Orthogeriatrics: a vital requirement for improving fragility fracture patient care internationally with particular reference to Turkey

Abstract

Purpose Orthogeriatrics is a team approach that aims to provide adequate and timely intervention for individuals suffering from fragility fractures, particularly hip fractures. These patients are mostly the frailest older adults. The aim of orthogeriatrics is to re-gain functionality as early as possible and to decrease disability and mortality. Some developed countries have established orthogeriatric services, while many others, including Turkey, have so far not. Here, to identify areas for improvement, we outline the status of the orthogeriatrics in older adults in Turkey. Methods We present clear calls for action, emphasizing possible and noteworthy areas for improvement. Results Our proposals include the need for an easily applied, short version of comprehensive geriatric assessment; appropriate laboratory testing on admission; paracetamol with a special emphasis in its dosings and clues for state-of-the-art analgesic management; the essential need to introduce oral nutritional supplementation, irrespective of nutritional status; the need for vitamin D commencement, in almost all patients; and starting osteoporosis treatment in fracture hospitalization, whenever appropriate. Last but not least, the ever-increasing prerequisite to establish "fracture liaison services" is stipulated. Conclusion We suggest that our recommendations offer great potential in Turkey, for the improvement of frail fracture patients' care. We call the other countries that do not have established orthogeriatric lines to model our approach to improve the management of fracture patients globally. Keywords Orthogeriatrics • Improve • Care • Fragility fracture • Turkey Abbreviations ACS Acute coronary syndromes BCIS Bone cement implantation syndrome CGA Comprehensive geriatric assessment CKD Chronic kidney disease COPD Chronic obstructive pulmonary disease CRP C-reactive protein ECG Electrocardiogram FFFAP Falls and Fragility Fracture Audit Programme FIC Fascia iliaca compartment FLS Fracture Liaison Service

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

“…While several developed countries have established orthogeriatric services to date, many others have not. Centers in Turkey that apply the orthogeriatric care concept are limited in number, with the first comprehensive orthogeriatric care concept in Turkey being established in our faculty -the Istanbul University Faculty of Medicine, followed by Istanbul Prof. Dr. Cemil Taşçıoğlu City Hospital [98]. Similar to FLS, the limited application of the orthogeriatric approach in Turkey can be linked to a lack of education, awareness, and resources and the limited number of geriatricians in the country [99].…”