Öz
Amaç
Bu çalışmada; 1990-2023 döneminde düşük kemik mineral yoğunluğuna atfedilen düşme kaynaklı yaşa standardize ve cinsiyete özel ölüm ve engelliliğe ayarlanmış yaşam yılı (DALY) hızlarının küresel ölçekte, sosyo-demografik indeks (SDI) gruplarında ve Türkiye özelinde zaman içindeki eğilimlerinin incelenmesi amaçlanmıştır.
Gereç ve Yöntem
Ekolojik zaman serisi desenindeki bu çalışmanın verileri global burden of disease study 2023’ten elde edildi. Otuz dört yıllık süreçteki yaşa standardize ve cinsiyete özel mortalite ve DALY hızları (yüz bin kişide) analiz edildi. Tanımlayıcı analizler JASP (versiyon 0.96.0.0) ile gerçekleştirildi ve trend Joinpoint regresyon modeli ile incelendi (p<0,05).
Bulgular
1990-2023 arasında küresel yaşa standardize ortalama mortalite hızı erkeklerde, DALY hızı ise kadınlarda daha yüksek bulundu. Otuz dört yıllık süreçte küresel mortalite hızları erkeklerde artış gösterirken, kadınlarda sabit kaldı. Düşük, düşük-orta ve yüksek-orta SDI gruplarında mortalite hızları azalırken, orta grupta sabit kaldı ve yüksek SDI grubunda artış gözlendi. Küresel mortalite hızı erkeklerde artarken, Türkiye verileri küresel trendden ayrılarak her iki cinsiyette de azalma sergiledi. Türkiye’de genel DALY hızı trendi sabit iken, son yıllarda erkeklerde artış, kadınlarda azalma gözlendi.
Sonuç
Bu çalışma, yüksek SDI grubunda artan mortalite hızına karşın, Türkiye’nin mortaliteyi azaltarak trendden pozitif yönde ayrıştığını göstermiştir. Ancak Türkiye’de azalan mortalite hızlarına rağmen, son dönemde erkeklerde artan hastalık yükü (DALY hızı), sağkalım başarısının sağlıklı yaşam süresine tam yansımadığını ortaya koymaktadır.
Anahtar Kelimeler:
Osteoporoz, düşük kemik mineral yoğunluğu, düşmeler, ölüm, engelliliğe ayarlanmış yaşam yılları, küresel hastalık yükü
Kaynaklar
1
World Health Organization (WHO). Fact sheet- Ageing and health [Internet]. Geneva: WHO; 2025 Oct 1 [cited 2025 Dec 3]. Available from: https://www.who.int/news-room/fact-sheets/detail/ageing-and-health
2
Liu M, Rong J, An X, Li Y, Min Y, Yuan G, et al. Global, regional, and national burden of musculoskeletal disorders, 1990-2021: an analysis of the global burden of disease study 2021 and forecast to 2035. Front Public Health. 2025;13:1562701.
3
Morin SN, Leslie WD, Schousboe JT. Osteoporosis: a review. JAMA. 2025;334:894-907.
4
Xiao PL, Cui AY, Hsu CJ, Peng R, Jiang N, Xu XH, et al. Global, regional prevalence, and risk factors of osteoporosis according to the World Health Organization diagnostic criteria: a systematic review and meta-analysis. Osteoporos Int. 2022;33:2137-53.
5
Salari N, Darvishi N, Bartina Y, Larti M, Kiaei A, Hemmati M, et al. Global prevalence of osteoporosis among the world older adults: a comprehensive systematic review and meta-analysis. J Orthop Surg Res. 2021;16:669.
6
Hoong CWS, Saul D, Khosla S, Sfeir JG. Advances in the management of osteoporosis. BMJ. 2025;390:e081250.
7
Kutsal FY, Ergin Ergani GO. Vertebral compression fractures: still an unpredictable aspect of osteoporosis. Turk J Med Sci. 2021;51:393-9.
8
Rashki Kemmak A, Rezapour A, Jahangiri R, Nikjoo S, Farabi H, Soleimanpour S. Economic burden of osteoporosis in the world: a systematic review. Med J Islam Repub Iran. 2020;34:154.
9
Pai MV. Osteoporosis prevention and management. J Obstet Gynaecol India. 2017;67:237-42.
10
Becheva M, Taneva D. Prevention and treatment of osteoporosis. Pharmacia. 2020;67:181-5.
11
Institute for Health Metrics and Evaluation (IHME). GBD results [Internet]. Seattle (WA): IHME, University of Washington; 2025 [cited 2025 Jul 15]. Available from: https://vizhub.healthdata.org/gbd-results/
12
GBD 2023 Disease and Injury and Risk Factor Collaborators. Burden of 375 diseases and injuries, risk-attributable burden of 88 risk factors, and healthy life expectancy in 204 countries and territories, including 660 subnational locations, 1990-2023: a systematic analysis for the global burden of disease study 2023. Lancet. 2025;406:1873-922.
13
Bhutta ZA. Global burden of disease 2023: challenges and opportunities for a growing collaboration. PLoS Med. 2025;22:e1004838.
14
Porta M, Greenland S, Hernán M, dos Santos Silva I, Last JM, editors. A dictionary of epidemiology. 6th ed. New York: Oxford University Press; 2014.
15
Global Burden of Disease Collaborative Network. Global burden of disease study 2023 (GBD 2023) socio-demographic index (SDI) 1950-2023 [Internet]. Seattle (WA): Institute for Health Metrics and Evaluation (IHME); 2025 [cited 2025 Jul 20]. Available from: https://ghdx.healthdata.org/record/gbd-2023-socio-demographic-index-sdi
16
Tang CE, Liu HT, Kuo PJ, Chen YC, Hsu SY, Lin CC, et al. Impact of sexual dimorphism on trauma patterns and clinical outcomes of patients with a high-risk score of the osteoporosis self-assessment tool for Asians: a propensity score-matched analysis. Int J Environ Res Public Health. 2018;15:418.
17
Gupta A, Cha T, Schwab J, Fogel H, Tobert D, Cho S, et al. Males have higher rates of peri-operative mortality following surgery for osteoporotic vertebral compression fracture. Osteoporos Int. 2021;32:699-704.
18
Zhang YY, Xie N, Sun XD, Nice EC, Liou YC, Huang C, et al. Insights and implications of sexual dimorphism in osteoporosis. Bone Res. 2024;12:8.
19
Guggenbuhl P. Osteoporosis in males and females: is there really a difference? Joint Bone Spine. 2009;76:595-601.
20
Mun SH, Jastrzebski S, Kalinowski J, Zeng S, Oh B, Bae S, et al. Sexual dimorphism in differentiating osteoclast precursors demonstrates enhanced inflammatory pathway activation in female cells. J Bone Miner Res. 2021;36:1104-16.
21
Almeida M, Laurent MR, Dubois V, Claessens F, O’Brien CA, Bouillon R, et al. Estrogens and androgens in skeletal physiology and pathophysiology. Physiol Rev. 2017;97:135-87.
22
Alswat K, Adler SM. Gender differences in osteoporosis screening: retrospective analysis. Arch Osteoporos. 2012;7:311-3.
23
Ramachandran S, Williams SA, Weiss RJ, Wang Y, Zhang Y, Nsiah I, et al. Gender disparities in osteoporosis screening and management among older adults. Adv Ther. 2021;38:3872-87.
24
Jehu DA, Davis JC, Barha CK, Vesely K, Cheung W, Ghag C, et al. Sex differences in subsequent falls and falls risk: a prospective cohort study in older adults. Gerontology. 2022;68:272-9.
25
Duckham RL, Procter-Gray E, Hannan MT, Leveille SG, Lipsitz LA, Li W. Sex differences in circumstances and consequences of outdoor and indoor falls in older adults in the MOBILIZE Boston cohort study. BMC Geriatr. 2013;13:133.
26
Reidy DE, Brookmeyer KA, Gentile B, Berke DS, Zeichner A. Gender role discrepancy stress, high-risk sexual behavior, and sexually transmitted disease. Arch Sex Behav. 2016;45:459-65.
27
Granié M, Thévenet C, Varet F, Evennou M, Oulid-Azouz N, Lyon C, et al. Effect of culture on gender differences in risky driver behavior through comparative analysis of 32 countries. Transp Res Rec. 2020;2675:274-87.
28
GBD 2021 Low Bone Mineral Density Collaborators. The global, regional, and national burden attributable to low bone mineral density, 1990-2020: an analysis of a modifiable risk factor from the global burden of disease study 2021. Lancet Rheumatol. 2025;7:e873-94.
29
Gao X, Song R, Park M, Li Y, Lyu L, Oh E, et al. The association of frailty and mortality in older adults: a systematic review and meta-analysis of cohort study. Innov Aging. 2023;7:868-9.
30
Chen KW, Chang SF, Lin PL. Frailty as a predictor of future fracture in older adults: a systematic review and meta-analysis. Worldviews Evid Based Nurs. 2017;14:282-93.
31
Ensrud KE, Ewing SK, Taylor BC, Fink HA, Stone KL, Cauley JA, et al. Frailty and risk of falls, fracture, and mortality in older women: the study of osteoporotic fractures. J Gerontol A Biol Sci Med Sci. 2007;62:744-51.
32
Omran AR. The epidemiologic transition: a theory of the epidemiology of population change. 1971. Milbank Q. 2005;83:731-57.
33
Olshansky SJ, Ault AB. The fourth stage of the epidemiologic transition: the age of delayed degenerative diseases. Milbank Q. 1986;64:355-91.
34
Aspray TJ, Hill TR. Osteoporosis and the ageing skeleton. Subcell Biochem. 2019;91:453-76.
35
Choi MH, Yang JH, Seo JS, Kim YJ, Kang SW. Prevalence and diagnosis experience of osteoporosis in postmenopausal women over 50: Focusing on socioeconomic factors. PLoS One. 2021;16:e0248020.
36
Park SB, Kim J, Jeong JH, Lee JK, Chin DK, Chung CK, et al. Prevalence and incidence of osteoporosis and osteoporotic vertebral fracture in Korea: nationwide epidemiological study focusing on differences in socioeconomic status. Spine. 2016;41:328-36.
37
Navarro MC, Sosa M, Saavedra P, Lainez P, Marrero M, Torres M, et al. Poverty is a risk factor for osteoporotic fractures. Osteoporos Int. 2009;20:393-8.
38
Martínez-Díaz-Guerra G, Hawkins Carranza F, Librizzi S. Socioeconomic status, osteoporosis and fragility fractures. Rev Esp Cir Ortop Traumatol. 2024;68:539-46.
39
Tariq S, Baig M, Tariq S, Shahzad M. Status of bone health and association of socio-demographic characteristics with bone mineral density in Pakistani females. Pak J Med Sci. 2019;35: 812-7.
40
Shen Y, Huang X, Wu J, Lin X, Zhou X, Zhu Z, et al. The global burden of osteoporosis, low bone mass, and its related fracture in 204 countries and territories, 1990-2019. Front Endocrinol (Lausanne). 2022;13:882241.
41
Harvey NC, Al-Daghri N, Beaudart C, Brandi ML, Burlet N, Campusano C, et al. Barriers and solutions for global access to osteoporosis management: a position paper from the International Osteoporosis Foundation. Osteoporos Int. 2025;36:1495-507.
42
Bahat G, Catikkas NM, Yavuz DG, Borman P, Guzel R, Reginster JY. The current situation in the approach to osteoporosis in older adults in Turkey: areas in need of improvement with a model for other populations. Arch Osteoporos. 2021;16:179.
43
Özkoç H, Erol S, Ergün A. Adult individuals applicable to the family health center knowledge and awareness about osteoporosis. Eur J Public Health. 2024;34:ckae144.1313.
