椎体骨折；应考虑将椎体骨折评估（VFA）软件纳入 DXA 评估中；应考虑纳入针对土耳其的特定骨折风险评估工具（FRAX）算法进行筛查；需要强化食物中的维生素 D；应根据国家特定的 FRAX 算法确定的高骨折风险和存在跌倒/高跌倒风险纳入报销条件；最后，应建立更多的“骨折联络服务”。
我们建议，对我们建议的实际考虑将为社会对抗 OP 的不良后果提供有力支持。这种方法可以为其他人群建模，以改善全球 OP 的管理。
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