Specialty-based differences in osteoporosis management in Türkiye: a national cross-sectional survey

This study showed significant specialty-based differences in osteoporosis management in Türkiye. Physical medicine and rehabilitation (PM&R) physicians demonstrated the highest awareness, whereas orthopedic physicians demonstrated the lowest. Guideline use, rather than seniority, was associated with better awareness, supporting targeted education and wider fracture liaison services (FLS) implementation. PURPOSE: This study aimed to compare adherence to current guidelines, clinical approaches, and awareness levels among physicians in internal medicine (IM), PM&R, and orthopedics and traumatology who are actively involved in osteoporosis management in Türkiye. METHODS: A total of 447 physicians from across Türkiye were included (122 IM, 203 PM&R, and 122 orthopedic physicians). A questionnaire was used to evaluate approaches to diagnosis, treatment, and follow-up. An osteoporosis awareness score was calculated as the mean of guideline-based awareness items (Cronbach's α = 0.890). Data were analyzed using the chi-square test, Kruskal-Wallis test, and multivariable linear regression. RESULTS: Awareness scores differed significantly across specialties (p < 0.001). The median (IQR) score was highest in PM&R physicians at 4.00 (3.75-4.25), followed by IM physicians at 3.50 (3.00-4.00) and orthopedic physicians at 2.88 (2.00-3.50). Significant between-specialty differences were also observed in diagnostic evaluation, pre-treatment laboratory assessment, denosumab preference, planning of treatment transition after discontinuation, and follow-up strategies (all p < 0.05). In multivariable regression analysis, specialty (B = 0.782, p < 0.001) and active guideline use (B = 0.344, p < 0.001) were the strongest independent predictors of awareness score, whereas years of professional experience and academic title were not significant. CONCLUSION: Osteoporosis management in Türkiye differs substantially by specialty. Lower concordance with guideline-based care among orthopedics and traumatology physicians may contribute to the treatment gap. Guideline-oriented education should therefore be prioritized over professional seniority, and multidisciplinary FLS should be further expanded.