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In 2019, Türkiye experienced 255,000 fragility fractures, imposing an economic burden of $455 million, including $347 million in hospital costs, $103 million in lost productivity, and $4 million in pharmaceutical expenses [6]. The Turkish Osteoporosis Society (TOS) should create a task force to develop these guidelines. Naranjo A, Prieto-Alhambra D, Sánchez-Martín J, Pérez-Mitru A, Brosa M (2022) Cost-effectiveness analysis of fracture liaison services compared with standard of care in the secondary prevention of fragility fractures in Spain.
Dear Editor;
Fracture liaison services (FLS) provide a standardized osteoporosis and fracture management model, systematically assessing, treating, and following up with patients [1]. FLS enhances health outcomes and reduces the financial strain on healthcare systems, making it a globally recognized model for decreasing fracture-related mortality and morbidity [2].
Countries with FLS report improved osteoporosis care. FLS resulted in a 30% increase in anti-osteoporotic treatment after fragility fractures and reduced the occurrence of secondary fractures in the UK [2]. Australia had fewer fracture recurrences and reduced healthcare costs [3]. In Canada, FLS led to a 20% reduction in second fractures and significant healthcare savings [4]. Spain’s program enabled 70% of fracture patients to begin osteoporosis treatment [5]. In Singapore, the OPTIMAL program has demonstrated the effectiveness of coordinated interventions in closing the care gap for fragility fractures [1]. These international examples underscore FLS’s potential to improve clinical outcomes and economic efficiency in healthcare systems [1, 2, 3, 4–5].
Türkiye’s osteoporosis management requires urgent action. In 2019, Türkiye experienced 255,000 fragility fractures, imposing an economic burden of $455 million, including $347 million in hospital costs, $103 million in lost productivity, and $4 million in pharmaceutical expenses [6]. Therefore, establishing a national osteoporotic fracture registry is essential, increasing awareness and screening and expanding the number of FLS centers [6, 7]. This letter aims to outline critical actions for addressing these challenges in Türkiye.
Introducing FLS in Türkiye is essential in osteoporosis management and secondary fracture prevention. However, several critical steps must be undertaken to ensure effective and sustainable implementation (Fig 1):
Establishing National Standards and Guidelines: National standards will ensure consistent FLS service delivery. The Turkish Osteoporosis Society (TOS) should create a task force to develop these guidelines.
Training Healthcare Professionals: Comprehensive training for both primary care providers and bone health specialists is crucial. National nonprofit organizations such as the TOS, the Society of Endocrinology and Metabolism, the Turkish Geriatrics Society, the Turkish Society of Orthopedics, and the Turkish Physical Medicine and Rehabilitation Society can collaborate on educational initiatives to ensure that healthcare professionals are equipped to implement FLS effectively [3].
Increasing Patient Participation: Patient education and engagement are fundamental to long-term osteoporosis management. Patient societies, in partnership with the Ministry of Health (TMH), should launch nationwide campaigns to enhance patient participation and treatment adherence [4].
Developing Sustainable Financing Models: Financial planning is essential for supporting FLS’s long-term success. Collaboration with healthcare providers to evaluate and create cost-effective models will be key to sustaining FLS programs, which can be facilitated by the TMH [1, 5].
Monitoring and Evaluating Outcomes: Ongoing assessment of FLS performance at national and regional levels will provide insights for continual improvement. The TMH can oversee these evaluations to ensure program effectiveness.
[See PDF for image]
Fig. 1
Steps to ensure effective and sustainable implementation of the FLS system in Türkiye. Icons: Flaticon.com
In conclusion, establishing FLS centers across Türkiye requires clear guidelines, comprehensive professional training, robust patient engagement, and sustainable financing (Fig. 1). Given Türkiye’s aging population, preventing secondary fractures is the key strategy in bone health. Implementing effective measures will not only improve osteoporosis care but also reduce fractures and alleviate the financial burden on the healthcare system.
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Conflict of interest
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References
1. Chandran, M; Tan, MZ; Cheen, M; Tan, SB; Leong, M; Lau, TC. Secondary prevention of osteoporotic fractures–an “OPTIMAL” model of care from Singapore. Osteoporos Int; 2013; 24, pp. 2809-2817. [DOI: https://dx.doi.org/10.1007/s00198-013-2368-8] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/23615816]
2. Mitchell, PJ. Fracture liaison services: the UK experience. Osteoporos Int; 2011; 22, pp. 487-494. [DOI: https://dx.doi.org/10.1007/s00198-011-1702-2] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/21847771]
3. Eisman, JA; Bogoch, ER; Dell, RM et al. Making the first fracture the last fracture: ASBMR task force report on secondary fracture prevention. J Bone Mineral Res; 2012; 27,
4. Jaglal, SB; Hawker, GA; Cameron, C et al. The Ontario Osteoporosis Strategy: implementation of a population-based osteoporosis action plan in Canada. Osteoporos Int; 2010; 21, pp. 903-908. [DOI: https://dx.doi.org/10.1007/s00198-010-1206-5] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/20309525][PubMedCentral: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5101075]
5. Naranjo A, Prieto-Alhambra D, Sánchez-Martín J, Pérez-Mitru A, Brosa M (2022) Cost-effectiveness analysis of fracture liaison services compared with standard of care in the secondary prevention of fragility fractures in Spain. Clinicoecon Outcomes Res 14:249–264. https://doi.org/10.2147/CEOR.S350790
6. Aziziyeh, R; Garcia Perlaza, J; Saleem, N et al. The burden of osteoporosis in Turkey: a scorecard and economic model. Arch Osteoporos; 2020; 15, 128. [DOI: https://dx.doi.org/10.1007/s11657-020-00801-9] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/32794017]
7. Kirazlı, Y; Atamaz Çalış, F; El, Ö et al. Updated approach for the management of osteoporosis in Turkey: a consensus report. Arch Osteoporos; 2020; 15, pp. 1-14. [DOI: https://dx.doi.org/10.1007/s11657-020-00799-0]
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