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Seiller J, Merle B, Fort R, Virot E, Poutrel S, Cannas G, Hot A, Chapurlat R. Prevalence of bone complications in young patients with sickle cell disease presenting low bone mineral density. Bone 2024; 178:116924. [PMID: 37783302 DOI: 10.1016/j.bone.2023.116924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/13/2023] [Accepted: 09/28/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE Bone fragility in sickle cell disease (SCD) has been previously reported even in young patients, but the clinical consequences and specific management remain unclear. The objective of this study was to assess the prevalence of bone fragility in sickle cell patients and to evaluate the potential risk factors and associated complications. METHODS We conducted a single-center cross-sectional study. Bone mineral densitometry (BMD) at the lumbar spine and the hip, Vertebral Fracture Assessment (VFA) and biological measurements were performed in patients aged between 20 and 40 years. RESULTS One hundred and thirty-eight patients with sickle cell disease were included between June 2020 and December 2021. One hundred and one patients (73.2 %) were from Sub-Saharan Africa, 13 from North Africa (9.4 %), 11 from the Caribbean (7.9 %), 6 from the Indian Ocean. A Z-score < -2 was found in 43 patients (31.2 %) at the lumbar spine, in 4 patients (3 %) at the total hip, and in 5 patients (3.7 %) at the femoral neck. 59 patients (46.8 %) had vertebral deformities. Fragility fractures were recorded in 9 patients (10.8 %). Patients with low BMD had lower BMI (21.3 (19.0, 24.0) versus 24.0 (20.7, 26.1) Kg/m2, p = 0.003), lower osteonecrosis history (7 % versus 25.3 %, p = 0.011) and lower hemoglobin levels (9.0 (8.0, 10.0) versus 10.0 (9.0, 11.0) g/dL, p < 0.01). No association was found between history of fracture and low BMD. CONCLUSION Young patients with SCD commonly have low BMD at the lumbar spine, but the prevalence of fragility fracture was low. Low BMD - specifically at the spine - may not be tantamount to bone fragility.
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Affiliation(s)
- Julien Seiller
- Service de Rhumatologie et Pathologies osseuses, Centre Hospitalier Universitaire Edouard Herriot, Hospices Civils de Lyon, Lyon, France.
| | | | - Romain Fort
- Service de Médecine Interne et Immunologie clinique, Centre Hospitalier Universitaire Edouard Herriot, Hospices Civils de Lyon, Lyon, France; Département d'Anesthésie Réanimation-Medecine Intensive, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Emilie Virot
- Service de Médecine Interne et Immunologie clinique, Centre Hospitalier Universitaire Edouard Herriot, Hospices Civils de Lyon, Lyon, France; Centre de Référence Constitutif Syndromes Drépanocytaires Majeurs, Thalassémies et Autres Pathologies Rares du Globule Rouge et de l'Erytropoïese, Lyon, France
| | - Solene Poutrel
- Service de Médecine Interne et Immunologie clinique, Centre Hospitalier Universitaire Edouard Herriot, Hospices Civils de Lyon, Lyon, France; Centre de Référence Constitutif Syndromes Drépanocytaires Majeurs, Thalassémies et Autres Pathologies Rares du Globule Rouge et de l'Erytropoïese, Lyon, France
| | - Giovanna Cannas
- Service de Médecine Interne et Immunologie clinique, Centre Hospitalier Universitaire Edouard Herriot, Hospices Civils de Lyon, Lyon, France; Centre de Référence Constitutif Syndromes Drépanocytaires Majeurs, Thalassémies et Autres Pathologies Rares du Globule Rouge et de l'Erytropoïese, Lyon, France
| | - Arnaud Hot
- Service de Médecine Interne et Immunologie clinique, Centre Hospitalier Universitaire Edouard Herriot, Hospices Civils de Lyon, Lyon, France; Centre de Référence Constitutif Syndromes Drépanocytaires Majeurs, Thalassémies et Autres Pathologies Rares du Globule Rouge et de l'Erytropoïese, Lyon, France
| | - Roland Chapurlat
- Service de Rhumatologie et Pathologies osseuses, Centre Hospitalier Universitaire Edouard Herriot, Hospices Civils de Lyon, Lyon, France; INSERM UMR1033, Université de Lyon, Lyon, France
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Adekunle MO, Dada AO, Njokanma FO, Solarin AU, Animasahun BA, Lamina MO. Comparative Effectiveness of a Six-Week Treatment Course of Vitamin D 2 and D 3 in Children With Sickle Cell Anemia in Steady State With Hypovitaminosis D: A Randomized Clinical Trial. J Hematol 2021; 10:114-122. [PMID: 34267848 PMCID: PMC8256915 DOI: 10.14740/jh817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 04/06/2021] [Indexed: 11/11/2022] Open
Abstract
Background Correction of vitamin D deficiency through administration of either vitamin D2 or D3 has been shown to reduce chronic bone pains and frequency of acute bone pains, increase bone density as well as improve growth stature in children with sickle cell anemia (SCA). Findings vary on the effectiveness of the two forms of the vitamin. The current study was carried out to compare the effectiveness of a 6-week treatment course of vitamin D2 and D3 in the correction of hypovitaminosis D (vitamin D insufficiency and deficiency) as well as evaluate treatment response to derangement of serum calcium and alkaline phosphatase (ALP) in children with SCA in steady state. Methods The study was a randomized, double-blind clinical trial of 174 children with SCA aged 1 - 18 years. Subjects with hypovitaminosis D (baseline serum 25-hydroxyvitamin D (25(OH)D) below 75 nmol/L) were randomized into two treatment arms. Each arm treated either of the two forms of vitamin D had a once weekly dose of 50,000 IU for a period of 6 weeks. Results Median rise in serum 25(OH)D after 6 weeks of oral vitamin D2 or D3 was similar between the two groups (median rise in 25(OH)D of 17.8 nmol/L in D2, 15.3 nmol/L in D3 groups). Also, there was no significant difference in the proportion of subjects that improved in their vitamin D status in both treatment arms (P = 0.409). Treatment was significantly associated with increase in proportion of subjects with normal serum calcium (P ≤ 0.001) and decrease in proportion of subjects with elevated serum ALP (P ≤ 0.001). Conclusion Once weekly dose (50,000 IU) of either vitamin D supplement has equal effectiveness in correction of hypovitaminosis D. However, vitamin D3 may be cost-effective because it is cheaper.
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Affiliation(s)
| | - Adeyemi Oluwaseun Dada
- Department of Chemical Pathology, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Fidelis Olisamedua Njokanma
- Department of Paediatrics and Child Health, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Adaobi Uzoamaka Solarin
- Department of Paediatrics and Child Health, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Barakat Adeola Animasahun
- Department of Paediatrics and Child Health, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Moriam Omolola Lamina
- Department of Paediatrics, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
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Mechanisms of Bone Impairment in Sickle Bone Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041832. [PMID: 33668588 PMCID: PMC7918363 DOI: 10.3390/ijerph18041832] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/05/2021] [Accepted: 02/08/2021] [Indexed: 11/23/2022]
Abstract
Sickle bone disease (SBD) is a chronic and invalidating complication of Sickle cell disease (SCD), a multisystem autosomal recessive genetic disorder affecting millions of people worldwide. Mechanisms involved in SBD are not completely known, especially in pediatric age. Among the hypothesized pathogenetic mechanisms underlying SBD are bone marrow compensatory hyperplasia and bone ischemic damage, both secondary to vaso-occlusive crisis (VOC), which leads to cell sickling, thus worsening local hypoxia with a negative impact on osteoblast recruitment. Furthermore, the hypoxia is a strong activator of erythropoietin, which in turn stimulates osteoclast precursors and induces bone loss. Hemolysis and iron overload due to a chronic transfusion regimen could also contribute to the onset of bone complications. Vitamin D deficiency, which is frequently seen in SCD subjects, may worsen SBD by increasing the resorptive state that is responsible for low bone mineral density, acute/chronic bone pain, and high fracture risk. An imbalance between osteoblasts and osteoclasts, with a relative decrease of osteoblast recruitment and activity, is a further possible mechanism responsible for the impairment of bone health in SCD. Moreover, delayed pubertal growth spurt and low peak bone mass may explain the high incidence of fracture in SCD adolescents. The aim of this review was to focus on the pathogenesis of SBD, updating the studies on biochemical, instrumental, and biological markers of bone metabolism. We also evaluated the growth development and endocrine complications in subjects affected with SCD.
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Garrido C, Bardón-Cancho EJ, Fajardo-Sánchez VDLÁ, Cascón-Pérez-Teijón ME, García-Morín M, Cela E. Evaluation of the effectiveness of prophylactic oral vitamin D (cholecalciferol) in children with sickle cell disease. Bone 2020; 133:115228. [PMID: 31972313 DOI: 10.1016/j.bone.2020.115228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/23/2019] [Accepted: 01/08/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND Vitamin D (25(OH)D) deficiency has become an emerging public health problem due to its influence on skeletal and extraskeletal diseases. Bone health in patients with sickle cell disease (SCD) is especially compromised and they are more likely to have 25(OH)D deficiency than the general population. Despite this, there is little information on the efficacy of vitamin D3 (vitD3) prophylaxis and its role in improving bone mineral density (BMD) in this population. PROCEDURES A prospective, longitudinal, single-center study was conducted with 136 children with SCD monitored at a tertiary referral hospital for SCD. Demographic, clinical and management data, 25(OH)D levels and bone densitometries (DXA) were collected. RESULTS Eighty patients were included. There are significant differences between the means of each of 25(OH)D levels as a function of whether the patient started prophylactic treatment as an infant or not (35.71 vs. 27.89 ng/ml, respectively [p = .014]). In multivariate analysis, 800 IU daily dose was shown as a protective factor (p = .044) to reach optimal blood levels (≥30 ng/ml). According to Kaplan-Meier curves, patients younger than 10 years reached optimal levels earlier than older (p = .002), as well as those who were not being treated with hydroxyurea (p = .039). CONCLUSIONS VitD3 prophylaxis is a safe practice in SCD. It is important to start this prophylactic treatment when the child is an infant. The daily regimen with 800 IU could be more effective for reaching levels ≥30 ng/ml, and, especially in preadolescent and adolescent patients, we should raise awareness about the importance of good bone health.
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Affiliation(s)
- Carmen Garrido
- Pediatric Hematology Unit, "Hospital General Universitario Gregorio Marañón", Facultad de Medicina, Universidad Complutense de Madrid, Spain; Instituto Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Instituto Nacional de Investigación Biomédica en Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Madrid, Spain.
| | - Eduardo J Bardón-Cancho
- Pediatric Hematology Unit, "Hospital General Universitario Gregorio Marañón", Facultad de Medicina, Universidad Complutense de Madrid, Spain; Instituto Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
| | | | - María Elena Cascón-Pérez-Teijón
- Musculoskeletal Section, Radiodiagnosis Department, "Hospital General Universitario Gregorio Marañón", Profesora asociada Facultad de Medicina, Universidad Complutense de Madrid, Spain.
| | - Marina García-Morín
- Pediatric Hematology Unit, "Hospital General Universitario Gregorio Marañón", Facultad de Medicina, Universidad Complutense de Madrid, Spain; Instituto Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Elena Cela
- Pediatric Hematology Unit, "Hospital General Universitario Gregorio Marañón", Facultad de Medicina, Universidad Complutense de Madrid, Spain; Instituto Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Instituto Nacional de Investigación Biomédica en Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Madrid, Spain.
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Adesina OO, Gurney JG, Kang G, Villavicencio M, Hodges JR, Chemaitilly W, Kaste SC, Zemel BS, Hankins JS. Height-corrected low bone density associates with severe outcomes in sickle cell disease: SCCRIP cohort study results. Blood Adv 2019; 3:1476-1488. [PMID: 31072833 PMCID: PMC6517655 DOI: 10.1182/bloodadvances.2018026047] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 04/01/2019] [Indexed: 11/20/2022] Open
Abstract
Low bone mineral density (BMD) disproportionately affects people with sickle cell disease (SCD). Growth faltering is common in SCD, but most BMD studies in pediatric SCD cohorts fail to adjust for short stature. We examined low BMD prevalence in 6- to 18-year-olds enrolled in the Sickle Cell Clinical Research and Intervention Program (SCCRIP), an ongoing multicenter life span SCD cohort study initiated in 2014. We calculated areal BMD for chronological age and height-adjusted areal BMD (Ht-aBMD) z scores for the SCCRIP cohort, using reference data from healthy African American children and adolescents enrolled in the Bone Mineral Density in Childhood Study. We defined low BMD as Ht-aBMD z scores less than or equal to -2 and evaluated its associations with demographic and clinical characteristics by using logistic regression analyses. Of the 306 children and adolescents in our study cohort (mean age, 12.5 years; 50% female; 64% HbSS/Sβ0-thalassemia genotype; 99% African American), 31% had low areal BMD for chronological age z scores and 18% had low Ht-aBMD z scores. In multivariate analyses, low Ht-aBMD z scores associated with adolescence (odds ratio [OR], 7.7; 95% confidence interval [CI], 1.94-30.20), hip osteonecrosis (OR, 4.0; 95% CI, 1.02-15.63), chronic pain (OR, 10.4; 95% CI, 1.51-71.24), and hemoglobin (OR, 0.74; 95% CI, 0.57-0.96). Despite adjusting for height, nearly 20% of this pediatric SCD cohort still had very low BMD. As the SCCRIP cohort matures, we plan to prospectively evaluate the longitudinal relationship between Ht-aBMD z scores and markers of SCD severity and morbidity.
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Affiliation(s)
- Oyebimpe O Adesina
- Division of Hematology, Department of Medicine, University of Washington School of Medicine, Seattle, WA
| | - James G Gurney
- School of Public Health, University of Memphis, Memphis, TN
| | | | | | | | | | - Sue C Kaste
- Department of Diagnostic Imaging, and
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
- Department of Radiology, University of Tennessee Health Science Center, Memphis, TN
| | - Babette S Zemel
- Division of Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA; and
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Han J, Zhang X, Saraf SL, Gowhari M, Molokie RE, Hassan J, Jain S, Shah BN, Abbasi T, Machado RF, Gordeuk VR. Risk factors for vitamin D deficiency in sickle cell disease. Br J Haematol 2018; 181:828-835. [PMID: 29767851 DOI: 10.1111/bjh.15270] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 03/23/2018] [Indexed: 12/22/2022]
Abstract
Vitamin D deficiency (VDD), 25-OHD levels <20 ng/ml, is prevalent among patients with sickle cell disease (SCD) and is linked to acute and chronic pain and bone fracture in this population. There is limited literature regarding VDD-associated risk factors for SCD. We examined potential clinical and genomic parameters associated with VDD in 335 adults with SCD in a cross-sectional study. VDD was present in 65% of adult SCD patients, and 25-OHD levels independently and positively correlated with older age (P < 0·001) and vitamin D supplementation (P < 0·001). 25-OHD levels were higher in SCD patients over 40 years of age compared to the general African-American population. Both lower 25-OHD levels and increased pain frequency were associated with increased expression of SLC6A5 encoding glycine transporter-2 (GlyT2), a protein involved in neuronal pain pathways. Lower 25-OHD levels were also associated with increased expression of CYP3A4, and with decreased expression of GC (also termed DBP) and VDR, three genes involved in vitamin D metabolism. We conclude that vitamin D supplementation should be an almost universal feature of the care of young adults with SCD, and that further research is warranted into genomic factors that regulate vitamin D metabolism in SCD.
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Affiliation(s)
- Jin Han
- Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, IL, USA.,Department of Medicine, Hematology/Oncology, University of Illinois at Chicago, Chicago, IL, USA.,Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago, Chicago, IL, USA
| | - Xu Zhang
- Department of Medicine, Hematology/Oncology, University of Illinois at Chicago, Chicago, IL, USA
| | - Santosh L Saraf
- Department of Medicine, Hematology/Oncology, University of Illinois at Chicago, Chicago, IL, USA
| | - Michel Gowhari
- Department of Medicine, Hematology/Oncology, University of Illinois at Chicago, Chicago, IL, USA
| | - Robert E Molokie
- Department of Medicine, Hematology/Oncology, University of Illinois at Chicago, Chicago, IL, USA.,Jesse Brown VA Medical Center, Chicago, IL, USA
| | - Johara Hassan
- Department of Medicine, Hematology/Oncology, University of Illinois at Chicago, Chicago, IL, USA
| | - Shivi Jain
- Department of Medicine, Hematology/Oncology, University of Illinois at Chicago, Chicago, IL, USA
| | - Binal N Shah
- Department of Medicine, Hematology/Oncology, University of Illinois at Chicago, Chicago, IL, USA
| | - Taimur Abbasi
- Department of Medicine, Hematology/Oncology, University of Illinois at Chicago, Chicago, IL, USA
| | - Roberto F Machado
- Division of Pulmonary, Critical Care, Sleep, and Occupational Medicine, Indiana University Department of Medicine, Indianapolis, IN, USA
| | - Victor R Gordeuk
- Department of Medicine, Hematology/Oncology, University of Illinois at Chicago, Chicago, IL, USA
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De Luna G, Ranque B, Courbebaisse M, Ribeil JA, Khimoud D, Dupeux S, Silvera J, Offredo L, Pouchot J, Arlet JB. High bone mineral density in sickle cell disease: Prevalence and characteristics. Bone 2018; 110:199-203. [PMID: 29428552 DOI: 10.1016/j.bone.2018.02.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 01/30/2018] [Accepted: 02/05/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Osteosclerosis (OSC) is a rarely studied complication of sickle cell disease (SCD). The objective of our study was to determine the prevalence and characteristics of high bone mineral density (BMD) and its radiological features in adult SCD patients. METHODS This prospective observational study was conducted from May 2007 to May 2016 in consecutive patients with steady-state SCD at two university hospitals. The BMD of the lumbar spine (L1-L4) and right femoral neck was determined by dual energy X-ray absorptiometry. Clinical, laboratory and radiographic data were recorded. High BMD was defined as a BMD Z-score of at least +2.5 standard deviations at the lumbar spine or hip. The characteristics of the patients with high BMD were compared to those of individuals with low or middle BMD, using multivariate ordinal logistic regression. RESULTS 135 patients (86 women and 49 men) with a median age of 27 (IQR 23-33) years were included. High BMD was diagnosed in 20 (15%) patients with a median age of 33.5 (IQR 28-45) years. The SCD genotypes of these patients were SS in 11, SC in 5, S/beta+ in 3, and S/beta0 in 1. High BMD patients more frequently harbored the S/beta SCD genotype (21% vs 5% in non-high BMD patients; p=0.047) and were older (p=0.0007). Compared to patients with low or middle BMD, after adjustment for age and SCD genotype, high BMD patients had a higher prevalence of avascular necrosis history (p=0.009), higher BMI (p=0.007), and lower serum resorption marker CTX (p=0.04), bilirubin (p=0.02) and parathyroid hormone levels (p=0.02). There were no differences between groups regarding fracture history, H-shaped vertebrae or other biological variables. CONCLUSION High-BMD values is a common manifestation in SCD patients, especially in those with the S/beta-thalassemia genotypes. The prevalence of high-BMD in SCD is associated with older age, suggesting that it will be more common in the future because the life span of patients with SCD is increasing thanks to significant progress in SCD treatment.
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Affiliation(s)
- Gonzalo De Luna
- Internal Medicine Department, Sickle Cell Referral Center, Georges Pompidou European Hospital, AP-HP, Paris, France; Faculté de Médecine Paris Descartes, Sorbonne Paris-Cité, Paris, France.
| | - Brigitte Ranque
- Internal Medicine Department, Sickle Cell Referral Center, Georges Pompidou European Hospital, AP-HP, Paris, France; Faculté de Médecine Paris Descartes, Sorbonne Paris-Cité, Paris, France; Laboratory of Excellence GR-Ex, Paris, France
| | - Marie Courbebaisse
- Faculté de Médecine Paris Descartes, Sorbonne Paris-Cité, Paris, France; Physiology Department, Georges Pompidou European Hospital, AP-HP, INSERM, Unit 1151, Paris, France
| | - Jean-Antoine Ribeil
- Faculté de Médecine Paris Descartes, Sorbonne Paris-Cité, Paris, France; Department of Biotherapy, Necker Hospital, AP-HP, Paris, France
| | - Djamal Khimoud
- Internal Medicine Department, Sickle Cell Referral Center, Georges Pompidou European Hospital, AP-HP, Paris, France
| | - Sidonie Dupeux
- Internal Medicine Department, Sickle Cell Referral Center, Georges Pompidou European Hospital, AP-HP, Paris, France
| | - Jonathan Silvera
- Radiology department, Georges Pompidou European Hospital, AP-, HP, Paris, France
| | - Lucile Offredo
- INSERM U970 PARCC Equipe 4 "Epidémiologie cardiovasculaire et mort subite", Paris, France
| | - Jacques Pouchot
- Internal Medicine Department, Sickle Cell Referral Center, Georges Pompidou European Hospital, AP-HP, Paris, France; Faculté de Médecine Paris Descartes, Sorbonne Paris-Cité, Paris, France
| | - Jean-Benoît Arlet
- Internal Medicine Department, Sickle Cell Referral Center, Georges Pompidou European Hospital, AP-HP, Paris, France; Faculté de Médecine Paris Descartes, Sorbonne Paris-Cité, Paris, France; Laboratory of Excellence GR-Ex, Paris, France
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8
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AlJama A, AlKhalifah M, Al-Dabbous IA, Alqudaihi G. Vitamin D deficiency in sickle cell disease patients in the Eastern Province of Saudi Arabia. Ann Saudi Med 2018; 38:130-136. [PMID: 29620547 PMCID: PMC6074368 DOI: 10.5144/0256-4947.2018.130] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Vitamin D deficiency (VDD) is a major global health problem. In sickle cell disease (SCD), VDD is highly prevalent, reaching up to 96% of populations. VDD may contribute to many of the complications of SCD. OBJECTIVE Estimate the 25-hydroxyvitamin D [25(OH)D] level and the frequency of VDD and insufficiency among among SCD patients by age group and disease status. DESIGN Analytical cross-sectional. SETTING Ministry of Health (MOH) secondary care hospital. PATIENTS AND METHODS Non-probability purposive sampling was used to select SCD patients, aged 12 years and older, of both sexes, who had visited the hospital during a period of 5 years (2010-2014). Blood samples were processed by electrochemiluminescence technology. MAIN OUTCOME MEASURE(S) 25(OH)D levels by demographic data, and disease activity. SAMPLE SIZE 640 patients. RESULTS Of those, 82% (n=523) had suboptimal 25(OH)D (0-<30 ng/ mL), and 67% were deficient (0-<20 ng/mL). Patients with any SCD crisis (20.7%, 144/694) had lower 25(OH)D (median, IQR: 10.1 ng/mL [8.6] ng/mL) compared to patients without crisis (71.0%, 493/694) (15.7 ng/ mL [18.2] ng/mL) (P<.001). Deficiency was more common in the young.er age groups and in sickle cell anemia patients with crisis. CONCLUSIONS VDD is highly prevalent in this population. Established vitamin D screening is a necessity, so that affected patients can be treated. LIMITATIONS Presence of residual confounders such as nutritional status, physical activity, lack of sun exposure, medications that alleviate SCD crises (such as hydroxyurea), and comorbid illnesses. The relationship between sickle cell disease genotype and vitamin D level was not analyzed. CONFLICT OF INTEREST None.
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Affiliation(s)
- Ali AlJama
- Ali AlJama Department of Internal Medicine, Qatif Central Hosptal, PO Box 627, Qatif 31911, Saudi Arabia, T: 966.13-855-5927, , ORCID: http://orcid.org/0000.0002-9985-7666
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Kawar N, Alrayyes S, Compton AA, Aljewari H, Baghdan D, Yang B, Goreishi R, Mohama S. WITHDRAWN: Sickle cell disease; An overview of systemic and oral effects. Dis Mon 2018:S0011-5029(17)30209-2. [PMID: 29428339 DOI: 10.1016/j.disamonth.2017.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Nadia Kawar
- American Board of Periodontology, Department of Periodontology, College of Dentistry, University of Illinois, USA.
| | - Sahar Alrayyes
- American Board of Pediatric Dentistry, Department of Pediatric Dentistry, College of Dentistry, University of Illinois, USA
| | | | - Haider Aljewari
- Postgraduate Periodontics Residency Program, College of Dentistry, University of Illinois, USA
| | | | - Bin Yang
- American Board of Prosthodontics, Department of Restorative Dentistry, College of Dentistry, University of Illinois, USA
| | - Reihaneh Goreishi
- Postgraduate Periodontics Residency Program, College of Dentistry, University of Illinois, USA
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10
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Alrayyes S, Baghdan D, Haddad RY, Compton AA, Mohama S, Goreishi R, Kawar N. Sickle cell disease; An overview of the disease and its systemic effects. Dis Mon 2018; 64:283-289. [PMID: 29395106 DOI: 10.1016/j.disamonth.2017.12.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Sahar Alrayyes
- Diplomate, American Board of Pediatric Dentistry, USA; Clinical Associate Professor, Department of Pediatric Dentistry, College of Dentistry, University of Illinois, USA
| | | | - Rami Y Haddad
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois
| | - Anne-Ashley Compton
- Diplomate, American Board of Pediatric Dentistry, USA; Private Practice, IL, USA
| | | | - Reihaneh Goreishi
- Postgraduate Periodontics Program, College of Dentistry, University of Illinois, USA
| | - Nadia Kawar
- Diplomate, American Board of Periodontology, USA; Clinical Associate Professor, Department of Periodontology, College of Dentistry, University of Illinois, USA.
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Al-Daghri NM. Vitamin D in Saudi Arabia: Prevalence,distribution and disease associations. J Steroid Biochem Mol Biol 2018; 175:102-107. [PMID: 28027916 DOI: 10.1016/j.jsbmb.2016.12.017] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 11/14/2016] [Accepted: 12/23/2016] [Indexed: 01/05/2023]
Abstract
More than 33 years have passed since the first paper highlighting vitamin D deficiency as a public health concern in Saudi Arabia was published in 1983. Despite "early" detection,it wasn't until the year 2010 where the interest in vitamin D research grew exponentially worldwide and was finally visible in Saudi clinical and academic areas. Since then,many landmark studies have been generated with regards to the physiologic functions of vitamin D,both skeletal and extra-skeletal. This review is limited to the prevalence,distribution A systematic review on the prevalence studies done in KSA from 2011 to 2016 was done and revealed that the prevalence of vitamin D deficiency (<50nmol/l) in Saudi Arabia among different populations (adults,children and adolescents,newborns and pregnant/lactating women) is 81.0% (Confidence Interval 95% 68.0-90.0),in line with most neighboring Gulf countries. Vitamin D deficiency in KSA has been mostly associated with bone and insulin-resistant diseases but limited data are available to prove causality. In conclusion,there is a need to develop local consensus guidelines that will identify candidates for screening,monitoring and treating those who are at most risk for vitamin D deficiency complications.
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Affiliation(s)
- Nasser M Al-Daghri
- Biomarkers Research Program, Biochemistry Department, College of Science, King Saud University, Riyadh 11451, Saudi Arabia; Prince Mutaib Chair for Biomarkers of Osteoporosis, Biochemistry Department, College of Science, King Saud University, Riyadh 11451, Saudi Arabia.
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12
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Bordbar MR, Haghpanah S, Zarei T, Dabbaghmanesh MH, Omrani GR, Saki F. Evaluation of bone mineral density in children with sickle-cell anemia and its associated factors in the south of Iran: a case-control study. Arch Osteoporos 2017; 12:70. [PMID: 28779437 DOI: 10.1007/s11657-017-0364-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 07/25/2017] [Indexed: 02/03/2023]
Abstract
Sickle-cell anemia is a hereditary hemoglobin disorder among children. We showed that the low bone mass is prevalent among these children, and it has a negative association with hemoglobin. In spite of using supplementary 200 IU/day vitamin D, 59.6% of children with sickle-cell anemia are vitamin D deficient. We suggest that early diagnosis and treatment of this problem could improve the bone health in them.
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Affiliation(s)
| | - Sezaneh Haghpanah
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, IR, Iran
| | - Tahereh Zarei
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, IR, Iran
| | | | - Gholamhossein Ranjbar Omrani
- Endocrinology and Metabolism Research Center, Shiraz University of Medical Sciences, P.O. Box: 71345-1744, Shiraz, Iran
| | - Forough Saki
- Endocrinology and Metabolism Research Center, Shiraz University of Medical Sciences, P.O. Box: 71345-1744, Shiraz, Iran.
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Martyres DJ, Vijenthira A, Barrowman N, Harris-Janz S, Chretien C, Klaassen RJ. Nutrient Insufficiencies/Deficiencies in Children With Sickle Cell Disease and Its Association With Increased Disease Severity. Pediatr Blood Cancer 2016; 63:1060-4. [PMID: 26855061 DOI: 10.1002/pbc.25940] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 01/11/2016] [Indexed: 01/28/2023]
Abstract
BACKGROUND Sickle cell disease (SCD) is characteristically described as a disease of hemolytic anemia and vaso-occlusive crises (VOCs). However, patients suffer from a multitude of other problems including impaired development, chronic pain, and increased susceptibility to infection. Nutritional deficiency has been implicated as a contributor to these issues. PROCEDURE We reported the nutrition status with respect to vitamin D, zinc, B6, B12, folate, and homocysteine serum levels in Canadian children with SCD (n = 91). We also tested for associations between nutrients and markers of disease severity and growth. RESULTS Almost half the sample (42%) had multiple nutrient insufficiencies/deficiencies, and a further 27% had a single insufficiency/deficiency. The most common insufficiency/deficiency was zinc in 57% followed by calcidiol (25 dihydroxyvitamin D (25(OH)D)) (52%). Sixteen percent of patients had low vitamin B6 levels, while folate, calcitriol (1,25(OH)D), and homocysteine levels were normal. Increased number of vitamin insufficiencies/deficiencies was associated with increasing disease severity (P = 0.018). Zinc insufficiency/deficiency was significantly associated with an increased number of home pain crises (P = 0.001) and an increased incidence of hospitalizations for VOCs (P = 0.01). CONCLUSIONS Our findings show that patients with SCD commonly have multiple nutrient insufficiencies/deficiencies and support the growing evidence for the link between low zinc and increased VOC. It also indicates that increased nutrient insufficiencies/deficiencies are associated with increased disease severity in SCD. Prospective studies with larger samples are needed to further elucidate the relationship between nutrient deficiencies and SCD, and to determine whether nutrient supplementation can improve the disease course.
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Affiliation(s)
- David J Martyres
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Abi Vijenthira
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nick Barrowman
- Clinical Research Unit, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Sydney Harris-Janz
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Christine Chretien
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Robert J Klaassen
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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Garrido Colino C, Beléndez Bieler C, Pérez Díaz M, Cela de Julián E. Evaluation of bone mineral density in children with sickle cell disease. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.anpede.2015.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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15
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Garrido Colino C, Beléndez Bieler C, Pérez Díaz M, Cela de Julián E. Evaluación de la densidad mineral ósea en pacientes con enfermedad de células falciformes. An Pediatr (Barc) 2015; 82:216-21. [DOI: 10.1016/j.anpedi.2014.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Revised: 03/28/2014] [Accepted: 04/03/2014] [Indexed: 12/24/2022] Open
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16
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Nolan VG, Nottage KA, Cole EW, Hankins JS, Gurney JG. Prevalence of vitamin D deficiency in sickle cell disease: a systematic review. PLoS One 2015; 10:e0119908. [PMID: 25734582 PMCID: PMC4347975 DOI: 10.1371/journal.pone.0119908] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 02/03/2015] [Indexed: 11/19/2022] Open
Abstract
Vitamin D deficiency has emerged as a public health focus in recent years and patients with sickle cell disease (SCD) reportedly have a high prevalence of the condition. Our objectives were to summarize definitions of vitamin D deficiency and insufficiency used in the literature, and to determine the prevalence and magnitude of each in patients with SCD through a systematic review conducted according to PRISMA guidelines. From a PubMed search, 34 potential articles were identified and 15 met eligibility criteria for inclusion. Definitions of deficiency and insufficiency varied greatly across studies making direct comparisons difficult. This review provides evidence to suggest that suboptimal vitamin D levels are highly prevalent among those with SCD, far more so than in comparable non-SCD patients or matched control populations. Defining deficiency as vitamin D < 20 ng/mL, prevalence estimates in SCD populations range from 56.4% to 96.4%. When compared with results from the population-based National Health and Nutrition Examination Survey, however, the general African American population appeared to have a similarly high prevalence of vitamin D deficiency. African American patients with and without SCD were both substantially higher than that of Caucasians. What remains to be determined is whether there are adverse health effects for patients with SCD because of concurrent vitamin D deficiency.
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Affiliation(s)
- Vikki G. Nolan
- Departments of Hematology, Division of Epidemiology, Biostatistics and Environmental Health, University of Memphis, School of Public Health, Memphis, TN, United States of America
| | - Kerri A. Nottage
- Epidemiology and Cancer Control, Division of Epidemiology, Biostatistics and Environmental Health, University of Memphis, School of Public Health, Memphis, TN, United States of America
| | - Elliott W. Cole
- Departments of Hematology, Division of Epidemiology, Biostatistics and Environmental Health, University of Memphis, School of Public Health, Memphis, TN, United States of America
| | - Jane S. Hankins
- Epidemiology and Cancer Control, Division of Epidemiology, Biostatistics and Environmental Health, University of Memphis, School of Public Health, Memphis, TN, United States of America
| | - James G. Gurney
- Departments of Hematology, Division of Epidemiology, Biostatistics and Environmental Health, University of Memphis, School of Public Health, Memphis, TN, United States of America
- St. Jude Children’s Research Hospital, Memphis, TN, United States of America
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Wykes C, Arasaretnam A, O'Driscoll S, Farnham L, Moniz C, Rees DC. Vitamin D deficiency and its correction in children with sickle cell anaemia. Ann Hematol 2014; 93:2051-6. [PMID: 24981689 DOI: 10.1007/s00277-014-2144-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 06/19/2014] [Indexed: 01/19/2023]
Abstract
Vitamin D deficiency is common in sickle cell anaemia (SCA, HbSS), although its significance and optimal means of correction are unknown. We conducted an audit to assess the clinical significance of 25-hydroxy vitamin D (25-OHD) deficiency in children with SCA and to evaluate two methods of vitamin D supplementation. We audited 25-OHD levels in 81 children with SCA and looked for statistical associations with biochemical, haematological and clinical parameters. In a separate group of regularly transfused children with SCA, we compared changes in 25-OHD blood concentrations following treatment with either high-dose intramuscular ergocalciferol (n = 15) or 4 days of high-dose oral cholecalciferol (n = 64). Ninety-one percent of children with SCA had 25-OHD levels <20 μg/L. The 25-OHD levels were negatively correlated with increasing age (P < 0.001) but showed no significant relationship to laboratory measurements, transcranial Doppler velocities or hospital attendance. Both intramuscular ergocalciferol and oral cholecalciferol supplementations resulted in increases of 25-OHD blood concentration to normal levels. The mean dose of ergocalciferol was greater than that of cholecalciferol (7,729 versus 5,234 international units (IU)/kg, P < 0.001), but the increment in 25-OHD levels was significantly greater in the oral cholecalciferol group (6.44 versus 2.82 (ng/L)/(IU/kg), P < 0.001). Both approaches resulted in vitamin D sufficiency for about 120 days. Increased 25-OHD concentration was significantly associated with increased serum calcium concentration. Vitamin D deficiency is very common in SCA and can be effectively corrected with high-dose intramuscular ergocalciferol or 4 days of high-dose oral cholecalciferol. Prospective, randomised studies are needed to assess the clinical value of vitamin D supplementation.
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Affiliation(s)
- Clare Wykes
- Department of Paediatric Haematology, King's College Hospital, King's College London, Denmark Hill, London, SE5 9RS, UK
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Bone mineral density patterns in vitamin D deficient African American men with sickle cell disease. Am J Med Sci 2014; 347:262-6. [PMID: 23538935 DOI: 10.1097/maj.0b013e3182893377] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe bone mineral density (BMD) patterns by densitometry in adult African American (AA) men with sickle cell disease (SCD) who are vitamin D deficient (Vit DD). INCLUSION/EXCLUSION CRITERIA All SCD phenotypes were eligible. Those with chronic renal failure or hyperparathyroidism were excluded. DATA COLLECTION Demographics, body mass index and SCD genotype. LABORATORY Albumin, ferritin, calcium, phosphorus, 25-hydroxy vitamin D and intact-parathyroid hormone were obtained. BMD, T and Z scores: T scores at the lumbar spine were used to categorize normal, osteopenia and osteoporosis based on World Health Organization criteria. STATISTICAL ANALYSES Mean ± standard deviation was used to describe continuous data, whereas categorical data were described by counts and percentages. The χ test was used to analyze categorical variables; Student's t test or one-way analysis of variance, when appropriate, was used to compare continuous variables. Rates of osteopenia-osteoporosis were determined, and the parameter with 95% confidence interval (CI) of a proportion was constructed. All tests were 2-sided, and a P ≤ 0.05 was considered statistically significant. We used StatView Version 5.01 (SAS institute Inc, Cary, NC) for the statistical analysis. RESULTS Seventy-eight AA men with SCD disease and Vit DD were enrolled in this study. We found that 42% of the men studied had low-BMD (osteopenia or osteoporosis) using T scores at the lumbar spine to establish densitometry strata. The prevalence of osteoporosis was 14%. CONCLUSIONS A large proportion of adult AA men with SCD and Vit DD showed low BMD.
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Abstract
PURPOSE OF REVIEW To summarize the findings of the recent publications on sickle cell bone disease (SBD). RECENT FINDINGS Individuals with sickle cell disease (SCD) are living longer and develop progressive organ damage including SBD with age. Recent studies suggest alternative radiological diagnostics such as ultrasound and scintigraphy can detect and differentiate between different forms of SBD. MRI with or without diffusion-weighted sequences remains the gold standard. Case reports of cranio-orofacial SBD highlight the rarity of this presentation. Vitamin D deficiency is highly prevalent at all ages, but may not be an independent risk factor for avascular necrosis (AVN). Gene polymorphisms of the Annexin A gene may predict AVN in SCD. A recent study demonstrated reduced days with pain and improved physical activity quality of life following high-dose vitamin D therapy. The high rates of osteopenia and osteoporosis in SCD support the need for research addressing this rising public health problem. Lastly, results of total hip arthroplasty for AVN in SCD has improved significantly over time with the use of cementless prosthetic material and improved supportive care. SUMMARY SBD remains poorly studied. Prospective randomized studies targeting predictors, diagnostics, prevention, and treatment options for SBD are sorely needed.
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Affiliation(s)
- Ifeyinwa Osunkwo
- Children's Healthcare of Atlanta and The Department of Pediatrics Emory University, Atlanta, Georgia, USA
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Arlet JB, Courbebaisse M, Chatellier G, Eladari D, Souberbielle JC, Friedlander G, de Montalembert M, Prié D, Pouchot J, Ribeil JA. Relationship between vitamin D deficiency and bone fragility in sickle cell disease: a cohort study of 56 adults. Bone 2013; 52:206-11. [PMID: 23072921 DOI: 10.1016/j.bone.2012.10.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Revised: 09/27/2012] [Accepted: 10/02/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Recent studies suggest that patients with sickle cell disease (SCD) have profound vitamin D (VD) deficiency. Limited data exist on the effect of VD deficiency on bone fragility in these patients. OBJECTIVES To assess the prevalence of VD deficiency in adults with SCD and its consequences on bone metabolism and fragility. METHODS This prospective study included 56 SCD adult patients (mean age 29.8 ± 9.5 years), in a clinically steady state. Clinical and laboratory data were recorded. Bone mineral density (BMD) was measured using dual X-ray absorptiometry. Fracture history, BMD, avascular osteonecrosis, H-shaped vertebra and markers of mineral metabolism were compared between two groups of patients presenting very low (≤ 6 ng/mL, n=26) (group 1) and low (>6 ng/mL, n=26) (group 2) 25(OH)D concentration, respectively. RESULTS Median 25(OH)D concentration was 6 ng/mL. VD deficiency (25(OH)D <10 ng/mL) was found in 42 out of 56 patients (75%) and secondary hyperparathyroidism in 40 (71.4%). History of fracture was documented in 17 patients (30.3%), osteopenia and/or osteoporosis in 39.6% of patients. Overall, patients of group 1 were more likely to have sustained a fracture (42.8%) compared to patients of group 2 (17.8%) (p=0.04). These patients had also lower body mass index and significantly higher parathyroid hormone, C-terminal telopeptides of type I-collagen and bone-specific alkaline phosphatase serum levels. There was no difference between group for BMD, avascular osteonecrosis history, H-shaped vertebra, and disease severity markers. CONCLUSION This study suggests that VD deficiency is a key feature in SCD-bone disease. It is highly prevalent and associated with hyperparathyroidism, bone resorption markers, and history of fracture. The optimal supplementation regimen remains to be determined.
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Affiliation(s)
- Jean-Benoît Arlet
- Service de médecine interne, Faculté de médecine Paris Descartes, Sorbonne Paris-Cité et Assistance publique - hôpitaux de Paris, hôpital européen Georges Pompidou, 75908 Paris, France.
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Sadat-Ali M, Al-Habdan IM, Al-Turki HA, Azam MQ. An epidemiological analysis of the incidence of osteoporosis and osteoporosis-related fractures among the Saudi Arabian population. Ann Saudi Med 2012; 32:637-41. [PMID: 23396029 PMCID: PMC6081105 DOI: 10.5144/0256-4947.2012.637] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Osteoporosis is common in Saudi Arabia and the burden of management in an aging population will increase in coming decades. There is still no national policy nor consensus on screening for this silent disease. The objective of this analysis was to determine from the published data the prevalence of osteopenia and osteoporosis in Saudi Arabians, the prevalence of secondary osteoporosis, and the prevalence of osteoporosis-related fractures (ORF). We also sought to determine the best age to begin and best modality for screening. METHODS Data Sources were MEDLINE (1966 to May 2011), EMBASE (1991 to May 2011), the Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews (1952 to May 2011), and the Science Citation Index (1966 to May 2011), published data from the Saudi Medical Journal (1985-2011) and Annals of Saudi Medicine (1985-2011). We selected English-language articles with at least 100 Saudi individuals. Two authors independently reviewed articles and abstracted data. RESULTS The authors identified 36 potentially relevant articles, of which 24 met the inclusion criteria. Of 5160 healthy women 50 to 79 years of age (mean, SD: 56.8 [2.7]), 36.6% (6.6%) were osteopenic and 34.0% (8.5%) were osteoporotic. In three studies on males (n=822), the prevalence of osteopenia was 46.3% and osteoporosis 30.7%. Males had a significantly higher frequency of osteopenia in comparison to females (P= < .001 95% CI < -0.0333), The mean age of the patients with secondary osteoporosis was 37.4 (13.5, 18-57) years, with the osteoporosis in 46.4% and osteopenia in 34.1%. In 5 studies of ORF, the incidence of vertebral fractures was between 20%-24%. CONCLUSION The currently available literature on Saudi Arabian population suggests that the ideal age for screening for low bone mass among the Saudi population should be earlier (55 years) than the >=65 years in Western countries. Both quatitative ultrasound and dual-energy x-ray absorptiometry could be used for screening. The relatively small number of studies on Saudi Arabians and the different machines used for diagnosis limited the authors ability make conclusions with surety.
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Affiliation(s)
- Mir Sadat-Ali
- PO Box 40071 King Fahd University Hospital Al-Khobar 31952 Saudi Arabia.
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Current world literature. Curr Opin Pediatr 2012; 24:134-44. [PMID: 22245849 DOI: 10.1097/mop.0b013e328350498a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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