Prevalence of low bone mass in postmenopausal Kuwaiti women residents in the largest province of Kuwait

Frequency of Osteoporosis-Related Fractures in the Kingdom of Bahrain

BACKGROUND

Osteoporosis-related fragility fractures are increasing worldwide. An assessment of the prevalence of fragility fractures in Bahrain is needed to determine proper action and preventive strategies. The main objective of this study was to conduct a retrospective cross-sectional study to investigate the prevalence of fragility fractures in adult Bahraini patients. Another objective was to explore the relationship of fragility fracture risk with BMD, age, sex, BMI, vitamin D status, and therapy.

METHODS

To investigate the fragility fractures, we retrospectively reviewed the dual-energy X-ray absorptiometry (DEXA) data of patients who underwent scans for the diagnosis of osteoporosis between 2016 and 2018. The data were collected from four large centers in Bahrain. The patients' medical records were reviewed for the fragility fracture data, BMD, sex, age, BMI, vitamin D status, and therapy.

RESULTS

Among a total of 4572 patients who visited the radiology departments during the 3-year study period, only 412 patients with fragility fractures were considered for the current study. The mean age of the patients in this cohort was 63.9 ± 12.2 years. There were 393 females (95.6%). Among the 431 fragility fractures, there were 175 (40.6%) belonging to three common fracture sites: vertebral (86, 20.9%), femur (60, 14.6%), and distal radius (Colles) fractures (29, 7%). Other fragility fractures were hand (7%), radius and ulna (3.7%), humerus (6.5%), tibia and fibula (5.6%), foot/ankle (27.9%), ribs (3.0%), and pelvis (1.6%). Our results revealed a significant association between the fragility fractures and BMD (χ2 = 6.7, p = 0.035). We reported a significant association of fragility fracture with sex (p = 0.006) and with denosumab therapy (p < 0.001).

CONCLUSIONS

This study reported a reduced BMD and an increased prevalence of fragility fractures among Bahraini subjects. The highest frequencies of fragility fractures among our cohort were foot/ankle, vertebral, and hip fractures, respectively. We showed a statistically significant association between fragility fractures and BMD. The current study indicated that not only patients with low BMD but also patients with fragility fractures were undertreated. Thus, the immediate initiation of treatment and the synthesis of local osteoporosis treatment guidelines are warranted.

Addressing gaps in osteoporosis screening in kuwait using opportunistic quantitative computer tomography (QCT): a retrospective study

Osteoporosis is a common skeletal disorder which is underdiagnosed and undertreated. Consequent fragility fractures are associated with high morbidity and mortality. Prevention of these fractures is possible by timely osteoporosis screening followed by timely therapeutic interventions when needed. Utilizing all available modalities such as bone density measurements on preexisting CT scans could help narrow the diagnostic gap.

PURPOSE

To demonstrate the feasibility and clinical utility of opportunistic osteoporosis screening in Kuwait using QCT, aiming to increase screening rates in a country with a relatively high prevalence of osteoporosis and an alarming trend of increasing incidence of fractures.

METHODS

At a tertiary referral center, all abdominal CT scans performed on females ≥60 years old between 12/2020 and 12/2021 were retrospectively utilized for asynchronous QCT acquisition. The average volumetric bone mineral density (vBMD) was calculated, and rates of osteoporosis (vBMD < 80 mg/cm³ calcium hydroxyapatite) and osteopenia (80-120 mg/cm³) were determined. CT images were reviewed to assess for the presence of vertebral fractures. For each patient, the electronic health record was reviewed for any previous DXA scans.

RESULTS

vBMD was calculated in 305 females ≥60 years old (mean [SD] 71 [8.7], range 60-93). Low bone mass was detected in 258 patients (84.6%); 148 (48.5%) met criteria for osteopenia and 110 (36.1%) for osteoporosis. Osteoporotic vertebral fractures were observed in 64 (21.0%) study participants. Only 73 patients (23.9% of total) had a previous DXA documented in the reviewed health records. For 231 patients who were ≥65 years old, who would routinely qualify for a screening DXA, only 63 (27.3%) had a documented DXA available.

CONCLUSION

vBMD measurements obtained by opportunistic QCT had comparable rates of osteopenia and osteoporosis detection to those previously reported using DXA in a similar population in Kuwait. These findings suggest that opportunistic QCT on preexisting CT scans can be effectively utilized to narrow gaps in osteoporosis screening.

Osteoporosis Among Bahraini Women Based on Bone Mineral Density Measurements: A Retrospective Study

Objectives The objective is to estimate the prevalence of osteoporosis among women in Bahrain who are aged ≥18 years. Methods In this retrospective study conducted at Salmaniya Medical Complex, a total of 590 Bahraini women were enrolled. Their bone mineral density measurements were obtained through dual-energy x-ray absorptiometry (DEXA) performed between January 2017 and December 2017. Six sites were chosen as the measurement targets. Patients were diagnosed with osteoporosis if their T-score was > -2.5 according to the World Health Organization guidelines. Results Osteoporosis was diagnosed in 27.1% of the patients; 53.2% had osteopenia, 0.3% had severe osteoporosis, and 19.3% had normal bone conditions. The prevalence of osteopenia as well as osteoporosis increased with age. Conclusion Osteoporosis and osteopenia are common among Bahraini women. This study provides useful information on the prevalence of osteoporosis among Bahraini women. Major steps by health authorities in the country are needed to reduce morbidity and improve the quality of life.

Prevalence of Osteoporosis Among Iranian Postmenopausal Women: A Systematic Review and Meta-analysis

Objectives:

Osteoporosis is the most common metabolic bone disease. It is considered the silent epidemic, with high prevalence after menopause, in the current time. Different studies conducted in Iran have reported different prevalence. The present systematic review and meta-analysis aims to estimate the overall prevalence of osteoporosis in Iranian postmenopausal women.

Methods:

The national scientific databases Scientific Information Database and MagIran and the international scientific databases PubMed, Web of Science, and Scopus were searched for related articles without any time limitation. The keywords osteopenia, osteoporosis, post menopause, OP, bone mineral density, and Iran along with their combinations were used in the search. The inconsistency in the data was examined using I² test. The data were analyzed using the meta-analysis method and the random-effects model in Stata software, version 14.

Results:

The analysis of 26 articles with a sample size of 6735 showed that the prevalence of osteoporosis and osteopenia in Iranian postmenopausal women is, respectively, 33.70% (95% CI [confidence interval]: 22.68-44.73) and 47.60% (95% CI: 32.88-62.32). The pooled prevalence of osteoporosis in the spine and in the femur bone was 31.99% and 15.93%, respectively. Also, the prevalence of osteopenia in the spine and in the femur bone was 22.48% and 39.88%, respectively.

Conclusion:

Osteoporosis and osteopenia are highly prevalent in Iranian postmenopausal women to the extent that one-third of women suffer from osteoporosis and nearly half of them suffer from osteopenia. It seems essential to teach a healthy lifestyle to these women to reduce the prevalence of these issues.

Optimization of osteoporosis and osteopenia management among renal transplant recipients

Background

Osteoporosis and osteopenia occur frequently in renal transplant recipients due to long-term use of immune-suppressants including corticosteroids. Previous treatment options like bisphosphonates had acceptable but rather unsatisfactory results after transplant. The aim of the current study is to directly compare the efficacy of denosumab and oral ibandronate in late RTR with low bone mineral density.

Results

The study was conducted Iin Hamed Al-Essa Kidney transplant center, Kuwait, in 2020. The data of 52 denosumab and 48 ibandronate patients were collected at the baseline and after one year of treatment. Spine and hip T-score readings, side effects, and other laboratory results were analyzed to evaluate the use of both medications. The mean number of months after transplant was 25 (± 13.9) months. After one year of treatment, denosumab alleviated both spinal osteoporosis and osteopenia T-score values from −3.13 to −2.4 (p = 0.008) and from −1.9 to −1.5 (p = 0.015), respectively. Besides, it reduced hip osteoporosis and osteopenia insignificantly from −3.45 to −3.1 and from −1.5 to −1.3, respectively (p > 0.05). Ibandronate improved spinal osteopenia from −1.6 to −1.55 (p = 0.97) and failed to show any positive impact on other sites; the spinal osteoporosis changed from −2.8 to −3 and hip osteoporosis and osteopenia changed from −3.1 to −3.12 and from −1.4 to −1.45, respectively (p > 0.05). The use of ibandronate was more associated with gastrointestinal tract (GIT) side effects, while hypocalcemia episodes were significantly higher in the denosumab group.

Conclusion

Denosumab improved both spinal and hip T-score values in comparison with ibandronate in RTR. Close monitoring is required for denosumab patients to prevent the associated hypocalcemia.

Graphical Abstract

Relationship between vitamin D receptor gene polymorphisms (BsmI, TaqI, ApaI, and FokI) and calcium intake on bone mass in young Japanese women

Background

The high prevalence of low bone mass in young women in Japan has emerged as a serious health issue in recent years. Therefore, the aim of the present study was to reevaluate the relationship between genetic and dietary factors, as well as its influence on bone mass in young Japanese women, with particular emphasis on vitamin D receptor (VDR) gene polymorphisms and calcium intake.

Methods

A total of 499 Japanese women aged 20–24 years were enrolled in the study. The bone mass of the calcaneus was assessed using the quantitative ultrasound method and expressed as the osteo sono-assessment index (OSI). VDR gene polymorphisms (BsmI, TaqI, ApaI, and FokI) were analyzed using DNA extracted from saliva. Calcium intake was assessed using the Food Frequency Questionnaire based on food groups (FFQg) and adjusted with the energy intake. Participants were divided into two groups based on the median calcium intake (250 mg/1000 kcal).

Results

Consequently, bone mass was significantly different among the BsmI and TaqI genotypes after adjusting for body mass index (BMI) (p = 0.030 and 0.019, respectively). In addition, the BsmI AA and ApaI GT genotypes showed significant differences in bone mass between the calcium-intake groups, with low OSI in the low-calcium intake group and high OSI in the high-calcium intake group, respectively, even after adjusting for BMI (p = 0.020 and 0.038, respectively).

Conclusions

These findings may prove instrumental in developing a logical approach towards preventing bone loss in young Japanese women.

Screening for Bone Mineral Density and Assessment Knowledge Level of Low Peak Bone Risk Factors and Preventive Practices Among Kuwaiti Future Mothers

Background

Attaining greater peak bone mass (PBM) prior to the onset of bone loss is getting increasing public health attention as healthy strong bones are essential to maintain our life. Females are more susceptible to bone loss. Knowledge and awareness about low peak bone mass and its related risk factors are important contributors to its preventive behavior.

Objective

To screen apparently healthy young Kuwaiti future mothers for low bone mineral density (BMD) and to assess their knowledge level about determinants of PBM and preventive practices.

Methods

A cross-sectional comparative study on 445 eligible women aged 18–35 years (either students or employees from Kuwait University) was performed. Data on socio-demographic and lifestyle variables were obtained by a semi-structured questionnaire. Their knowledge was assessed using the modified Osteoporosis Knowledge Assessment Tool (OKAT). Bone mineral Density (BMD) was measured using Quantitative Ultrasonography (QUS).

Results

More than half (59.3%) of females had poor knowledge. A statistically significant relation was noted between the overall knowledge score and age, college, occupation, and socioeconomic class (P<0.05 for each). Only 13.9% have low Z-score by QUS. By logistic regression, less carbonated beverages and coffee consumption positively affect BMD, while inadequate exercises level, indoor exposure to sunlight, and less frequency of brisk walking negatively affect BMD.

Conclusion

Unacceptable knowledge score significantly associated with BMD Z-score status. More attention should be devoted to education programs targeting adolescents and young females to promote knowledge about PBM and practice towards accrual and maintenance of bone health.

Osteoporosis among Bahraini Citizens: The First Report

Background and Objective

Osteoporosis and its complications are increasing as the population is aging world over. Every country needs an initial assessment of prevalence to take appropriate steps in limiting the complications of osteoporosis. The objective of this study was to find the prevalence of osteoporosis in the Kingdom of Bahrain.

Methods

We retrospectively reviewed dual-energy X-ray absorptiometry scans of patients who underwent scans for the diagnosis of osteoporosis between January 2016 and December 2017 at the University Medical Center, King Abdullah Medical City, Dr. Sulaiman AlHabib Hospital, Kingdom of Bahrain. The data were collected from the picture archiving and communication system for the study period. Patients' medical records were reviewed for the investigations and treatment ordered. The data were entered into the database and analyzed using SPSS Inc., version 19.

Results

A total of 205 patients with an average age of 58.39 ± 12.12 years were included in the study. There were 185 (90.25%) females and 20 (9.75%) males. Seventy-nine (38.5%) were osteoporotic based on the T score of either at the hip (-< 2.61 ± 1.08) or the spine (-< 3.26 ± 0.78), with a mean age of 60.8 ± 13.1 years. Seventy-two (91.1%) of the osteoporotic patients were female and 42 (58.4%) were ≥65 years. Patients who were osteoporotic were significantly older with P < 0.001. There were 9 patients (4.39%) who had osteoporosis-related fractures.

Conclusions

This study indicates that the prevalence of osteoporosis is common among Bahraini citizens. As the country's total population is <1.2 million, it will not be difficult to target the ≥65-year-old men and women in early diagnosis and treatment to prevent osteoporosis-related fractures.

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.

Bone Health after Fifth Decade in Rural Ambulatory South Indian Postmenopausal Women

Background:

The incidence of postmenopausal osteoporosis continues to rise, as population ages. The morbidity and mortality associated with osteoporotic fractures have a significant negative impact on the economy and quality of life of the affected individual and the community, at large.

Objectives:

We aimed to study the prevalence of osteoporosis in ambulant rural postmenopausal women, and to look at their dietary calcium intake (DCI) and Vitamin D status.

Subjects and Methods:

This was a cross-sectional study conducted in 1565 ambulant South Indian rural postmenopausal women. Bone mineral density was estimated by a dual-energy X-ray absorptiometry scan at the femoral neck (FN) and lumbar spine (LS). DCI was calculated by recall for the previous week, and the blood bone biochemical profile was measured.

Results:

The mean standard deviation (SD) age and body mass index of this population were 60.7 (7.2) years and 26.2 (4.8) kg/m², respectively. The prevalence of osteoporosis was 22% at the FN and 39% at the LS. An increase in the prevalence of osteoporosis was noted at both sites, in successive age categories. Mean (SD) DCI was 420 (282) mg/24 h. Fifty-four percent had Vitamin D deficiency (VDD) (<20 ng/ml) and 6% had severe VDD (<10 ng/ml).

Conclusion:

A significant proportion of this large cohort of south Indian healthy rural postmenopausal women had osteoporosis at either site with advancing age. Most of them had a suboptimal DCI, and over half of them had VDD.

Are we treating osteoporotic fractures of the hip adequately? A Middle Eastern cohort study

Fragility hip fractures treated in a center in the Middle East were retrospectively studied for adequacy of osteoporosis management. Of the 318 patients treated, over 70% did not have a structured investigation and about 30% did not receive any therapeutic supplements. Our series showed a preventable 8.8% secondary fracture rate.

PURPOSE

To study the adequacy of evaluation and treatment of osteoporosis after fragility fractures of the hip. The study also attempts to estimate the prevalence of secondary fractures after the original injury.

METHODS

This is a retrospective evaluation of the electronic database to search all the admissions for fractures of the hip in patients over 50 years at a tertiary care Trauma and Orthopaedic center in the Sultanate of Oman. The study period was defined as October 2010 to December 2015. Their case records, BMD reports, and laboratory data were analyzed. Pharmacological interventions and the documented compliance with such therapy were also recorded.

RESULTS

Over the study period, 318 fragility fractures of the hip were treated. Of these, 233 (73.3%) did not receive a DEXA scan and 94% did not have their vitamin D₃ (vit D) tested. About 29.9% percent cases did not receive any nutritional supplement or therapeutic intervention though diagnosed as fragility fracture. Twenty-eight patients (8.8%) reported for secondary fractures of the hip. Of these, 86% was initiated on supplement after their index fracture though 78.6% had not had a BMD study.

CONCLUSIONS

Less than 27% patients receive BMD test following fragility fracture of the hip and only 6% a vit D3 assay. Secondary fractures of the hip tend to occur in approximately 9% of the cases in Oman; this seems to occur equally in patients who have had as well as not had any calcium and vit D supplements after the index injury.

Bone mineral density in midlife women: the Study of Women's Health in Qatar

OBJECTIVES

The aim of this study is to investigate bone mineral density (BMD) for a large cross-section of midlife Arab women living in Qatar and to evaluate the association of body mass index (BMI), menopause status, and nationality, on BMD of the spine and femur.

STUDY DESIGN

A cross-sectional study was conducted among women aged 40-60 years recruited from nine primary-care health centers in Qatar. BMD (g/m(2)) was assessed at the lumbar spine and the femur.

RESULTS

The combined prevalence of osteopenia and osteoporosis was 4% at the femur and 16.2% at the spine. BMI and menstrual status were both independently associated with BMD at the spine and at the femur (all p values < 0.001). As BMI increased, BMD increased at both the spine and femur. Women who menstruated in the past 12 months had 0.82 g/cm(2) and 0.61 g/cm(2) greater BMD at the spine and femur, respectively, compared with women who had not menstruated in 12 months. Nationality was not associated with mean BMD of the spine or the femur.

CONCLUSIONS

No significant differences were observed between Qatari and non-Qatari women in terms of mean BMD values at the spine and the femur except for the femur in the age group 55-60, where values were lower among non-Qataris (p = 0.04). Multivariable analyses showed that BMI and menstrual status were found to be strongly associated with BMD levels at the spine and femur. The high prevalence of obesity observed in this sample may explain the low levels of osteopenia and osteoporosis observed.