Osteoporosis among male Saudi Arabs: a pilot study

Determinants of Z-Score of Bone Mineral Density among Premenopausal Saudi Females in Different Age Groups: A Cross Sectional Study

This is a comparative multicenter cross-sectional study that evaluated the potential determinants of Z-scores among premenopausal Saudi women before and after the age of peak bone density. The Study concluded that for better BMD among premenopausal women, attention should be paid to early physical activity and healthy nutrition, especially vitamin D, during the childbearing period.

OBJECTIVE

To explore the potential determinants of Z-scores among premenopausal Saudi females in different age groups before and after the expected age of peak bone density (PBD).

METHODS

This multicenter comparative cross-sectional study was conducted in Madinah and Jeddah, Saudi Arabia, between August 2021 and March 2022. We recruited 886 premenopausal females (605 (68.3%) below and 281 (31.7%) at or above the age of 30). The structured pre-coded Arabic questionnaire included sociodemographic data, a BMD questionnaire, menstrual history, an Arab Teen Lifestyle Study questionnaire, and food frequency data. Metabolic Equivalents (METs) were calculated from physical activity. Analysis of serum PTH, 25(OH) vitamin D (VD) was performed with chemiluminescent immunoassay. BMD was measured with a calcaneal qualitative ultrasound.

RESULTS

Most women had age-matched Z-scores, with very few (24 (2.7%)) being non-age-matched with no identified secondary causes. Significant Z-score determinants before PBD were BMI (OR: 0.167, p = 0.003) and total METs (OR: 0.160, p < 0.005). After the age of PBD, significant predictors were parity (OR: 0.340, p = 0.042), history of vitamin D deficiency (OR: 0.352, p = 0.048), and BMI (OR: 0.497, p = 0.019).

CONCLUSIONS

Early determinants of Z-scores among premenopausal women were the nutritional status and physical activity. After the age of PBD, parity and vitamin D status offer additional determinants. For better BMD, attention should be paid to early physical activity and healthy nutrition, especially for vitamin D, with intensification of efforts during the childbearing period.

Gender Disparities in Osteoporosis Knowledge, Health Beliefs and Preventive Behaviors in Najran City, Saudi Arabia

Osteoporosis is a chronic bone disease affecting both men and women, but it is more prevalent in women. Promoting a healthy lifestyle among adults, particularly women, is crucial in preventing and reducing the osteoporosis impact. This study aimed to compare the osteoporosis knowledge, health beliefs and preventive behaviors among adult male and female in Najran city Saudi Arabia. This cross-sectional study was performed on 516 males and 581 females in Najran City, Saudi Arabia, from January to April 2023. The data collection instrument is a self-reported online questionnaire consisting of basic data, the Osteoporosis Preventive Behavior (OPB) scale, the osteoporosis knowledge assessment tool, and the osteoporosis health belief scale. The results revealed that male participants had a higher OPB (26.70) than females (20.32). However, females have a higher knowledge (10.71), perceive themselves as more susceptible to osteoporosis (20.34) and had higher exercise barriers (20.11) compared to males (9.97, 18.79 and 19.20, respectively). Statistically significant correlations (p < 0.001) were observed between OPB, osteoporosis knowledge (r = 0.26), perceived susceptibility (r = 0.33), severity (r = 0.53), exercise (r = 0.54) and calcium (r = 0.33) benefits, exercise (r = 0.40) and calcium (r = 0.81) barriers and health motivation (r = 0.37). The study concluded significant disparities between males and females regarding osteoporosis-related knowledge, preventive behaviors, perceived susceptibility, severity, and exercise perceived barriers. The results suggest gender-based educational interventions to enhance OPB by addressing osteoporosis-related knowledge, perceived susceptibility, seriousness, benefits, and health motivation.

The Prevalence of Osteoporosis and Osteopenia Among Older Adults in a Community-Based Setting in Riyadh, Saudi Arabia

Background Osteoporosis is a disease of bone density. It makes bones fragile and easy to break. Fragility fractures can cause significant morbidity, mortality, poor quality of life, and financial stress on medical care. Osteoporosis is overlooked and undertreated. Saudi Arabia issued a national plan promoting the early diagnosis and management of osteoporosis. Few and old studies are available in Saudi Arabia estimating the prevalence of osteoporosis in the Saudi older adult population. The aim of this study is to measure the prevalence of osteoporosis and osteopenia among older adult patients. Methodology This retrospective cross-sectional study is based on data gathered from patients ≥60 years of age. Data were collected from January 1, 2016, to December 31, 2021, for patients who were attending family medicine clinics at King Faisal Specialist Hospital & Research Centre in Riyadh, Saudi Arabia, who were screened using dual-energy X-ray absorptiometry (DEXA). Patients who have secondary causes of osteoporosis were excluded. Results A total of 1,302 patients were studied during the course of data collection. The mean age was 68.26. Out of the studied subjects, 75% were female and 25% were males. The prevalence of osteoporosis was 8.2% and 11.8% in femoral and lumbar bone mineral density (BMD) results, respectively. The prevalence of osteopenia based on femoral and lumbar BMD results was 50.2% and 41.2%, respectively. Conclusion Osteoporosis and osteopenia are prevalent in the Saudi older adult population. Multiple clinical characteristics have been associated with low bone density disease. Thus, it is important to reinforce primary care physicians' efforts for early screening and treatment of the Saudi older adult population based on their clinical and demographic risk factors.

Osteoporosis: Is the prevalence increasing in Saudi Arabia

Background and Objective:

The objective of this analysis is to report from a teaching hospital in eastern Saudi Arabia hospital based prevalence of osteopenia and osteoporosis.

Methods:

This is a retrospective study of all patients who underwent dual-energy X-ray absorptiometry (DXA) scan between January 1, and December 31, 2018, at King Fahd Hospital of the University at Alkhobar, Saudi Arabia. Demographic data of patients, which included age, sex, diabetes mellitus status based on fasting blood sugar, hemoglobin A1C, Vitamin D level, parathormone level, and T score of the neck of femur and lumbar spine was extracted from the Quadrumed patient care system. The data was entered into database and analyzed.

Results:

Three hundred and one patients had a DXA scan for the year 2018, a jump of 27.2% of requests to diagnose osteoporosis. There were 55 (18.27%) were male and rest females (246). The average age for males was 65.2 ± 10.5 and females 62.9 ± 9.4 years. Using T score of the lumbar spine, 63.6% were osteoporotic in males and 52.8% in females.

Conclusions:

The hospital-based study shows that the prevalence of osteoporosis has significantly increased in men to 63.6%, while in postmenopausal women to 58.4%, this is high compared to the earlier reports.

Estimated Direct Medical Cost of Osteoporosis in Saudi Arabia: A Single-Center Retrospective Cost Analysis

Osteoporosis and its complications are a major health concern in Saudi Arabia, and the prevalence of osteoporosis is on the rise. The aim of this study was to estimate the direct healthcare cost for patients with osteoporosis. A retrospective study was carried out among adult patients with osteoporosis in a teaching hospital in Saudi Arabia. A bottom-up approach was conducted to estimate the healthcare resources used and the total direct medical cost for the treatment of osteoporosis and related fractures. The study included 511 osteoporosis patients, 93% of whom were female. The average (SD) age was 68.5 years (10.2). The total mean direct medical costs for patients without fractures were USD 975.77 per person per year (PPPY), and for those with osteoporotic fractures, the total direct costs were USD 9716.26 PPPY, of which 56% of the costs were attributable to surgery procedures. Prior to fractures, the main cost components were medication, representing 61%, and physician visits, representing 18%. The findings of this study indicated the economic impact of osteoporosis and related fractures. With the aging population in Saudi Arabia, the burden of disease could increase significantly, which highlights the need for effective prevention strategies to minimize the economic burden of osteoporosis.

Diagnosis and management of osteoporosis in postmenopausal women in Gulf Cooperation Council (GCC) countries: consensus statement of the GCC countries' osteoporosis societies under the auspices of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO)

A consensus platform is provided by the experts of the Gulf Cooperation Council (GCC) countries' respective osteoporosis societies, on which specific guidelines can be developed further for regional use on the assessment and treatment of postmenopausal women at risk from fractures due to osteoporosis.

INTRODUCTION

Guidance is provided in a Gulf Cooperation Council (GCC) country setting on the assessment and treatment of postmenopausal women at risk from fractures due to osteoporosis, which is an adaptation of the European guidance by Kanis et al., jointly published by the International Osteoporosis Foundation and the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). The respective osteoporosis societies of the Gulf Cooperation Council (GCC) countries assembled for a unifying consensus on the diagnosis and management of osteoporosis in postmenopausal women for the region.

METHODS

The Chair for Biomarkers of Chronic Diseases (CBCD) in King Saud University (KSU), Riyadh, Kingdom of Saudi Arabia (KSA), in cooperation with the Saudi Osteoporosis Society (SOS), hosted regional experts and respective leaders from different GCC osteoporosis societies, together with an adviser from the ESCEO. An assembly of experts representing the different osteoporosis societies from Saudi Arabia, the UAE, Bahrain, Oman, and Kuwait gathered on February 15-16, 2019 in Riyadh, KSA for the formulation of a general osteoporosis consensus for the region.

RESULTS

The following areas were covered: diagnosis of osteoporosis and assessment of fracture risk; general and pharmacological management of osteoporosis; and hip fractures, vitamin D, recommendation on which FRAX tool to follow, and the importance of country-specific FRAX® and fracture liaison services for secondary fracture prevention.

CONCLUSIONS

A platform is provided on which specific guidelines can be developed for regional use in GCC.

Influence of bone mineral density in circulating adipokines among postmenopausal Arab women

Osteoporosis and osteopenia has a significant link with substantial fracture risk. Epidemiological data revealed a protective role of adipose tissue on bone biology in postmenopausal osteoporosis. The current study assessed the associations between select adipokines and bone mineral density (BMD) in postmenopausal women. A total of 175 Saudi postmenopausal women were selected and categorized based on their BMD (normal & low-BMD). Circulating levels of select adipokines (adiponectin, resistin, leptin, and adipsin), insulin, 25(OH)D and RANKl were determined using commercially available assay kits. BMD was measured by dual-energy X-ray absorptiometry (DXA). Overall and among low-BMD subjects, adiponectin consistently showed a significant inverse association with BMD (overall −0.34, p < 0.01; low BMD group −0.34, p < 0.01). In multiple regression, adiponectin (−0.29 ± 0.06, p < 0.00) and resistin (−0.08 ± 0.04, p < 0.05) were inversely significant with BMD overall, but after stratification the significance was lost for resistin (−0.05 ± 0.04, p < 0.224) whereas adiponectin remained (−0.22 ± 0.07, p < 0.02) in low-BMD subjects. Adipsin, leptin and lipocalin-2 showed no significant associations. Findings of the present study revealed that only adiponectin showed a significantly strong inverse association with low BMD, suggesting that insulin sensitivity may influence bone health in Arab postmenopausal women.

Reassessment of osteoporosis-related femoral fractures and economic burden in Saudi Arabia

The current study reassesses the prevalence of fragility fractures and lifetime costs in the Eastern Province of Saudi Arabia. Forty-two percent (391) of the fractures were at the neck of the femur, and 38.6 % (354) were inter-trochanteric fractures. The overall incidence was assessed to be 7528 (1,300,336 population 55 years or older) with the direct cost of SR564.75 million ($150.60 million). A National Fracture Registry and osteoporosis awareness programs are recommended.

PURPOSE

Proximal femur fragility fractures are reported to be increasing worldwide due to increased life expectancy. The current study is carried out to assess the incidence of such fractures in the Eastern Province of Saudi Arabia and to assess the costs incurred in managing them annually. Finally, by extrapolating the data, the study can calculate the overall economic burden in Saudi Arabia.

METHODS

The data of fragility proximal femur fractures was collected from 24 of 28 hospitals in the Eastern Province. The data included age, sex, mode of injury, type of fracture, prescribed drug (and its cost), and length of hospital stay. Population statistics were obtained from the Department of Statistics of the Saudi Arabian government Web site.

RESULTS

Twenty-four hospitals (85 %) participated in the study. A total of 780 fractures were sustained by 681 patients. Length of stay in the hospital averaged 23.28 ± 13.08 days. The projected fracture rate from all the hospitals would be 917 (an incidence of 5.81/1000), with a total cost of SR68.77 million. Further extrapolation showed that the overall incidence could be 7528 (1,300,336 population 55 years or older) with the direct cost of SR564.75 million ($150.60 million).

CONCLUSIONS

Osteoporosis-related femoral fractures in Saudi Arabia are significant causes of morbidity besides incurring economic burden. We believe that a National Fracture Registry needs to be established, and osteoporosis awareness programs should be instituted in every part of Saudi Arabia so that these patients can be diagnosed early and treated appropriately to reduce both the number of fractures and the economic burden of the fractures.

2015 Guidelines for Osteoporosis in Saudi Arabia: Recommendations from the Saudi Osteoporosis Society

BACKGROUND AND OBJECTIVES

To provide guidelines for medical professionals in Saudi Arabia regarding osteoporosis.

DESIGN AND SETTINGS

A panel of 14 local experts in osteoporosis assembled to provide consensus based on the strength of evidence and expert opinions on osteoporosis treatment.

PATIENTS AND METHODS

The Saudi Osteoporosis Society (SOS) formed a panel of experts who performed an extensive published studies search to formulate recommendations regarding prevention, diagnosis, and treatment of osteoporosis in Saudi Arabia. Both local and international published studies were utilized whenever available.

RESULTS

Dual x-ray absorptiometry (DXA) scanning is still the golden standard for assessing bone mineral density (BMD). In the absence of local, country-specific fracture risk assessment tool (FRAX), the SOS recommends using the USA (White) version of the FRAX tool. All women above 60 years of age should be evaluated for BMD. This is because the panel recognized that osteoporosis and osteoporotic fractures occur at a younger age in Saudi Arabia. Hormone replacement therapy (HRT) is not recommended for treating postmenopausal women with osteoporosis. BMD evaluation should be performed 1-2 years after initiating intervention, and the assessment of bone turnover biomarkers should be performed whenever available to determine the efficacy of intervention.

CONCLUSION

All Saudi women above the age of 60 years must undergo a BMD assessment using DXA. Therapy decisions should be formulated with the use of the USA (White) version of the FRAX tool.

The impact of adding weight-bearing exercise versus nonweight bearing programs to the medical treatment of elderly patients with osteoporosis

BACKGROUND

Osteoporosis is a major public health problem affecting the elderly population, particularly women. The objective of the study was to evaluate the effects of adding weight-bearing exercise as opposed to nonweight-bearing programs to the medical treatment of bone mineral density (BMD) and health-related quality of life (HRQoL) of elderly patients with osteoporosis.

MATERIALS AND METHODS

Participating in the study were 40 elderly osteoporotic patients (27 females and 13 males), with ages ranging from 60 to 67 years, who were receiving medical treatment for osteoporosis. They were assigned randomly into two groups: Group-I: Twenty patients practiced weight-bearing exercises. Group-II: Twenty patients did nonweight-bearing exercises. All patients trained for 45-60 min/session, two sessions/week for 6 months. BMD of the lumbar spine, right neck of femur, and right distal radial head of all patients were measured by dual-energy X-ray absorptiometry before and after both treatment programs. In addition, the QoL was measured by means of the HRQoL "ECOS-16" questionnaire.

RESULTS

T-tests proved that mean values of BMD of the lumbar spine, right neck of femur and right distal radial head were significantly increased in both groups with greater improvement in the weight-bearing group. The QoL was significantly improved in both groups, but the difference between them was not significant.

CONCLUSION

Addition of weight-bearing exercise program to medical treatment increases BMD more than nonweight-bearing exercise in elderly subjects with osteoporosis. Furthermore, both weight-bearing and nonweight-bearing exercise programs significantly improved the QoL of patients with osteoporosis.

Inflammatory and bone turnover markers in relation to PTH and vitamin D status among saudi postmenopausal women with and without osteoporosis

Postmenopausal osteoporosis is characterized by rapid bone loss occurring in the post-menopausal period. The bone loss predominantly involves the trabecular bone and is brought about by an imbalance between the bone remodeling process which can be influenced by factors that could cause or contribute to osteoporosis. Pro-inflammatory cytokines (Il-1β, Il-6, IL-8 and TNF-α) have been implicated in the regulation of bone cells and play a critical role in bone remodeling. They act both directly and indirectly to increase bone resorption, and/or inhibit bone formation. The aim of the study is to determine whether pro-inflammatory cytokines correlate with bone turnover markers (BTM) in a cohort of Saudi post-menopausal women with or without osteoporosis and which BTMs will correlate with PTH and Vitamin D for use in osteoporosis diagnosis. The study is composed of 100 post-menopausal patients and 100 controls aged around 50 years. Serum concentrations of pro-inflammatory and BTMs as well as PTH and vitamin D were determined by ELISA, Luminex and electrochemiluminescence. Serum calcium, phosphorus, glucose, and lipid profile were measured by using a chemical analyzer. There was a significant increase in the levels of pro-inflammatory cytokines, PTH, CTx, and glucose. A significantly lower vitamin D and osteocalcin levels were observed in subjects with osteoporosis than those without. No significant differences were recorded in the circulating lipid profile between groups. The present study proved that the pro-inflammatory cytokines accelerate the bone loss in postmenopausal women.

Inflammatory and bone turnover markers in relation to PTH and vitamin D status among Saudi postmenopausal women with and without osteoporosis

Postmenopausal osteoporosis is characterized by rapid bone loss occurring in the post-menopausal period. The bone loss predominantly involves the trabecular bone and is brought about by an imbalance between the bone remodeling process which can be influenced by factors that could cause or contribute to osteoporosis. Pro-inflammatory cytokines (Il-1β, Il-6, IL-8 and TNF-α) have been implicated in the regulation of bone cells and play a critical role in bone remodeling. They act both directly and indirectly to increase bone resorption, and/or inhibit bone formation. The aim of the study is to determine whether pro-inflammatory cytokines correlate with bone turnover markers (BTM) in a cohort of Saudi post-menopausal women with or without osteoporosis and which BTMs will correlate with PTH and Vitamin D for use in osteoporosis diagnosis. The study is composed of 100 post-menopausal patients and 100 controls aged 50 years and above. Serum concentrations of pro-inflammatory and BTMs as well as PTH and vitamin D were determined by ELISA, Luminex and electrochemiluminescence. Serum calcium, phosphorus, glucose, and lipid profile were measured by using a chemical analyzer. There was a significant increase in the levels of pro-inflammatory cytokines, PTH, CTx, and glucose. A significantly lower vitamin D and osteocalcin levels were observed in subjects with osteoporosis than those without. No significant differences were recorded in the circulating lipid profile between groups. The present study proved that the pro-inflammatory cytokines accelerate the bone loss in postmenopausal women.

Effect of simvastatin and atorvastatin on serum vitamin d and bone mineral density in hypercholesterolemic patients: a cross-sectional study

Background. Besides lipid-lowering effect of statins, they have been shown to have nonlipid lowering effects, such as improving bone health. An improvement in bone mineral density (BMD) has been indicated in some studies after the use of statins, in addition to an increase in 25-hydroxyvitamin D (25OHD) level. The aim of this study is to explore the association between statins and bone health taking into consideration 25OHD level and BMD. Methods. This is a randomized, cross-sectional comparative study. Subjects were divided into two groups, hypercholesterolemic participants taking simvastatin or atorvastatin as the study group and a matched control group not taking statins. All participants were assessed for serum 25OHD and BMD at lumbar spine and femoral neck. Results. A total of 114 participants were included in the study, 57 participants in each group. Results of serum 25OHD showed no significant difference between study and control groups (P = 0.47), while BMD results of lumbar spine and femoral neck showed significant difference (P = 0.05 and 0.03, resp.). Conclusion. Simvastatin and atorvastatin, at any dose for duration of more than one year, have no additive effect on 25OHD level but have a positive effect on the BMD.

Established Osteoporosis and Gaps in the Management: Review from a Teaching hospital

Background:

International osteoporosis foundation described severe or established osteoporosis as an osteoporotic individual with a fragility fracture. Orthopaedic surgeons frequently manage fractures, but we believe that large gaps are prevalent in the medical management of osteoporosis after fractures are fixed.

Aim:

The aim of this analysis is to assess the investigations and gaps in the management of osteoporosis in patients admitted with a fragility fracture of femur at King Fahd Hospital of the University, AlKhobar, Saudi Arabia.

Materials and Methods:

A retrospective analysis of all admission and discharge; medical and pharmacy records database of patients over ≥ 50 years with fragility fracture between January 2001 and December 2011. The outcome measures assessed were investigations such as serum calcium, phosphorous, alkaline phosphatase, parathormone, 25 hydroxy vitamin D (25OHD) levels and a dual energy X-ray absorptiometry (DEXA). Secondly once the fracture was fixed what medications were prescribed, calcium and vitamin D, antiresorptives and anabolic agents.

Results:

There were 207 patients admitted during the study period with an average age of 69.2 (12.1) years and 118 were females. In 169 (81.6%) patients, the fracture site was proximal femur. Vitamin D (25OHD) was requested in 31/207 (14.9%). DEXA scan was ordered in 49/207 (24.1%). A total of 78/207 (37.6%) patients received calcium and vitamin D3 and 94/207 (45.4%) either got calcium or vitamin D3. Bisphosphonates was used in 35, miacalcic nasal spray in 25 and anabolic agent teriparatide was prescribed in 21 patients. Post-fixation 126/207 (60.8%) patients did not receive any anti-osteoporotic medication. In untreated group, there were 87 males and 39 females.

Conclusions:

The study found that in patients, who sustained a fragility fracture, confirmation of osteoporosis by DEXA was very low and ideal treatment for severe osteoporosis was given out to few patients. More efforts are needed to fill this large gap in the correct management of osteoporosis related fractures by orthopaedic surgeons.

Evaluation and identification of damaged single nucleotide polymorphisms in COL1A1 gene involved in osteoporosis

INTRODUCTION

Single-nucleotide polymorphisms (SNPs) are biomarkers for exploring the genetic basis of many complex human diseases. The prediction of SNPs is promising in modern genetic analysis but it is still a great challenge to identify the functional SNPs in a disease-related gene. The computational approach has overcome this challenge and an increase in the successful rate of genetic association studies and reduced cost of genotyping have been achieved. The objective of this study is to identify deleterious non-synonymous SNPs (nsSNPs) associated with the COL1A1 gene.

MATERIAL AND METHODS

The SNPs were retrieved from the Single Nucleotide Polymorphism Database (dbSNP). Using I-Mutant, protein stability change was calculated. The potentially functional nsSNPs and their effect on proteins were predicted by PolyPhen and SIFT respectively. FASTSNP was used for estimation of risk score.

RESULTS

Our analysis revealed 247 SNPs as non-synonymous, out of which 5 nsSNPs were found to be least stable by I-Mutant 2.0 with a DDG value of > -1.0. Four nsSNPs, namely rs17853657, rs17857117, rs57377812 and rs1059454, showed a highly deleterious tolerance index score of 0.00 with a change in their physicochemical properties by the SIFT server. Seven nsSNPs, namely rs1059454, rs8179178, rs17853657, rs17857117, rs72656340, rs72656344 and rs72656351, were found to be probably damaging with a PSIC score difference between 2.0 and 3.5 by the PolyPhen server. Three nsSNPs, namely rs1059454, rs17853657 and rs17857117, were found to be highly polymorphic with a risk score of 3-4 with a possible effect of non-conservative change and splicing regulation by FASTSNP.

CONCLUSIONS

Three nsSNPs, namely rs1059454, rs17853657 and rs17857117, are potential functional polymorphisms that are likely to have a functional impact on the COL1A1 gene.

An epidemiological analysis of the incidence of osteoporosis and osteoporosis-related fractures among the Saudi Arabian population

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.

Are we missing osteoporosis-related vertebral fractures in men?

STUDY DESIGN

Retrospective study.

PURPOSE

To assess the prevalence of osteoporosis related spinal fractures among Saudi Arabian males.

OVERVIEW OF LITERATURE

Vertebral fractures are the most common complication of osteoporosis and is the first sign in both sexes and only 25 to 30% of radiographically observed vertebral deformities are recognized.

METHODS

We analyzed the chest radiographs of consecutive Saudi Arabian men ≥ 50 years and who visited the emergency room of King Fahd University Hospital, Al Khobar, Saudi Arabia for a period of 12 months between November 1, 2007 and October 31, 2008. The site and type of fractures were classified as per the semi-quantitative technique. The other data retrieved from the medical records of patients included medications and clinical investigations for osteoporosis.

RESULTS

Nine hundred seventy chest radiographs were performed during the study period and 876 radiographs could be analyzed. One hundred fifteen patients (13.1%) had 157 fractures. The mean age was 67.85 ± 10.1 years. There was more than one fracture in 21 patients (18.2%). The majority of fractures (n = 102, 64.9%) were observed in thoracic spine. Seventy-one (45.2%) fractures were classified as mild, 54 (34.4%) were moderate and 32 (20.4%) were severe. For 26 (22.6%) patients, the report of the radiologist highlighted the fracture.

CONCLUSIONS

Saudi Arabian males with osteoporosis continue to be missed despite the high prevalence osteoporosis leading to vertebral fractures. We believe it is important for physicians to identify vertebral fractures early and treat then appropriately before an extremity fracture occurs with high mortality.

Vitamin D levels in healthy men in eastern Saudi Arabia

BACKGROUND

Studies in 1980s and 1990s indicated that vitamin D levels in the ethnic Saudi Arabian population were low but no studies since that time have evaluated vitamin D levels among healthy young or middle-aged Saudi men. Thus, we assessed the serum level of 25-hydroxyvitamin D (25OHD) among healthy Saudi Arabian men living in the Eastern Province.

SUBJECTS AND METHODS

One hundred males aged 25-35 years (the age range of peak bone mass) and 100 males aged 50 years or older were randomly selected and evaluated clinically, including measurement of serum calcium, parathyroid hormone (PTH) and serum 25OHD levels. Vitamin D deficiency was defined as a serum level of 25OHD of </=20 ng/mL and insufficiency as a serum level between >20 ng/mL and <30 ng/mL and normal >or=30 ng/mL.

RESULTS

The mean (SD) age of subjects in the younger age group was 28.2 (4.5) years. Twenty-eight (28%) had low 25OHD levels; 10 (10%) subjects were vitamin D deficient with a mean level of 16.6 (3.4) ng/mL and 18 (18%) were vitamin D insufficient with a mean level of 25.4 (2.7) ng/mL. In the older age group, the mean age was 59.4 (15.6) years and 37 (37%) had low 25OHD; 12 (12%) subjects were deficient with a mean 25OHD level of 16.7 (3.4) ng/mL and 25 (25%) were insufficient with a mean 25OHD level of 25.3 (3.3) ng/mL.

CONCLUSIONS

The prevalence of vitamin D deficiency among healthy Saudi men is between 28% to 37%. Vitamin D deficiency among young and middle age Saudi Arabian males could lead to serious health consequences if the issue is not urgently addressed.

Osteoporosis prophylaxis in patients receiving chronic glucocorticoid therapy

BACKGROUND AND OBJECTIVES

Glucocorticoid-induced osteoporosis (GIOP) is the most common form of secondary osteoporosis, yet few patients receive proper measures to prevent its development. We retrospectively searched prescription records to determine if patients receiving oral prednisolone were receiving prophylaxis or treatment for osteopenia and osteoporosis.

METHODS

Patients who were prescribed > or =7.5 milligrams of prednisolone for 6 months or longer during a 6- month period were identified through the prescription monitoring system. Demographic and clinical data were extracted from the patient records, and dual energy x-ray absorptiometry (DEXA) scans were retrieved, when available. Use of oral calcium, vitamin D and anti-resorptives was recorded.

RESULTS

One hundred males and 65 females were receiving oral prednisolone for a mean (SD) duration of 40.4 (29.9) months in males and 41.2 (36.4) months in females. Twenty-one females (12.7%) and 5 (3%) males had bone mineral density measured by DEXA. Of those, 10 (47.6%) females and 3 (50%) males were osteoporotic and 11(52.4%) females and 2 (40%) males were osteopenic. Calcium and vitamin D were prescribed to the majority of patients (60% to 80%), but none were prescribed antiresorptive/anabolic therapy.

CONCLUSIONS

Patients in this study were neither investigated properly nor treated according to the minimum recommendations for the management of GIOP. Physician awareness about the prevention and treatment of GIOP should be a priority for the local health care system.

Osteoporosis in developing countries

Osteoporosis poses a huge challenge in developing countries due to demographic transition and aging of the population coupled with limited availability of resources. The exact disease burden is difficult to quantify because of the paucity of data. Ethnicity affects bone density as well as fracture risk. Population-specific normative data for bone density are lacking in large parts of the world. Vitamin D deficiency is common even in sunny countries. The WHO has developed an algorithm for estimation of 10-year fracture risk which may be used even in the absence of bone mineral density.

Economic implications of osteoporosis-related femoral fractures in Saudi Arabian society

PURPOSE

To assess the prevalence of proximal femoral fractures due to osteopenia and osteoporosis in the eastern province of Saudi Arabia and to estimate the cost of management of osteoporosis-related femoral fractures.

METHODS

This is a retrospective study of all patients admitted to the orthopaedic department of the King Fahd Hospital of the University, AlKhobar between January 2001 and December 2006. There were 63 patients admitted to the hospital with osteoporosis-related fractures and 43 sustained proximal femoral fractures. The cost of management of these patients from admission to discharge was analyzed. A verbal survey was carried with all the hospitals in the eastern province to establish the prevalence of osteoporosis-related femoral fractures for a 12 month period.

RESULTS

There were 23 male and 20 female patients with average age of 72.11 years and the hospital stay was for 760 days. The cost of managing these patients was SR2.09 million (US$557,333.00) at the rate of SR48,712 (US$12,989.90) per patient. The survey of all hospitals in the eastern province of Saudi Arabia showed that 984 proximal femoral fractures occurred in a population of 164,121. The estimated cost was SR48 million (US$12.78 million) annually. On a national basis, with a population of 1,461,401 Saudis aged 50 years or more, 8,768 would suffer femoral fractures yearly at a cost of SR4.27 billion (US$1.14 billion).

CONCLUSION

This study raises serious economic concerns. The annual cost of management of osteoporosis-related proximal femoral fractures in the eastern province of Saudi Arabia is US$12.78 million. As the Saudi Arabian population is aging and the number of elderly patients is bound to increase, with an accompanying increase in fractures, the impact on health care budgets will be tremendous.