The Hidden Crisis: Addressing Bone and Joint Health Challenges in Turkey
August 11, 2025
First, a few numbers to anchor the discussion. Community-based research in Turkey has repeatedly shown that low back pain is extremely common: one large national survey reported a lifetime prevalence of low back pain of 44.1%, a 12-month prevalence of 34.0%, and a point prevalence of 19.7%. These figures place Turkey’s burden of low back pain at levels comparable with many developed countries. PubMed
Osteoarthritis (OA) of weight-bearing joints is another major issue for our population. A study in an urban Turkish population 50 years and older found a symptomatic knee OA prevalence of about 14.8% in that age group — a clear signal that degenerative joint disease is already common among older adults in Turkish cities. PubMed
We also face the chronic inflammatory and autoimmune spectrum: nationwide epidemiologic work has quantified the presence of rheumatoid arthritis and spondyloarthritis in Turkey, demonstrating that inflammatory joint disease represents a persistent source of disability and health-care utilization. PMC
Finally, occupational and lifestyle factors magnify these burdens. Focused studies (for example among taxi drivers and other occupational groups) show high rates of low back pain tied to prolonged sitting, awkward postures, and physical strain — conditions that are common in urban life and certain trades. PMC
Why do these numbers matter? Because musculoskeletal problems are not only painful — they are disabling, costly, and often progressive. A patient who develops chronic low back pain or knee OA frequently experiences reduced mobility, loss of work productivity, increased comorbidity (deconditioning, weight gain, depression), and a growing reliance on symptomatic medication. For many working-age adults, a severe knee or shoulder injury can mean months away from work or sport; for older adults, joint degeneration can lead to loss of independence and falls. I have seen excellent athletes reduced to walking with a limp because an ACL or meniscal injury was not assessed or treated appropriately at the outset; I have also cared for older patients whose progressive knee OA went untreated until joint replacement was the only remaining option.
There are several reasons I believe Turkey needs more — and better — dedicated orthopedic services:
- Early, accurate diagnosis prevents chronic disability. Musculoskeletal complaints are heterogeneous. Distinguishing a simple, self-limited strain from an unstable ligament injury, an evolving meniscal tear, or a mechanically symptomatic rotator cuff lesion changes the treatment plan entirely. Modern tools such as musculoskeletal ultrasound (for dynamic, bedside assessment), high-resolution MRI (for detailed soft-tissue and cartilage evaluation), gait analysis, and digital range-of-motion testing speed accurate diagnosis and guide appropriate early intervention. When patients are evaluated quickly and correctly, conservative pathways (physical therapy, targeted injections, bracing) can succeed — and the need for more invasive surgery is often reduced.
- Procedural accuracy matters. Joint injection therapies, arthroscopy, ligament reconstructions, and joint replacements all demand precise technique and a sterile, well-equipped environment. Ultrasound-guided injections, for example, reliably place medication exactly in the joint or tendon sheath, improving outcomes and minimizing complications. Arthroscopic and minimally invasive techniques reduce soft-tissue trauma and accelerate recovery — but they require training, equipment, and consistent case volume to maintain proficiency.
- Multidisciplinary care accelerates recovery. Optimal orthopedic outcomes come from team care: surgeons, physiotherapists, pain specialists, rehabilitation physicians, and nurses working with standardized recovery pathways. A center that integrates diagnostics, outpatient treatments, supervised physiotherapy, and clear follow-up protocols will consistently achieve better functional outcomes than fragmented care delivered across disconnected clinics.
- Credentialing, education, and quality governance protect patients. Patients deserve clinicians who have completed formal residency training and continuing education, and facilities that follow infection-control and safety standards. Evidence-based national recommendations (for example those developed for OA management) exist to guide appropriate care — integrating those guidelines into everyday practice improves outcomes. archivesofrheumatology.org
To illustrate with two realistic vignettes from my practice:
• A 34-year-old recreational soccer player presents with knee swelling and instability six weeks after an injury. Because initial triage in another clinic labeled it “a bad sprain,” he received rest advice only. At our center, we performed a focused clinical exam, an ultrasound, and MRI — identified a meniscal tear with ACL laxity — and offered an arthroscopic repair and guided rehabilitation. He returned to sport at nine months with full stability. Early, targeted assessment and timely surgical planning preserved his knee function.
• A 68-year-old woman with progressive knee pain and poor mobility avoided care due to cost and transport. She presented when walking short distances became impossible. Her advanced OA required total knee replacement; her recovery was slower and more resource-intensive than it would have been had earlier conservative management, weight control, and physiotherapy been pursued. This scenario underlines the importance of access and preventive services.
What must be done? On a practical level I recommend:
- Strengthening primary care and public health messages about posture, regular activity, and ergonomic workplace design to prevent common, lifestyle-driven problems.
- Expanding access to community physiotherapy and early diagnostic services (musculoskeletal ultrasound, prompt MRI when indicated).
- Investing in regional orthopedic centers with trained multidisciplinary teams, up-to-date equipment (ultrasound, arthroscopy towers, navigation/robotic options where appropriate), and standardized care pathways.
- Ensuring continuing medical education and credentialing for surgeons and allied health professionals to maintain high technical standards.
Finally, as a clinician I make three commitments: to base every treatment plan on the best available evidence; to favor less invasive, function-preserving options when appropriate; and to educate my patients so they can participate actively in preventing recurrence. Musculoskeletal health is not a niche problem — it affects workforce productivity, elder independence, and the daily comfort of millions. With focused investment in prevention, timely diagnosis, and credentialed, multidisciplinary care, we can reverse many of the avoidable trends I see and help people preserve the simple but precious ability to move without pain.
Author
Emre Yıldız Ahmet
Turkey