Osteoporosis - An Emerging Disease of the 21(st) Century, Part 1: An Overview

FRAX-derived intervention and assessment thresholds for osteoporosis in ten Middle Eastern countries

This study established FRAX-based age-specific assessment and intervention thresholds for ten Middle Eastern countries where FRAX is currently available, but the lack of specific thresholds has limited its usefulness. The intervention thresholds ranged from 0.6 (Saudi Arabia) to 36.0% (Syria) at the ages of 40 and 90 years, respectively.

INTRODUCTION

Developing fracture risk assessment tools allows physicians to select patients for therapy based on their absolute fracture risk instead of relying solely on bone mineral density (BMD). The most widely used tool is FRAX, currently available in ten Middle Eastern countries. This study aimed to set FRAX-derived assessment and intervention thresholds for individuals aged 40 or above in ten Middle Eastern countries.

METHODS

The age-specific 10-year probabilities of a major osteoporotic fracture (MOF) for a woman with a BMI of 25.0 kg/m2, without BMD and clinical risk factors except for prior fracture, were calculated as intervention Threshold (IT). The upper and lower assessment thresholds were set at 1.2 times the IT and an age-specific 10-year probability of a MOF in a woman with a BMI of 25.0 kg/m2, without BMD, prior fracture, and other clinical risk factors, respectively. IT is utilized to determine treatment or reassurance when BMD facilities are unavailable. However, with BMD facilities, assessment thresholds can offer treatment, reassurance, or bone densitometry based on MOF probability.

RESULTS

The age-specific IT varied from 0.9 to 11.0% in Abu Dhabi, 2.9 to 10% in Egypt, 2.7 to 14.0% in Iran, 1.0 to 28.0% in Jordan, 2.7 to 27.0% in Kuwait, 0.9 to 35.0% in Lebanon, 1.0 to 16.0% in Palestine, 4.1 to 14% in Qatar, 0.6 to 3.7% in Saudi Arabia, and 0.9 to 36.0% in Syria at the age of 40 and 90 years, respectively.

CONCLUSIONS

FRAX-based IT in Middle Eastern countries provides an opportunity to identify individuals with high fracture risk.

Pharmacotherapy costs and medicines reimbursement policies of osteoporosis in the Republic of Bulgaria and Republic of North Macedonia

The aim of the present study was to analyze and compare the number of health insured persons suffering from osteoporosis and antiosteoporotic drugs reimbursed by the National Health Insurance Funds (NHIF) in the Republic of Bulgaria (RBG) and Republic of North Macedonia (RNM) for the period 2015–2018. The reimbursement cost paid by the NHIF for the same period in both countries was surveyed.

The results show an increase in both the number of patients with osteoporosis and the cost of the treatment. The most prescribed drug in R. Bulgaria is denosumab and it has the highest costs respectively, while in R.N. Macedonia the most prescribed and respectively the most expensive treatment is the bisphosphonate ibandronic acid, tablets of 150 mg. The trend of rising costs in both countries is likely to continue due to the increasing number of patients with osteoporosis.

The number of patients and cost of pharmacotherapy in RNM and RBG are increasing but the reimbursement policy in RNM is more restrictive in terms of reimbursed medicines. On the other side, the RNM is with a higher level of reimbursement that might positively affect the cost of pharmacotherapy.

Editorial Commentary: Aging and Rotator Cuff Tears

Osteoporosis is associated with failure of rotator cuff repair. Optimizing bone density, as well as rotator cuff tendon-to-bone fixation in an osteoporotic humeral head, is a necessary approach to the patient as a whole.

Longan fruit increase bone mineral density in zebrafish and ovariectomized rat by suppressing RANKL-induced osteoclast differentiation

BACKGROUND

The receptor activator of nuclear factor-kappa B ligand (RANKL)-induced nuclear factor-kappa B (NF-κB) signaling pathway plays essential roles in osteoclast differentiation and may serve as an attractive target for the development of therapeutics for osteoporosis.

PURPOSE

This study aimed to identify plant extracts that attenuated RANKL-induced NF-κB signaling pathway and examine their anti-osteoporotic effects in animal model systems.

METHODS

Osteoclast differentiation was determined by western blot analysis, RT-PCR, and tartrate-resistant acid phosphatase (TRAP) assay. The effect of Longan (Dimocarpus longan Lour.) fruit extract (LFE) on bone mineral density was evaluated by calcein staining in zebrafish and micro-CT analysis in ovariectomized (OVX) rat.

RESULTS

LFE nullified RANKL-induced down-regulation of inhibitor of NF-κB, which keeps NF-κB sequestered in the cytosol, thereby inhibiting translocation of NF-κB to the nucleus, in RAW264.7 cells. In addition, LFE decreased the nuclear levels of c-Fos and nuclear factor of activated T-cells c1, which play crucial roles in RANKL-induced osteoclast differentiation, in RAW264.7 cells. LFE repressed RANKL-activated cathepsin K and TRAP expression in RAW264.7 cells, resulting in a reduction of the number of TRAP-positive multinucleated cells, without cytotoxicity. Furthermore, LFE increased bone mineralization in zebrafish and prevented bone loss in OVX rat.

CONCLUSION

Collectively, our findings suggest that LFE exerts its anti-osteoporotic activity through inhibition of osteoclast differentiation and may have potential as a herbal therapeutic or preventive agent for the treatment of osteoporosis.

Osteoporosis strategic plan for the Middle East and North Africa region

The first step to achieve a world without fragility fractures is to devise a strategic plan to improve research and planning, and assisting member states to acquire the required financial, technical, and other resources. This article aims to outline the first strategic plan devised for the Middle East and North Africa region proposed by the International Osteoporosis Foundation's (IOF) Middle East and North Africa (MENA) Regional Advisory Council (RAC).

PURPOSE

Osteoporosis is no exception in this rising tide of non-communicable diseases, not only sharing common risk factors but also contributing substantially to a heavy social and economic burden on society. During the past decade and after the establishment of the International Osteoporosis Foundation (IOF), a goal-directed movement has started to achieve a world without fragility fractures. In order to achieve this goal, regional councils were formed to maximize the effectiveness of national osteoporosis societies in raising awareness of effective prevention, diagnosis, and treatment strategies.

METHODS AND RESULTS

The first step to achieve this goal is to devise a strategic plan to improve the research and planning, assisting all member states to acquire the financial, technical, and other resources needed in order to achieve a world-class program in the fight against osteoporosis.

CONCLUSION

This article therefore aims to outline the first strategic plan devised by the IOF's MENA RAC for the Middle East and North Africa region.