Skip to main content

Advertisement

SpringerLink
Log in

The burden of osteoporosis in Turkey: a scorecard and economic model

  • Original Article
  • Published:
Archives of Osteoporosis Aims and scope Submit manuscript

Abstract

Summary

The burden of osteoporosis in Turkey is not well characterized. Our results indicate that osteoporosis is undertreated in Turkey with 1.35 million fractures predicted to occur from 2019 to 2023 at an associated cost of 2.42 billion USD. Interventions are needed to close the treatment gap and minimize the economic burden.

Purpose

The number of osteoporotic fractures is expected to increase as populations age, posing a major risk to health systems and patients. We created a scorecard summarizing the burden of disease, policy framework, service provision, and service uptake for osteoporosis in Turkey and estimated the economic burden of osteoporotic fractures in Turkey.

Methods

A systematic review of osteoporosis in Turkey was performed. Gaps in the literature were supplemented by surveys with osteoporosis experts. The findings were used to populate a scorecard and burden of illness model focused on adults aged 50 to 89 years in Turkey. The scorecard provided a visual representation of osteoporosis burden and management using a traffic light color coding system. The model quantified osteoporosis-related fracture costs (2019 USD) including hospitalizations, dual-energy x-ray absorptiometry testing, hip fracture surgery, prescription drugs, and patient productivity losses.

Results

The scorecard showed that osteoporosis is undertreated in Turkey. Despite timely access to diagnosis, > 75% of high-risk patients fail to initiate on appropriate therapies. In 2019, the economic model predicted that 255,183 osteoporosis-related fractures would occur in Turkey with an associated annual cost of approximately 455 million USD and an average burden per 1000 at risk of 23,987 USD. The cumulative 5-year cost of 1,354,817 fractures was 2.42 billion USD.

Conclusions

Approximately 1.35 million fragility fractures are predicted to occur in Turkey during the next 5 years with costs of 2.42 billion USD. Closing the treatment gap will be imperative for preventing these fractures and minimizing the burden of osteoporosis in Turkey.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Alejandro P, Constantinescu F (2018) A review of osteoporosis in the older adult: an update. Rheum Dis Clin N Am 44(3):437–451

    Article  Google Scholar 

  2. Imerci A, Yalin KC, Aydogan NH, Karalezli MN, Savran A (2017) Fracture Risk Assessment Tool (FRAX) results calculated with and without bone mineral density values for the evaluation of fracture risk in postmenopausal women with osteopenia. J Clin Densitom 21(4):464–471

    Article  Google Scholar 

  3. Tuzun S, Eskiyurt N, Akarirmak U, Saridogan M, Senocak M, Johansson H, Kanis JA, Turkish Osteoporosis Society (2012) Incidence of hip fracture and prevalence of osteoporosis in Turkey: the FRACTURK study. Osteoporos Int 23(3):949–955

    Article  CAS  Google Scholar 

  4. Kuru P, Akyuz G, Cersit HP, Celenlioglu AE, Cumhur A, Biricik S, Kozan S, Goksen A, Ozdemir M, Luleci E (2014) Fracture history in osteoporosis: risk factors and its effect on quality of life. Balkan Med J 31(4):295–301

    Article  Google Scholar 

  5. Kilci O, Un C, Sacan O, Gamli M, Baskan S, Baydar M, Ozkurt B (2016) Postoperative mortality after hip fracture surgery: a 3 years follow up. PLoS One 11(10):e0162097

    Article  Google Scholar 

  6. International Osteoporosis Foundation (2011) The Middle East & Africa regional audit: epidemiology, Costs & Burden of Osteoporosis in 2011. https://www.iofbonehealth.org/sites/default/files/PDFs/Audit Middle East_Africa/ME_audit-executive_summary.pdf. Accessed 13 March 2019

  7. Elffors I, Allander E, Kanis JA, Gullberg B, Johnell O, Dequeker J, Dilsen G, Gennari C, Vaz AAL, Lyritis G, Mazzuoli GF, Miravet L, Passeri M, Cano RP, Rapado A, Ribot C (1994) The variable incidence of hip fracture in southern Europe: the MEDOS study. Osteoporos Int 4(5):253–263

    Article  CAS  Google Scholar 

  8. United Nations Population Division of the Department of Economic and Social Affairs (2017) World population ageing. https://www.un.org/en/development/desa/population/publications/pdf/ageing/WPA2017_Highlights.pdf. Accessed 24 April 2018

  9. Kanis JA, Borgström F, Compston J, Dreinhöfer K, Nolte E, Jonsson L, Lems WF, McCloskey EV, Rizzoli R, Stenmark J (2013) SCOPE: a scorecard for osteoporosis in Europe. Arch Osteoporos 8(1–2):144

    Article  CAS  Google Scholar 

  10. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535

    Article  Google Scholar 

  11. McGowan J, Sampson M, Salzwedel DM, Cogo E, Foerster V, Lefebvre C (2016) PRESS peer review of electronic search strategies: 2015 guideline statement. J Clin Epidemiol 75:40–46

    Article  Google Scholar 

  12. Aziziyeh R, Amin M, Habib M, Garcia Perlaza J, Szafranski K, McTavish RK, Disher T, Lüdke A, Cameron C (2019) The burden of osteoporosis in four Latin American countries: Brazil, Mexico, Colombia, and Argentina. J Med Econ 22(7):638–644

    Article  Google Scholar 

  13. Aziziyeh R, Amin M, Habib M, Perlaza JG, McTavish RK, Ludke A, Fernandes S, Sripada K, Cameron C (2019) A scorecard for osteoporosis in four Latin American countries: Brazil, Mexico, Colombia, and Argentina. Arch Osteoporos 14(1):69

    Article  Google Scholar 

  14. Canadian Agency for Drugs and Technologies in Health (CADTH) Grey Matters: a practical tool for searching health-related grey literature. https://www.cadth.ca/resources/finding-evidence/grey-matters. Accessed March 13, 2019

  15. International Osteoporosis Foundation (2012) SCORECARD Questionnaire. https://www.iofbonehealth.org/sites/default/files/PDFs/SCOPE/SCOPE_questionnaire_template.pdf. Accessed 24 August 2018

  16. Kaltenthaler E, Tappende P, Paisley S, Squires H (2011) NICE DSU technical support document 13: identifying and reviewing evidence to inform the conceptualisation and population of cost-effectiveness models. http://nicedsu.org.uk/wp-content/uploads/2016/03/TSD-13-model-parameters.pdf. Accessed 8 January 2019

  17. Kanis JA, Odén A, McCloskey EV, Johansson H, Wahl DA, Cooper C, on behalf of the IOF Working Group on Epidemiology and Quality of Life (2012) A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int 23(9):2239–2256

    Article  CAS  Google Scholar 

  18. Centre for Metabolic Bone Diseases University of Sheffield (2018) FRAX: Fracture Risk Assessment Tool. https://www.sheffield.ac.uk/FRAX/. Accessed 13 March 2018

  19. International Osteoporosis Foundation (2017) National Societies. https://www.iofbonehealth.org/societies-country-index-view/all. Accessed 13 March 2019

  20. Tuzun S, Eskiyurt N, Akarirmak U, Saridogan M, Johansson H, McCloskey E, Kanis JA, Turkish Osteoporosis Society (2012) The impact of a FRAX-based intervention threshold in Turkey: the FRAX-TURK study. Arch Osteoporos 7:229–235

    Article  Google Scholar 

  21. International Osteoporosis Foundation (2019) Capture the Fracture: Map of Best Practice https://www.capturethefracture.org/map-of-best-practice. Accessed 6 May 2019

  22. Kanis JA, Johansson H, Oden A, Cooper C, McCloskey EV (2014) Worldwide uptake of FRAX. Arch Osteoporos 9:166

    Article  CAS  Google Scholar 

  23. Organisation for Economic Co-operation and Development (2019) Inflation (CPI). https://data.oecd.org/price/inflation-cpi.htm. Accessed 13 March 2019

  24. Organisation for Economic Co-operation and Development (2019) Currency exchange rates. https://stats.oecd.org/. Accessed 10 May 2019

  25. Sullivan SD, Mauskopf JA, Augustovski F, Jaime Caro J, Lee KM, Minchin M, Orlewska E, Penna P, Rodriguez Barrios JM, Shau WY (2014) Budget impact analysis-principles of good practice: report of the ISPOR 2012 Budget Impact Analysis Good Practice II Task Force. Value Health 17(1):5–14

    Article  Google Scholar 

  26. Kanis JA, Oden A, Johnell O, Jonsson B, de Laet C, Dawson A (2001) The burden of osteoporotic fractures: a method for setting intervention thresholds. Osteoporos Int 12(5):417–427

    Article  CAS  Google Scholar 

  27. Jaller-Raad JJ, Jaller-Char JJ, Lechuga-Ortiz JA, Navarro-Lechuga E, Johansson H, Kanis JA (2013) Incidence of hip fracture in Barranquilla, Colombia, and the development of a Colombian FRAX model. Calcif Tissue Int 93(1):15–22

    Article  CAS  Google Scholar 

  28. Zerbini CA, Szejnfeld VL, Abergaria BH, McCloskey EV, Johansson H, Kanis JA (2015) Incidence of hip fracture in Brazil and the development of a FRAX model. Arch Osteoporos 10:224

    Article  CAS  Google Scholar 

  29. United Nations Population Division of the Department of Economic and Social Affairs (2017) World population prospects: the 2017 revision. https://esa.un.org/unpd/wpp/. Accessed 13 March 2019

  30. Hepguler S, Cetin A, Deger C, Erkent U (2011) Osteoporotic hip fracture costs in the elderly Turkish population. Acta Orthop Traumatol Turc 45(5):316–325

    PubMed  Google Scholar 

  31. Joestl J, Lang N, Bukaty A, Tiefenboeck TM, Platzer P (2017) Osteoporosis associated vertebral fractures—health economic implications. PLoS One 12(5):e0178209

    Article  Google Scholar 

  32. World Health Organization (2008) Country-specific unit costs. http://www.who.int/choice/country/country_specific/en/. Accessed 29 March 2018

  33. Tanriover MD, Oz SG, Tanriover A, Kilicarslan A, Turkmen E, Guven GS, Saracbasi O, Tokgozoglu M, Sozen T (2010) Hip fractures in a developing country: osteoporosis frequency, predisposing factors and treatment costs. Arch Gerontol Geriatr 50(3):e13–e18

    Article  Google Scholar 

  34. Turktas H, Bavbek S, Sekerel B, Oksuz E, Malhan S (2018) Economic burden of adult asthma in Turkey: a cost of illness study from payer perspective. J Respir Med 2(1):1–6

    Google Scholar 

  35. Turkish Statistical Institute (2018) Central dissemination system—labour force statistics. https://biruni.tuik.gov.tr/medas/?kn=72&locale=en. Accessed 15 April 2019

  36. Turkish Statistical Institute (2015) Structure of Earnings Survey, 2014. http://www.turkstat.gov.tr/PreHaberBultenleri.do?id=18861. Accessed 28 August 2018

  37. Tarride JE, Hopkins RB, Leslie WD, Morin S, Adachi JD, Papaioannou A, Bessette L, Brown JP, Goeree R (2012) The burden of illness of osteoporosis in Canada. Osteoporos Int 23(11):2591–2600

    Article  Google Scholar 

  38. Pincus D, Ravi B, Wasserstein D, Huang A, Paterson JM, Nathens AB, Kreder HJ, Jenkinson RJ, Wodchis WP (2017) Association between wait time and 30-day mortality in adults undergoing hip fracture surgery. JAMA 318(20):1994–2003

    Article  Google Scholar 

  39. Kutsal YG, Atalay A, Arslan S, Basaran A, Canturk F, Cindas A, Eryavuz M, Irdesel J, Karadavut KI, Kirazli Y, Sindel D, Senel K, Guler-Uysal F, Yildirim K (2005) Awareness of osteoporotic patients. Osteoporos Int 16(2):128–133

    Article  Google Scholar 

  40. Keskin Y, Cekin MD, Gunduz H, Luleci NE, Giray E, Sur H, Akyuz G (2014) The prevalence of osteoporosis in the Thrace region of Turkey: a community-based study. Turk J Phys Med Rehab 60(4):335–340

    Article  Google Scholar 

Download references

Acknowledgments

We wish to thank the information specialists who conducted our searches for the systematic review. We would also like to thank Ana Lüdke for helping to coordinate the early stages of our study as well as Kirk Szafranski and Tim Disher for their work in building the economic model.

Funding

This study was funded by Amgen Inc.

Author information

Authors and Affiliations

  1. Amgen Inc., 6775 Financial Dr #100, Mississauga, ON, L5N 0A4, Canada

    Rima Aziziyeh

  2. Amgen Inc., Thousand Oaks, CA, USA

    Javier Garcia Perlaza & Najma Saleem

  3. Medical Faculty, Ege University, Bornova, İzmir, Turkey

    Yeşim Kirazlı

  4. Medical Faculty, Dokuz Eylül University, Balçova, İzmir, Turkey

    Elif Akalın

  5. EVERSANA, Burlington, ON, Canada

    Rebecca K. McTavish, Corinne Duperrouzel & Chris Cameron

Authors
  1. Rima Aziziyeh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Javier Garcia Perlaza
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Najma Saleem
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yeşim Kirazlı
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Elif Akalın
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rebecca K. McTavish
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Corinne Duperrouzel
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Chris Cameron
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

RA, JGP, NS, RKM, and CC were involved in the conception and design of the study. YK, EA, RKM, CD, and CC were involved in the analysis of data and all authors contributed to the interpretation of data. All authors participated in drafting of the paper and critical revisions for intellectual content. All authors approved the final version. All authors agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Rima Aziziyeh.

Ethics declarations

Conflicts of interest

EVERSANA received financial support from Amgen for the conduct of this study. RA, JGP, and NS are employees of Amgen. RKM and CD are employees of EVERSANA. CC is an employee and shareholder of EVERSANA. EVERSANA consults for various pharmaceutical, medical device, and biotech companies. YK and EA declare that they have no conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(DOCX 84 kb).

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Aziziyeh, R., Garcia Perlaza, J., Saleem, N. et al. The burden of osteoporosis in Turkey: a scorecard and economic model. Arch Osteoporos 15, 128 (2020). https://doi.org/10.1007/s11657-020-00801-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s11657-020-00801-9

Keywords

Search

Navigation