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Almaddah M, Alzahrani F, Gaowgzeh R, Alqarni A, Othman R, Gmmash A. Knowledge and Awareness of Osteoporosis: A Survey of Physical Therapy Providers in Saudi Arabia. Int J Clin Pract 2024; 2024:2797382. [PMID: 38529258 PMCID: PMC10963116 DOI: 10.1155/2024/2797382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 03/10/2024] [Accepted: 03/13/2024] [Indexed: 03/27/2024] Open
Abstract
Background Osteoporosis "OP" is classified as one of the most serious health conditions worldwide. OP increases the skeletal fracture risk by 35%, particularly at hip, spine, and wrist joints. Healthcare professionals should be aware of OP clinical signs and have good knowledge while managing all patients. Objectives This study aims to investigate the current level of osteoporosis knowledge and awareness among physical therapy providers in Saudi Arabia. Methods One hundred and sixty-eight physical therapy providers participated in this cross-sectional electronic survey from February to July of 2021. The participants completed the Osteoporosis Knowledge Assessment Tool questionnaire (OKAT). Descriptive analysis was utilized to assess the current level of osteoporosis knowledge among physical therapy providers. Results Among the 168 participants, 55% (n = 92) were over 31 years old and 45% (n = 76) were 30 years old or under. The majority of participants 37% (n = 62) had more than 10 years of experience, 45% (n = 76) mainly treat orthopedic conditions, and 70% (n = 117) live in the western region. The results showed that 67.9% (n = 114) of participants had good knowledge about osteoporosis, while 19.6% (n = 33) had poor knowledge, and only 12.5% (n = 21) had excellent knowledge. Conclusion Physical therapy providers in Saudi Arabia have a good knowledge of osteoporosis. The overall OP preventive measure knowledge questions were poor. It is crucial for physical therapy providers to act appropriately to prevent falls and mitigate any potential risks.
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Affiliation(s)
- Muataz Almaddah
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Fahad Alzahrani
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - RiziqAllah Gaowgzeh
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdullah Alqarni
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Rani Othman
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Afnan Gmmash
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
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Fallatah AM, Fallatah AM, Hariri A, Alshadadi F, Al-Abbadi WS, Alsaad MS, Ghalimah B, Hamdi AS. Assessing Osteoporosis Knowledge and Beliefs Among Adults Living in Saudi Arabia: A Cross-Sectional Study. Cureus 2024; 16:e53466. [PMID: 38440027 PMCID: PMC10911639 DOI: 10.7759/cureus.53466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Knowledge and beliefs about osteoporosis have been considered one of the vital parts of early prevention against it. OBJECTIVES This study aimed to evaluate knowledge and beliefs toward osteoporosis using the Osteoporosis Knowledge Assessment Tool (OKAT) and Osteoporosis Health Belief Scale (OHBS) questionnaires among the public in Jeddah, Saudi Arabia. METHODS This cross-sectional study was conducted from March 2019 to April 2019 among adults aged 15 years and above. A validated questionnaire was allocated electronically to the participants through social platforms (such as Twitterand WhatsApp) using a convenience sampling technique. RESULTS A total of 754 participants completed the questionnaire. The majority were females 481 (63.8%). A total of 34 (4.1%) have not heard about osteoporosis before. Respondents scored a total mean of 7.92±3.0for the OKAT questionnaire and a mean score of 126.74±22.38for the OHBS questionnaire. These two scores were significantly associated with age groups and gender (P < 0.05). CONCLUSION Although there is a relative increase in the knowledge of our sample, the belief towardosteoporosis is evidently lower. Therefore, implementing educational programs that tackle belief perception and other preventive measures such as healthy eating habits, physical activities, and educational materials are needed in the future.
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Affiliation(s)
- Anas M Fallatah
- Internal Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Alaa M Fallatah
- College of Medicine, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Abdulaziz Hariri
- Orthopedics and Trauma Surgery, Hôpitaux Universitaires de Marseille, Marseille, FRA
| | - Faisal Alshadadi
- General Surgery, King Abdulaziz University Hospital, Jeddah, SAU
| | - Wid S Al-Abbadi
- Obstetrics and Gynecology, Dr. Soliman Fakeeh Hospital, Jeddah, SAU
| | - Mohammed S Alsaad
- Orthopedic Surgery, International Medical Center Hospital, Jeddah, SAU
| | - Bayan Ghalimah
- Orthopedic Surgery, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Amre S Hamdi
- Orthopedic Surgery, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
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Hassan AB, Tayem YI, Sadat-Ali M, Almarabheh AJ, Alawadhi A, Butt AJ, Jahrami H, Saleh J, Matar ME, Shaikh M, Hasan SK, Karashi AR. The estimated prevalence of osteoporosis in Bahrain: a multi-centered-based study. BMC Musculoskelet Disord 2024; 25:9. [PMID: 38167308 PMCID: PMC10759480 DOI: 10.1186/s12891-023-07145-8] [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: 09/23/2023] [Accepted: 12/21/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVES the primary aim of this study was to examine the prevalence and risk factors of low bone mineral density in Bahrain. METHODS this was a retrospective study, which targeted a cohort of 4822 Bahraini subjects (mean age 59.36 years: 93% females). Demographic data and results of lumbar and femur DEXA scan for the targeted sample, over the period 2016-2018, were retrieved from four hospitals. RESULTS The prevalence of low BMD was 62.3% (46.4% had osteopenia and 15.9% had osteoporosis). The highest rate of osteopenia was detected at the age group younger than 44 years. However, with increasing age, the rate of osteopenia declined, whereas osteoporosis increased (P < 0.001). Females were found to be at higher risk of developing both osteopenia (45.8%) and osteoporosis (18.1%) compared to males (39% and 12.4%, respectively) (P < 0.001). Postmenopausal women exhibited higher rates of low BMD (42.4% osteopenia, 22.3% osteoporosis) compared to elderly men (30.9% osteopenia, 9% osteoporosis). CONCLUSIONS We reported high prevalence of osteopenia and osteoporosis in Bahrain. Low BMD was more common in females, especially in postmenopausal women. Highest prevalence of osteopenia happened at young age. Therefore, we advocate screening at younger age than previously recommended.
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Affiliation(s)
- Adla Bakri Hassan
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain.
- King Abdullah Medical City, Manama, Kingdom of Bahrain.
| | - Yasin I Tayem
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain
| | - Mir Sadat-Ali
- King Abdullah Medical City, Manama, Kingdom of Bahrain
| | - Amer J Almarabheh
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain
| | | | - Ahsan J Butt
- King Hamad University Hospital, Manama, Kingdom of Bahrain
| | - Haitham Jahrami
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain
- Psychiatric Hospital, Government Hospitals, Manama, Kingdom of Bahrain
| | - Jamal Saleh
- Orthocare, Orthopaedic Centre, Manama, Kingdom of Bahrain
| | - Mai E Matar
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain
- King Abdullah Medical City, Manama, Kingdom of Bahrain
| | - Mansoor Shaikh
- Orthocare, Orthopaedic Centre, Manama, Kingdom of Bahrain
| | - Salman K Hasan
- King Hamad University Hospital, Manama, Kingdom of Bahrain
| | - Ali R Karashi
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain
- Salmaniya Medical Complex, Government Hospitals, Manama, Kingdom of Bahrain
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Krueger D, Tanner SB, Szalat A, Malabanan A, Prout T, Lau A, Rosen HN, Shuhart C. DXA Reporting Updates: 2023 Official Positions of the International Society for Clinical Densitometry. J Clin Densitom 2024; 27:101437. [PMID: 38011777 DOI: 10.1016/j.jocd.2023.101437] [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] [Indexed: 11/29/2023]
Abstract
INTRODUCTION Professional guidance and standards assist radiologic interpreters in generating high quality reports. Initially DXA reporting Official Positions were provided by the ISCD in 2003; however, as the field has progressed, some of the current recommendations require revision and updating. This manuscript details the research approach and provides updated DXA reporting guidance. METHODS Key Questions were proposed by ISCD established protocols and approved by the Position Development Conference Steering Committee. Literature related to each question was accumulated by searching PubMed, and existing guidelines from other organizations were extracted from websites. Modifications and additions to the ISCD Official Positions were determined by an expert panel after reviewing the Task Force proposals and position papers. RESULTS Since most DXA is now performed in radiology departments, an approach was endorsed that better aligns with standard radiologic reports. To achieve this, reporting elements were divided into required minimum or optional. Collectively, required components comprise a standard diagnostic report and are considered the minimum necessary to generate an acceptable report. Additional elements were retained and categorized as optional. These optional components were considered relevant but tailored to a consultative, clinically oriented report. Although this information is beneficial, not all interpreters have access to sufficient clinical information, or may not have the clinical expertise to expand beyond a diagnostic report. Consequently, these are not required for an acceptable report. CONCLUSION These updated ISCD positions conform with the DXA field's evolution over the past 20 years. Specifically, a basic diagnostic report better aligns with radiology standards, and additional elements (which are valued by treating clinicians) remain acceptable but are optional and not required. Additionally, reporting guidance for newer elements such as fracture risk assessment are incorporated. It is our expectation that these updated Official Positions will improve compliance with required standards and generate high quality DXA reports that are valuable to the recipient clinician and contribute to best patient care.
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Affiliation(s)
- Diane Krueger
- School of Medicine and Public Health, Osteoporosis Clinical Research Program, University of Wisconsin-Madison, Madison, WI, USA.
| | - S Bobo Tanner
- Department of Medicine, Divisions of Rheumatology, Allergy & Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Auryan Szalat
- Osteoporosis Center, Internal Medicine Ward, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Alan Malabanan
- Bone Health Clinic, Boston Medical Center, Boston, MA, USA
| | - Tyler Prout
- Radiology Department, University of Wisconsin, Madison, WI, USA
| | - Adrian Lau
- Division of Endocrinology and Metabolism, Department of Medicine, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Harold N Rosen
- Osteoporosis Prevention and Treatment Center, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Christopher Shuhart
- Bone Health and Osteoporosis Center, Swedish Medical Group, Seattle, WA, USA
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Tanner SB, Krueger D, Szalat A, Prout T, Lau A, Malabanan A, Rosen H, Shuhart C. Bilateral hip DXA Reporting: 2023 Official Positions of the International Society for Clinical Densitometry. J Clin Densitom 2024; 27:101438. [PMID: 38030473 DOI: 10.1016/j.jocd.2023.101438] [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] [Indexed: 12/01/2023]
Abstract
INTRODUCTION This position development conference (PDC) Task Force examined the use and reporting of bilateral hip bone mineral density (BMD) measurements. This was deemed appropriate as increased availability of Dual-energy X-ray Absorptiometry (DXA) technology offering bilateral hip measurement resulted in more routine clinical use. The International Society for Clinical Densitometry Official Positions accept bilateral hip BMD measurement for clinical use but currently do not include recommendations for reporting those studies. METHODS Four key questions regarding bilateral hip reporting were proposed by the PDC Steering Committee. Relevant literature was identified using PubMed. Questions included whether bilateral hip measurements are appropriate for diagnostic classification or monitoring, as well as which bilateral hip regions of interest should be reported for diagnosis and monitoring. Additionally, the appropriate nomenclature for bilateral hip acquisition was defined. RESULTS The literature review demonstrated that bilateral hip measurement is appropriate and diagnostic classification should be based on the lowest T-score at the right or left side femoral neck or total hip; the mean T-score should not be used for diagnostic purposes. Mean bilateral total hip is preferred for BMD monitoring. The terms hip, or total hip were deemed appropriate nomenclature instead of femur or total proximal femur. CONCLUSION Bilateral hip acquisition is clinically appropriate and reporting and nomenclature standards are offered herein when a bilateral hip study is acquired. In terms of future research, the impact of discordant hips on diagnosis and monitoring was identified as a significant knowledge gap.
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Affiliation(s)
- S Bobo Tanner
- Department of Medicine, Divisions of Rheumatology, Allergy & Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Diane Krueger
- School of Medicine and Public Health, Osteoporosis Clinical Research Program, University of Wisconsin-Madison, Madison, WI, USA.
| | - Auryan Szalat
- Osteoporosis Center, Internal Medicine Ward, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Tyler Prout
- Radiology Department, University of Wisconsin, Madison, Wisconsin USA
| | - Adrian Lau
- Division of Endocrinology and Metabolism, Department of Medicine, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Alan Malabanan
- Bone Health Clinic, Boston Medical Center, Boston, MA, USA
| | - Harold Rosen
- Osteoporosis Prevention and Treatment Center, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Christopher Shuhart
- Bone Health and Osteoporosis Center, Swedish Medical Group, Seattle, WA, USA
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Al Zomia AS, Sabah Z, Deajim M, Alamri AH, Asiri GB, Lahiq LA, Alhadi W, Alwaqdi NA. Blood Parameter Profiles and Their Clinical Implications in Hypertensive Patients: A Retrospective Chart Review. Cureus 2023; 15:e43691. [PMID: 37724207 PMCID: PMC10505352 DOI: 10.7759/cureus.43691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2023] [Indexed: 09/20/2023] Open
Abstract
Introduction Hypertension (HTN) is a chronic condition that serves as a major risk factor for cardiovascular diseases, leading to increased mortality and morbidity. It is a frequent modifiable illness affecting global health, resulting in catastrophic fatalities and morbidity. Aim This study aims to investigate blood parameter profiles and their clinical implications in hypertensive patients at the Prince Faisal bin Khalid Cardiac Center in Abha, Saudi Arabia. Methods Utilizing retrospective data from 121 patients at the Prince Faisal bin Khalid Cardiac Center in Abha, Saudi Arabia. The hematological parameter examined were hemoglobin (HB), platelets, hematocrit (HCT), calcium, phosphorus, sodium, potassium, urea, creatinine, and uric acid. The SPSS version 28 software was used for data analysis. Results Significant correlations between various hematological parameters were found in the results, pointing to potential connections between kidney function, the production of blood cells, and electrolyte balance in hypertensive patients. The results align with earlier studies carried out in the area and offer insightful information for clinicians and researchers interested in managing HTN and its complications. Conclusion The study emphasized the significance of considering hypertensive patients' age, gender, and lifestyle when interpreting their blood parameter profiles. The findings imply that a thorough comprehension of these blood parameter values and their potential effects on HTN is necessary for effectively managing HTN in this population. This study on the blood parameter profiles in hypertensive patients in Saudi Arabia provides the relationships between various hematological parameter and their clinical implications. These findings should be considered when creating targeted interventions and strategies to address the specific requirements and difficulties of managing HTN and its associated complications in this population. More research is required to comprehend the underlying reasons for the observed variations in hematological parameter profiles and their effects on the management of HTN.
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Affiliation(s)
| | - Zia Sabah
- Department of Medicine, King Khalid University, Abha, SAU
| | - Mosab Deajim
- College of Medicine, King Khalid University, Abha, SAU
| | | | - Ghufran B Asiri
- Department of Medicine and Surgery, King Khalid University, Abha, SAU
| | - Lama A Lahiq
- Department of Medicine and Surgery, King Khalid University, Abha, SAU
| | - Wajd Alhadi
- College of Medicine, King Khalid University, Abha, SAU
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Jepsen DB, Bergen ES, Pan J, van Poelgeest E, Osman A, Burghle A, Ryg J, Thompson W, Lundby C. Recommendations on deprescribing of bisphosphonates in osteoporosis guidelines: a systematic review. Eur Geriatr Med 2023; 14:747-760. [PMID: 37393587 DOI: 10.1007/s41999-023-00820-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 06/14/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE Advancing age, declining health status, and a shift in benefit/risk balance warrant judicious use of preventive medications in older persons, including consideration of deprescribing. Lack of guidance on deprescribing is a major barrier for prescribers to consider deprescribing in daily practice. The aim of this review was to evaluate to what extent osteoporosis guidelines include bisphosphonate deprescribing recommendations. METHODOLOGY We conducted a systematic review, searching PubMed, Embase, and grey literature. We included guidelines on treatment of osteoporosis with bisphosphonates. Two independent reviewers screened titles, abstracts, and full texts. Recommendations for deprescribing were extracted, and quality of guidelines were assessed. RESULTS Among 9345 references, 42 guidelines were included. A total of 32 (76%) guidelines included deprescribing recommendations: 29 (69%) guidelines included non-specific deprescribing recommendations framed as a drug holiday, of which 2 (5%) also included specific deprescribing recommendations based on individual health context (e.g. life expectancy, frailty, function, preferences/goals). Twenty-four (57%) guidelines included practical deprescribing recommendations, and 27 (64%) guidelines included recommendations for when deprescribing should not be considered. CONCLUSION Bisphosphonate deprescribing recommendations in osteoporosis guidelines were primarily framed as drug holidays, with limited guidance on how to make individualized deprescribing decisions based on individual health context. This suggests a need for additional focus on deprescribing in osteoporosis guidelines.
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Affiliation(s)
- Ditte Beck Jepsen
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark.
| | - Emilie Sofie Bergen
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jeffrey Pan
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Eveline van Poelgeest
- Department of Internal Medicine, Section of Geriatrics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Aging and Later Life, Amsterdam, The Netherlands
| | - Abdiaziz Osman
- Hospital Pharmacy Funen, Odense University Hospital, Odense, Denmark
| | - Alaa Burghle
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Hospital Pharmacy Funen, Odense University Hospital, Odense, Denmark
| | - Jesper Ryg
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Wade Thompson
- Department of Anesthesiology, Pharmacology and Therapeutics, Therapeutics Initiative, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Carina Lundby
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Hospital Pharmacy Funen, Odense University Hospital, Odense, Denmark
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
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Al-Saleh Y, Sulimani R, Sabico S, Alshahrani FM, Fouda MA, Almohaya M, Alaidarous SB, Alkhawashki HM, Alshaker M, Alrayes H, Saleh N, Al-Daghri NM. Diagnosis and management of osteoporosis in Saudi Arabia: 2023 key updates from the Saudi Osteoporosis Society. Arch Osteoporos 2023; 18:75. [PMID: 37213036 PMCID: PMC10202978 DOI: 10.1007/s11657-023-01242-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/04/2023] [Indexed: 05/23/2023]
Abstract
The Saudi Osteoporosis Society (SOS) has updated its guidelines for the diagnosis and management of osteoporosis in Saudi Arabia (SA), with emphasis on postmenopausal women. This document is relevant to all healthcare professionals in SA involved in the care of patients with osteoporosis and osteoporosis-related fractures. INTRODUCTION The SOS launched the first national osteoporosis guidelines in 2015 and spearheaded the Gulf Cooperation Council Countries (GCC) osteoporosis consensus report in 2020 which was under the auspices of the European Society for Clinical and Economic Aspects of Osteoporosis (ESCEO). This paper highlights a major update of the guidelines in the SA setting. METHODS This guideline is an adaptation of the current guidelines derived from ESCEO, the American Association of Clinical Endocrinologists (AACE), and the GCC osteoporosis consensus report and studies on osteoporosis done in SA. Where accessible, the timeliest systematic review, meta-analysis, and randomized controlled trials were used as evidence. RESULTS The present update includes new recommendations for the assessment of osteoporosis taking into consideration the Saudi model of FRAX for fracture probabilities, appropriate doses for the maintenance of vitamin D status and calcium, the use of representative blood analytes for therapy monitoring, the use of romosozumab and sequential therapy in the pharmacological management strategies, and the establishment of fracture liaison services to prevent secondary fractures. CONCLUSION This updated guideline is for all healthcare professionals involved in osteoporosis and post-fracture care and management in SA and harmonized the most up-to-date changes in the field based on evidence-based medicine for use in the local setting.
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Affiliation(s)
- Yousef Al-Saleh
- Department of Endocrinology, Dr. Mohammad Alfagih Hospital, Riyadh, Saudi Arabia.
- Chair for Biomarkers of Chronic Diseases, College of Science, King Saud University, Riyadh, Saudi Arabia.
| | - Riad Sulimani
- Department of Medicine, College of Medicine, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Shaun Sabico
- Chair for Biomarkers of Chronic Diseases, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Fahad M Alshahrani
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mona A Fouda
- Department of Medicine, College of Medicine, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Mohammed Almohaya
- Obesity, Endocrine and Metabolism Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Salwa B Alaidarous
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- Department of Medicine, King Abdulaziz Medical City, Jeddah, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
| | | | - Mohammed Alshaker
- Department of Family Medicine and Polyclinic, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Hanan Alrayes
- Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Najla Saleh
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Nasser M Al-Daghri
- Chair for Biomarkers of Chronic Diseases, College of Science, King Saud University, Riyadh, Saudi Arabia
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Al Nozha OM, El Tarhouny S, Taha I, Sultan I, Abdu Allah AM, Hammoda MA, Elmehallawy G, Elmehallawy Y, Eysawi EA, Desouky MK. Association Between Vitamin D Level and Z-Score Changes of Bone Density in College-Age Saudi Girls: A Cross-Sectional Study. Int J Gen Med 2023; 16:865-874. [PMID: 36910567 PMCID: PMC9997091 DOI: 10.2147/ijgm.s396536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 02/18/2023] [Indexed: 03/07/2023] Open
Abstract
Objective Vitamin D (VD) deficiency is a worldwide health problem. VD plays a crucial role in calcium homeostasis, phosphorus metabolism and bone health. Still much remain to understand the effect of VD deficiency on bone mass. This study aimed to evaluate the relationship between VD levels and bone mass density (BMD) among college-age Saudi females. Methods In a cross-sectional study, 460 females with a median age of 21 years, were enrolled, completed a comprehensive, structured questionnaire which was validated by experienced endocrinologist, a dietician, and a statistician. Body mass indexes (BMI) were calculated, and BMD was estimated through quantitative ultrasound to ankle. Serum VD, calcium, phosphate, parathyroid hormone, and alkaline phosphatase were measured using chemiluminescent immunoassay technique. Results VD deficiency reached up to 83.3% (66.9% insufficiency and 16.4% deficiency). Lower than normal BMD was detected in 18.3% of subjects, with only 1.1% having a non-age-matched high risk for osteoporosis. The significant independent predictors of Z-score were age of menarche, menstrual irregularities, dairy products consumption, physical activity, BMI, alkaline phosphatase, and history of previous VD supplementation. Conclusion VD deficiency and low BMD are highly prevalent among college-age Saudi females. Low BMD is not linked to serum level of VD but to its previous use as a supplementation. Early lifestyle changes, attention to gynecological problems, and prevention of VD deficiency are all needed to support BMD among these girls.
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Affiliation(s)
- Omar M Al Nozha
- Department of Medicine, College of Medicine, Taibah University, Madinah, Saudi Arabia
| | - Shereen El Tarhouny
- Department of Medical Biochemistry and Molecular Biology, College of Medicine, Zagazig University, Egypt
| | - Inass Taha
- Department of Medicine, College of Medicine, Taibah University, Madinah, Saudi Arabia
| | - Intessar Sultan
- Department of Medicine, Ibn Sina National College for Medical Studies, Jeddah, Saudi Arabia
| | - Azza M Abdu Allah
- Department of Laboratory, College of Biomedical Sciences, Taibah University, Yanbu, Saudi Arabia
| | | | - Ghaidaa Elmehallawy
- Department of Medicine, College of Medicine, Taibah University, Madinah, Saudi Arabia
| | | | - Eman A Eysawi
- College of Medicine, Al Rayan Colleges, Madinah, Saudi Arabia
| | - Maha K Desouky
- Department of Anatomy,College of Medicine, Minia University, Minia, Egypt
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10
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Influence of Vitamin D Consumption on Bone Mineral Density Among Saudi Women in Jeddah Not Taking Supplements. TOP CLIN NUTR 2022. [DOI: 10.1097/tin.0000000000000293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Al-Ansari MM, Aleidi SM, Masood A, Alnehmi EA, Abdel Jabar M, Almogren M, Alshaker M, Benabdelkamel H, Abdel Rahman AM. Proteomics Profiling of Osteoporosis and Osteopenia Patients and Associated Network Analysis. Int J Mol Sci 2022; 23:ijms231710200. [PMID: 36077598 PMCID: PMC9456664 DOI: 10.3390/ijms231710200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 11/29/2022] Open
Abstract
Bone mass reduction due to an imbalance in osteogenesis and osteolysis is characterized by low bone mineral density (LBMD) and is clinically classified as osteopenia (ON) or osteoporosis (OP), which is more severe. Multiple biomarkers for diagnosing OP and its progression have been reported; however, most of these lack specificity. This cohort study aimed to investigate sensitive and specific LBMD-associated protein biomarkers in patients diagnosed with ON and OP. A label-free liquid chromatography-mass spectrometry (LC-MS) proteomics approach was used to analyze serum samples. Patients’ proteomics profiles were filtered for potential confounding effects, such as age, sex, chronic diseases, and medication. A distinctive proteomics profile between the control, ON, and OP groups (Q2 = 0.7295, R2 = 0.9180) was identified, and significant dysregulation in a panel of proteins (n = 20) was common among the three groups. A comparison of these proteins showed that the levels of eight proteins were upregulated in ON, compared to those in the control and the OP groups, while the levels of eleven proteins were downregulated in the ON group compared to those in the control group. Interestingly, only one protein, myosin heavy chain 14 (MYH14), showed a linear increase from the control to the ON group, with the highest abundance in the OP group. A significant separation in the proteomics profile between the ON and OP groups (Q2 = 0.8760, R2 = 0.991) was also noted. Furthermore, a total of twenty-six proteins were found to be dysregulated between the ON and the OP groups, with fourteen upregulated and twelve downregulated proteins in the OP, compared to that in the ON group. Most of the identified dysregulated proteins were immunoglobulins, complement proteins, cytoskeletal proteins, coagulation factors, and various enzymes. Of these identified proteins, the highest area under the curve (AUC) in the receiver operating characteristic (ROC) analysis was related to three proteins (immunoglobulin Lambda constant 1 (IGLC1), RNA binding protein (MEX3B), and fibulin 1 (FBLN1)). Multiple reaction monitoring (MRM), LC-MS, was used to validate some of the identified proteins. A network pathway analysis of the differentially abundant proteins demonstrated dysregulation of inflammatory signaling pathways in the LBMD patients, including the tumor necrosis factor (TNF), toll-like receptor (TL4), and interferon-γ (IFNG) signaling pathways. These results reveal the existence of potentially sensitive protein biomarkers that could be used in further investigations of bone health and OP progression.
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Affiliation(s)
- Mysoon M. Al-Ansari
- Department of Botany and Microbiology, College of Science, King Saud University, Riyadh 11451, Saudi Arabia
- Department of Molecular Oncology, King Faisal Specialist Hospital and Research Centre (KFSHRC), Riyadh 11211, Saudi Arabia
| | - Shereen M. Aleidi
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan, Amman 11942, Jordan
| | - Afshan Masood
- Proteomics Resource Unit, Obesity Research Center, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia
| | - Eman A. Alnehmi
- Department of Botany and Microbiology, College of Science, King Saud University, Riyadh 11451, Saudi Arabia
- Metabolomics Section, Department of Clinical Genomics, Center for Genomics Medicine, King Faisal Specialist Hospital and Research Centre (KFSHRC), Riyadh 11211, Saudi Arabia
| | - Mai Abdel Jabar
- Metabolomics Section, Department of Clinical Genomics, Center for Genomics Medicine, King Faisal Specialist Hospital and Research Centre (KFSHRC), Riyadh 11211, Saudi Arabia
| | - Maha Almogren
- Metabolomics Section, Department of Clinical Genomics, Center for Genomics Medicine, King Faisal Specialist Hospital and Research Centre (KFSHRC), Riyadh 11211, Saudi Arabia
- Department of Biochemistry and Molecular Medicine, College of Medicine, Al Faisal University, Riyadh 11533, Saudi Arabia
| | - Mohammed Alshaker
- Department of Family Medicine and Polyclinic, King Faisal Specialist Hospital & Research Center, Riyadh 11211, Saudi Arabia
| | - Hicham Benabdelkamel
- Proteomics Resource Unit, Obesity Research Center, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia
| | - Anas M. Abdel Rahman
- Metabolomics Section, Department of Clinical Genomics, Center for Genomics Medicine, King Faisal Specialist Hospital and Research Centre (KFSHRC), Riyadh 11211, Saudi Arabia
- Department of Biochemistry and Molecular Medicine, College of Medicine, Al Faisal University, Riyadh 11533, Saudi Arabia
- Department of Chemistry, Memorial University of Newfoundland, St. John’s, NL A1C 5S7, Canada
- Correspondence:
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Alhaidari HM, Babtain F, Alqadi K, Bouges A, Baeesa S, Al-Said YA. Association between serum vitamin D levels and age in patients with epilepsy: a retrospective study from an epilepsy center in Saudi Arabia. Ann Saudi Med 2022; 42:262-268. [PMID: 35933609 PMCID: PMC9357294 DOI: 10.5144/0256-4947.2022.262] [Citation(s) in RCA: 2] [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: 11/22/2022] Open
Abstract
BACKGROUND Vitamin D deficiency has been linked to various medical conditions such as bone loss, decreased mineralization, endocrine disorders, and central nervous system disorders, including epilepsy. Vitamin D deficiency is prevalent among patients with epilepsy (PWE). However, the specific association between vitamin D levels and age in PWE is unclear. OBJECTIVES Identify the relation between vitamin D level and age in PWE and evaluate factors that may play a role in seizure control. DESIGN Retrospective analytical medical record review SETTING: Outpatient epilepsy research clinic in Saudi Arabia PATIENTS AND METHODS: Between November 2016 and April 2020, we selected eligible PWE aged older than 14 years whose vita-min D levels were recorded at least once after reviewing 1550 patient electronic files. We analyzed data on serum vitamin D level by age and other factors, vitamin D supplement use, seizure classification, and conducted a multivariate logistic regression to assess associations with seizure control. MAIN OUTCOME MEASURES Relationships between vitamin D levels and age and factors that might affect seizure control. SAMPLE SIZE 524 patients RESULTS: The prevalence of low serum vitamin D levels was high (86.8%). The median vitamin D level in all patients was low (38 nmol/L), and was lower in young PWE than in adult PWE (P<.01). Only 146 patients received vitamin D supplements. High vitamin D levels were associated with a 40% seizure reduction. CONCLUSION Vitamin D deficiency is underestimated in PWE in Saudi Arabia, and is more prevalent among young adults and patients on polytherapy than in other PWE. Patients with high vitamin D levels had good seizure control compared with those with low levels. The effect of vitamin D supplements on seizure control should be further investigated in randomized control trials. LIMITATIONS Retrospective study and no categorization by presence of supplementation. CONFLICT OF INTEREST None.
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Affiliation(s)
| | - Fawzi Babtain
- From the Department of Neurosciences, King Faisal Specialist Hospital and Research Centre-Jeddah, Jeddah, Saudi Arabia
| | - Khalid Alqadi
- From the Department of Neurosciences, King Faisal Specialist Hospital and Research Centre-Jeddah, Jeddah, Saudi Arabia
| | - Abdulrahman Bouges
- From the Department of Neurosciences, King Faisal Specialist Hospital and Research Centre-Jeddah, Jeddah, Saudi Arabia
| | - Saleh Baeesa
- From the Department of Neurosciences, King Faisal Specialist Hospital and Research Centre-Jeddah, Jeddah, Saudi Arabia
| | - Youssef A Al-Said
- From the Department of Neurosciences, King Faisal Specialist Hospital and Research Centre-Jeddah, Jeddah, Saudi Arabia
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13
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Al-Saleh Y, AlSohaim A, AlAmoudi R, AlQarni A, Alenezi R, Mahdi L, Alzanbaqi H, Nawar SM, AlHarbi H, ALMulla A, Al Qahtani M, Salih SB, Al Anazi F, Saleh N, Saleh S, AlAklabi A, Sabico S, Al-Daghri NM. Primary hyperparathyroidism in Saudi Arabia revisited: a multi-centre observational study. BMC Endocr Disord 2022; 22:155. [PMID: 35676656 PMCID: PMC9178811 DOI: 10.1186/s12902-022-01059-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 04/07/2022] [Indexed: 12/03/2022] Open
Abstract
PURPOSE Primary hyperparathyroidism (PHPT) is a common cause of hypercalcemia and remains understudied within the Arabian population. The present study, the largest of its kind within the Gulf Cooperation Council (GCC) countries, aims to determine the demographics and clinical presentation of PHPT in Saudi Arabia. METHODS In this multi-center retrospective study involving three tertiary hospitals in different geographic locations of Saudi Arabia namely, Riyadh, Al Ahsa and Jeddah, a total of 205 out of 243 confirmed PHPT cases aged 16 to 93 years old were included (N = 96 from Riyadh; N = 59 from Al Ahsa and N = 50 from Jeddah). Demographics, clinical manifestations and surgical outcomes were recorded as well as laboratory and radiologic investigations including serum parathyroid hormone (PTH), 25(OH)D, adjusted calcium, estimated glomerular filtration rate (eGFR) and nuclear scan outcome. RESULTS PHPT cases appeared to increase over time when compared to other local studies published so far, with 12.8 cases per 100,000 hospital population. Females outnumber males (3:1) with 86% seen as out-patients. The average age was 59.8 ± 15.5 years. Abnormal PTH scan was seen in 171 patients (83.4%). Kidney stones was the most common renal manifestation (32 cases, 15.6%) and osteoporosis was the most common skeletal manifestation (67 cases, 32.7%). Al Ahsa had the highest prevalence of multiple comorbidities at 54% and the highest prevalence of obesity as a single comorbidity (17%) compared to other regions (p < 0.05). Jeddah recorded the highest prevalence of osteoporosis with bone and joint pains (30%) (p < 0.05). CONCLUSION Comparison of present data with previous local studies suggest an increasing trend in PHPT cases in Saudi Arabia. Regional variations in the clinical presentation of PHPT were observed and warrant further investigation.
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Affiliation(s)
- Yousef Al-Saleh
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, 22490, Riyadh, Saudi Arabia.
- King Abdullah International Medical Research Center, Riyadh, 11481, Saudi Arabia.
- Department of Medicine, King Abdulaziz Medical City, Riyadh, Ministry of National Guard-Health Affairs, Riyadh, 14611, Saudi Arabia.
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, 11451, Saudi Arabia.
| | - Abdullah AlSohaim
- King Abdullah International Medical Research Center, Riyadh, 11481, Saudi Arabia
- Department of Medicine, King Abdulaziz Medical City, Riyadh, Ministry of National Guard-Health Affairs, Riyadh, 14611, Saudi Arabia
| | - Reem AlAmoudi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- Department of Medicine, King Abdulaziz Medical City, Jeddah, Ministry of National Guard-Health Affairs, Jeddah, Saudi Arabia
| | - Ali AlQarni
- King Saud Bin Abdulaziz University for Health Sciences, Al Ahsa, Saudi Arabia
- King Abdullah International Medical Research Center, Al Ahsa, Saudi Arabia
- Department of Medicine, King Abdulaziz Hospital, Ministry of National Guard Health Affairs, Al Ahsa, Saudi Arabia
| | - Raed Alenezi
- Department of Medicine, King Abdulaziz Medical City, Riyadh, Ministry of National Guard-Health Affairs, Riyadh, 14611, Saudi Arabia
- Department of Medicine, Johns Hopkins Aramco Health Care, Dhahran, Saudi Arabia
| | - Layla Mahdi
- King Abdullah International Medical Research Center, Riyadh, 11481, Saudi Arabia
- Department of Medicine, King Abdulaziz Medical City, Riyadh, Ministry of National Guard-Health Affairs, Riyadh, 14611, Saudi Arabia
| | - Hend Alzanbaqi
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- Department of Medicine, King Abdulaziz Medical City, Jeddah, Ministry of National Guard-Health Affairs, Jeddah, Saudi Arabia
| | - Samah M Nawar
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- Department of Medicine, King Abdulaziz Medical City, Jeddah, Ministry of National Guard-Health Affairs, Jeddah, Saudi Arabia
| | - Hibah AlHarbi
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- Department of Medicine, King Abdulaziz Medical City, Jeddah, Ministry of National Guard-Health Affairs, Jeddah, Saudi Arabia
| | - Abdulrhman ALMulla
- King Abdullah International Medical Research Center, Al Ahsa, Saudi Arabia
- Department of Medicine, King Abdulaziz Hospital, Ministry of National Guard Health Affairs, Al Ahsa, Saudi Arabia
| | - Maryam Al Qahtani
- King Abdullah International Medical Research Center, Al Ahsa, Saudi Arabia
- Department of Medicine, King Abdulaziz Hospital, Ministry of National Guard Health Affairs, Al Ahsa, Saudi Arabia
| | - Salih Bin Salih
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, 22490, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, 11481, Saudi Arabia
- Department of Medicine, King Abdulaziz Medical City, Riyadh, Ministry of National Guard-Health Affairs, Riyadh, 14611, Saudi Arabia
| | - Faisal Al Anazi
- Department of Medicine, College of Medicine, Majmaah University, AlMajmaah, 11952, Saudi Arabia
| | - Najla Saleh
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, 22490, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, 11481, Saudi Arabia
| | - Seham Saleh
- Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Ali AlAklabi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, 22490, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, 11481, Saudi Arabia
- Department of Medicine, King Abdulaziz Medical City, Riyadh, Ministry of National Guard-Health Affairs, Riyadh, 14611, Saudi Arabia
| | - Shaun Sabico
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, 11451, Saudi Arabia
| | - Nasser M Al-Daghri
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, 11451, Saudi Arabia
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14
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Hartley GW, Roach KE, Nithman RW, Betz SR, Lindsey C, Fuchs RK, Avin KG. Physical Therapist Management of Patients With Suspected or Confirmed Osteoporosis: A Clinical Practice Guideline From the Academy of Geriatric Physical Therapy. J Geriatr Phys Ther 2022; 44:E106-E119. [PMID: 35384943 PMCID: PMC8983944 DOI: 10.1519/jpt.0000000000000346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A clinical practice guideline on physical therapist management of patients with suspected or confirmed osteoporosis was developed by a volunteer guideline development group (GDG) that was appointed by the Academy of Geriatric Physical Therapy (APTA Geriatrics). The GDG consisted of an exercise physiologist and 6 physical therapists with clinical and methodological expertise. The guideline was based on a systematic review of existing clinical practice guidelines, followed by application of the ADAPTE methodological process described by Guidelines International Network for adapting guidelines for cultural and professional utility. The recommendations contained in this guideline are derived from the 2021 Scottish Intercollegiate Guideline Network (SIGN) document: Management of Osteoporosis and the Prevention of Fragility Fractures. These guidelines are intended to assist physical therapists practicing in the United States, and implementation in the context of the US health care system is discussed.
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Affiliation(s)
- Gregory W. Hartley
- Department of Physical Therapy, University of Miami Miller School of Medicine, Coral Gables, Florida
| | - Kathryn E. Roach
- Department of Physical Therapy, University of Miami Miller School of Medicine, Coral Gables, Florida
| | - Robert W. Nithman
- Physical Therapy Program, Center for Graduate Studies, West Coast University, Los Angeles, California
| | - Sherri R. Betz
- TheraPilates Physical Therapy Clinics, LLC, Monroe, Louisiana
| | | | - Robyn K. Fuchs
- Department of Physical Therapy, School of Health & Human Sciences, Indiana University, Indianapolis
| | - Keith G. Avin
- Department of Physical Therapy, School of Health & Human Sciences, Indiana University, Indianapolis
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15
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Al-Daghri NM, Yakout S, Ghaleb A, Hussain SD, Sabico S. Iron and 25-hydroxyvitamin D in postmenopausal women with osteoporosis. Am J Transl Res 2022; 14:1387-1405. [PMID: 35422903 PMCID: PMC8991132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/22/2022] [Indexed: 06/14/2023]
Abstract
Iron and vitamin D deficiencies are some of the most common health problems in the world. Iron is essential in oxygen transport and participates in many enzymatic systems in the body, with important roles in vitamin D metabolism. Osteoporosis is one of the most prevalent chronic disease of the elderly in the world as well as in the Saudi population. The relationship between iron, vitamin D deficiency and bone health comes from clinical observations in iron overload patients who suffered bone loss. The opposite scenario, whether iron and vitamin D deficiencies affect bone metabolism, has not been fully addressed. This is of great interest, as this nutrient deficiency is a worldwide public health problem and at the same time osteoporosis and bone alterations are highly prevalent. The relationship between 25(OH)D and iron deficiencies with osteoporosis is unknown up to date. This review presents the current knowledge on nutritional iron and vitamin D deficiencies in bone remodeling, and discuss the link between iron and bone metabolism among postmenopausal women. Finally, it is hypothesized that chronic iron and vitamin D deficiencies induces bone resorption and risk of osteoporosis, thus complete recovery from anemia and its prevention should be promoted in order to improve quality of life including bone health. Several mechanisms are implicated; hence, further investigation on the possible impact of iron and vitamin D deficiencies on the development of osteoporosis is needed.
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Affiliation(s)
- Nasser M Al-Daghri
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University Riyadh 11451, Saudi Arabia
| | - Sobhy Yakout
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University Riyadh 11451, Saudi Arabia
| | - Afnan Ghaleb
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University Riyadh 11451, Saudi Arabia
| | - Syed Danish Hussain
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University Riyadh 11451, Saudi Arabia
| | - Shaun Sabico
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University Riyadh 11451, Saudi Arabia
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16
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PTHR1 Genetic Polymorphisms Are Associated with Osteoporosis among Postmenopausal Arab Women. BIOMED RESEARCH INTERNATIONAL 2022; 2021:2993761. [PMID: 34977236 PMCID: PMC8716221 DOI: 10.1155/2021/2993761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 12/13/2021] [Indexed: 11/24/2022]
Abstract
The parathyroid hormone 1 receptor (PTHR1) plays a crucial role in calcium homeostasis and bone metabolism. However, its genetic role in regulating bone turnover markers (BTMs) in postmenopausal osteoporosis (PMO) remains unclear. Herein, we explored parathyroid hormone (PTH) and PTHR gene variant susceptibility to osteoporosis and their association with various circulating BTM and inflammatory markers in postmenopausal women of Arab ethnicity. In total, 600 postmenopausal Arab women (300-PMO and 300-control) were genotyped for selected SNPs in PTH (rs1459015, rs307253, rs6054, rs307247, rs10500783 and rs10500784), PTHR1 (rs6442037, rs1138518, and rs724449 SNPs) and PTHR2 (rs9288393, rs10497900, and rs897083). Anthropometrics, BTMs, and inflammatory markers were measured. Bone mineral density (BMD) was measured at the lumbar spine L1–L4 and the femoral neck using dual-energy X-ray absorptiometry (DXA). PTHR1 rs1138518 genotype C/T was found to be a significant risk factor for PMO (OR = 1.49, 95% CI 1.0-2.1, P = 0.03). The genotypes C/T and T/T of PTHR1 rs1138518 were associated with 25-hydroxy-vitamin D (25(OH)D) regulation. In the PMO group, carriers of the C/T genotype had significantly lower 25(OH)D levels than carriers of the same genotypes in the control group (59.9 (36.7-92.4) nmol/l and 66.4 (43.5-87.8) nmol/l, respectively; P = 0.048]. Our study concludes that the PTHR1 rs1138518 genotype could be a potential risk factor for osteoporosis and 25(OH)D regulation in Arab women with PMO.
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17
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Mahzari M, Alibrahim A, Alghamdi N, Alsadhan M, Almoamary S, Masuadi E, Al Shahrani A. Prevalence and risk factors of osteoporosis in saudi end-stage renal disease patients on hemodialysis. SAUDI JOURNAL OF MEDICINE AND MEDICAL SCIENCES 2022; 10:259-265. [PMID: 36247063 PMCID: PMC9555032 DOI: 10.4103/sjmms.sjmms_639_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 04/01/2022] [Accepted: 06/30/2022] [Indexed: 11/04/2022] Open
Abstract
Background: Objective: Methods: Results: Conclusion:
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18
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Ng JY, Hilal A, Maini I. What traditional, complementary, and integrative medicine recommendations exist across osteoporosis clinical practice guidelines? A systematic review and quality assessment. Integr Med Res 2021; 11:100803. [PMID: 34840950 PMCID: PMC8605333 DOI: 10.1016/j.imr.2021.100803] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 09/07/2021] [Accepted: 10/13/2021] [Indexed: 12/18/2022] Open
Abstract
Background Traditional, complementary and integrative medicine (TCIM) is sought by more than 50% of patients with osteoporosis. Despite this, many healthcare providers lack the knowledge to adequately counsel patients on safe and effective TCIM use. The purpose of this study was to determine the quantity and quality of TCIM recommendations in clinical practice guidelines (CPGs) for the treatment and/or management of osteoporosis. Methods MEDLINE, EMBASE and CINAHL databases, in addition to the Guidelines International Network, and the National Center for Complementary and Integrative Health website were searched from 2009–2020. CPGs making TCIM recommendations for the treatment/management of osteoporosis were assessed with the AGREE II instrument. Results Of 536 unique search results, 27 osteoporosis CPGs made mention of TCIM therapies. From highest to lowest, scaled domain percentages of all eligible CPGs averaged to 92.59% for scope and purpose, 88.79% for clarity in presentation, 55.04% for stakeholder involvement, 47.84% for editorial independence, 46.53% for rigor of development, and 36.96% for applicability. Of the 27 CPGs assessed, 4 CPGs were recommended as is by both appraisers, while 23 CPGs were recommended with modifications. Conclusions Recommendations pertaining to calcium and vitamin D supplementation and exercise were favorably recommended across nearly all CPGs. In the case of other TCIM interventions, recommendations varied greatly, which may present challenges for CPGs target users due to a lack of consistency. Given the varying quality of osteoporosis CPGs found, those requiring improvement may benefit from their guideline development panel utilizing the AGREE II instrument to inform future updates.
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Affiliation(s)
- Jeremy Y Ng
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, Centre for Learning and Discovery, McMaster University, Hamilton, Ontario, Canada
| | - Arwa Hilal
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, Centre for Learning and Discovery, McMaster University, Hamilton, Ontario, Canada
| | - Ishana Maini
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, Centre for Learning and Discovery, McMaster University, Hamilton, Ontario, Canada
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19
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Al-Daghri NM, Sabico S, Al-Saleh Y, Sulimani R, Aljohani NJ, Sheshah E, Alodhayani A, Harvey NC, Liu E, Lorentzon M, McCloskey EV, Vandenput L, Johansson H, Kanis JA. The application of FRAX in Saudi Arabia. Arch Osteoporos 2021; 16:166. [PMID: 34739604 DOI: 10.1007/s11657-021-01024-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 10/06/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED Assessment and treatment pathways based on age-specific intervention thresholds in Saudi Arabi can be used to identify patients at high risk of fracture and avoid unnecessary treatment in those at low fracture risk. PURPOSE Intervention thresholds for the treatment of osteoporosis have historically been based on the measurement of bone mineral density. The aim of the present study was to explore treatment paths and characteristics of women eligible for treatment in Saudi Arabia based on fracture probabilities derived from FRAX®. METHODS The approach to the setting of intervention and assessment thresholds used the methodology adopted by the National Osteoporosis Guideline Group for FRAX-based guidelines in the UK but based on the epidemiology of fracture and death in Saudi Arabia. The methodology was applied to women age 40 years or more drawn from a tertiary referral population for skeletal assessment. Missing data for the calculation of FRAX was simulated using data from the referral and FRAX derivation cohorts. RESULTS Intervention thresholds expressed as a 10-year probability of a major osteoporotic fracture ranged from 2.0% at the age of 50 years increasing to 7.6% at the age of 70 years. A total of 163 of 1365 women (11.9%) had a prior fragility fracture and would be eligible for treatment for this reason. An additional 5 women were eligible for treatment in that MOF probabilities lay above the upper assessment threshold. A BMD test would be recommended for 593 women (43.4%) so that FRAX could be recalculated with the inclusion of femoral neck BMD. Of these, 220 individuals would be eligible for treatment after a BMD test and 373 women categorised at low risk after a BMD test. CONCLUSION Probability-based assessment of fracture risk using age-specific intervention thresholds was developed for Saudi Arabia to help guide decisions about treatment.
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Affiliation(s)
- Nasser M Al-Daghri
- Biochemistry Department, College of Science, King Saud University, 11451, Riyadh, Kingdom of Saudi Arabia.
| | - Shaun Sabico
- Biochemistry Department, College of Science, King Saud University, 11451, Riyadh, Kingdom of Saudi Arabia
| | - Yousef Al-Saleh
- Biochemistry Department, College of Science, King Saud University, 11451, Riyadh, Kingdom of Saudi Arabia.,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia.,Department of Medicine, King Abdulaziz Medical City, Riyadh, Ministry of National Guard-Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Riad Sulimani
- Department of Internal Medicine, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Naji J Aljohani
- Biochemistry Department, College of Science, King Saud University, 11451, Riyadh, Kingdom of Saudi Arabia.,Obesity, Endocrine and Metabolism Center, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Eman Sheshah
- Diabetes Care Center, King Salman Bin Abdulaziz Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Abdulaziz Alodhayani
- Department of Family Medicine and Community, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Enwu Liu
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Mattias Lorentzon
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.,Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Eugene V McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK.,MRC and Arthritis Research UK Centre for Integrated Research in Musculoskeletal Ageing, Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK
| | - Liesbeth Vandenput
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.,Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Helena Johansson
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.,Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.,Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
| | - John A Kanis
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia. .,Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK.
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Abed H, Obaid M, Al-Johani K. The association between medical diseases and orofacial abscess: A retrospective, hospital-based study. Saudi Dent J 2021; 33:731-737. [PMID: 34803327 PMCID: PMC8589582 DOI: 10.1016/j.sdentj.2020.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 03/24/2020] [Accepted: 03/30/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE This study aimed to identify the most commonly reported medical diseases among dental patients and to assess its association with the development of the orofacial abscess. METHODS The medical records (n = 3164) of dental patients who visited the dental hospital at Umm-Al-Qura University (Makkah, Saudi Arabia) were reviewed. Demographic characteristics of eligible patients were collected. Medical diseases were collected as reported by the patients in the medical records. The International Classification of Diseases (ICD-10) was used to classify the reported medical diseases. Simple descriptive statistics were used to define the characteristics of the study variables through a form of counts and percentages. Multivariable logistic regression analysis was carried out to find out the significant predictors of orofacial abscess. RESULTS Upon reviewing 3164 medical records, almost half of the patients had medical diseases (n = 1543, 49%). The mean age of the cohort was 30.3 (SD = 16.43). Diabetes mellitus (n = 316, 20%) and hypertension (n = 210, 14%) were the most common reported medical diseases. Male patients reported having more medical diseases compared to the female. Hypertension was found to be significantly high among female patients (X 2 = 3.167, P-value < 0.001). Multivariable logistic regression analysis indicated that the female gender is significantly associated with the development of orofacial abscess after adjustment for age and vascular risk factors (i.e., hypertension) (B = 1.26, S.E. = 0.57, OR = 3.54, 95%CI = 1.13 to 11.40, P-value = 0.028). CONCLUSION Dentists should be aware that diabetes mellitus and hypertension are prevalent among patients visiting dental services. The female gender has a higher association of developing orofacial abscess than male. Within the limitation of this study in a single study center with few patients having orofacial abscess, this study found no association between medical diseases and the development of orofacial abscess.
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Affiliation(s)
- Hassan Abed
- Department of Basic and Clinical Oral Sciences, Faculty of Dentistry, Umm Al-Qura University, Makkah, Saudi Arabia
- Department of Sedation and Special Care Dentistry, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Majed Obaid
- Department of Community Medicine and Medical Care for Pilgrims, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
- Division of Health and Social Care, School of Population Health and Environmental Science, King’s College London, London, United Kingdom
| | - Khalid Al-Johani
- Department of Oral Diagnostic Science, Faculty of Dentistry, King Abdul-Aziz University, Jeddah, Saudi Arabia
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Huang X, Chen B, Thabane L, Adachi JD, Li G. Fragility of results from randomized controlled trials supporting the guidelines for the treatment of osteoporosis: a retrospective analysis. Osteoporos Int 2021; 32:1713-1723. [PMID: 33595680 DOI: 10.1007/s00198-021-05865-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 01/29/2021] [Indexed: 12/11/2022]
Abstract
UNLABELLED This is the first report on the fragility of results from randomized controlled trials (RCTs) for the treatment of osteoporosis. The results of aforementioned RCTs appear to depend on a small number of events and are generally statistically fragile. INTRODUCTION Osteoporosis remains a health concern worldwide. Evidence-based guideline recommendations that are mainly based on results of clinical trials are important to clinical decision-making. The fragility index (FI) is a novel statistical metric to measure the fragility of results from an RCT. Our study aimed to analyze the fragility of the clinical trials referenced in the guidelines for the treatment of osteoporosis. METHODS Trials were included if they investigated primary osteoporosis, randomized patients to treatment or control in a 1:1 design, and reported fracture outcome as the primary endpoint. The FI and fragility quotient (FQ) were calculated for assessing the robustness of results from the eligible RCTs. An FI was defined as the minimum number of events in the intervention group that needs to change from a non-event to an event in order to render a significant result non-significant (or vice versa). The FQ was calculated by dividing the FI by the sample size of the trial. RESULTS Of the 372 RCTs identified from the guidelines, 42 were eligible for analyses. Their median FI was 10 (25th-75th percentile [Q1-Q3]: 4-18), with a median FQ of 0.007 (Q1-Q3: 0.0017-0.019). Approximately one third of the RCTs had a FI of less than or equal to 5. There were 17 (40.5%) trials where the number of patients lost to follow-up was greater than the FI. The FI was significantly associated with sample size, journal impact factor, and the percent of patients lost to follow-up. CONCLUSION Results from some RCTs supporting guideline recommendations for the treatment of osteoporosis depend on a small number of events. The FI and FQ may provide additional, intuitive metrics to help interpret the robustness of trial results.
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Affiliation(s)
- X Huang
- Center for Clinical Epidemiology and Methodology (CCEM), Guangdong Second Provincial General Hospital, Guangzhou, China
| | - B Chen
- Department of Endocrinology, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - L Thabane
- Department of Health research methods, Evidence, and Impact (HEI), McMaster University, 1280 Main St West, Hamilton, ON, L8S 4 L8, Canada
| | - J D Adachi
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - G Li
- Center for Clinical Epidemiology and Methodology (CCEM), Guangdong Second Provincial General Hospital, Guangzhou, China.
- Department of Health research methods, Evidence, and Impact (HEI), McMaster University, 1280 Main St West, Hamilton, ON, L8S 4 L8, Canada.
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Al-Daghri NM, Hussain SD, Ansari MGA, Khattak MNK, Aljohani N, Al-Saleh Y, Al-Harbi MY, Sabico S, Alokail MS. Decreasing prevalence of vitamin D deficiency in the central region of Saudi Arabia (2008-2017). J Steroid Biochem Mol Biol 2021; 212:105920. [PMID: 34004334 DOI: 10.1016/j.jsbmb.2021.105920] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 04/05/2021] [Accepted: 05/04/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Widespread vitamin D deficiency (serum 25-hydroxyvitamin D < 50 nmol/L) in Saudi Arabia (SA) has been documented, yet a time trend is needed to establish where the prevalence is headed. This study aims to fill this gap. STUDY DESIGN AND SETTING This cross-sectional series (N = 7360) were conducted in the central region of SA from 2008 to 2017. Participants of all ages were taken from multiple cohorts that included the Biomarker Screening in Riyadh (2008-2010; N = 1460), the Osteoporosis Registry (2014-2017; N = 1225), Gestational Diabetes Mellitus cohort (2014-2017, N = 281), Vitamin D School Project (2011-2017; N = 3039) and Prediabetes cohort (2012-2017; N = 1355) master databases. RESULTS Vitamin D deficiency in SA has a 10-year prevalence of 73.2 %. Between 2008-2017, the prevalence of vitamin D deficiency decreased from 87.1% to 64.7% for participants aged 18-40 years (p-trend<0.001), and from 86.2% to 45.7% in participants aged > 40 years (p-trend<0.001). During this period, vitamin D deficiency in females decreased from 80.1% to 69.6% (p-trend<0.001), whereas in males, it decreased from 93.2% to 49.3% (p-trend<0.001). Serum 25(OH)D was observed to have an overall increase of 2.2 ± 0.1 nmol/l (p < 0.001) along with the seasonally adjusted annual increase of 1.3 ± 0.2 nmol/l from 2008 to 2017 (p < 0.001). CONCLUSION The decreasing trend in vitamin D deficiency in SA across all demographics suggests successful public health campaigns over time. It will be interesting to investigate further whether the general improvement in the vitamin D status at the community level also translated in lesser incidences of vitamin d-related diseases over time.
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Affiliation(s)
- Nasser M Al-Daghri
- Chair for Biomarkers of Chronic Diseases, Riyadh Biochemistry Department, College of Science, King Saud University, 11451, Riyadh, Saudi Arabia.
| | - Syed Danish Hussain
- Chair for Biomarkers of Chronic Diseases, Riyadh Biochemistry Department, College of Science, King Saud University, 11451, Riyadh, Saudi Arabia
| | - Mohammed G A Ansari
- Chair for Biomarkers of Chronic Diseases, Riyadh Biochemistry Department, College of Science, King Saud University, 11451, Riyadh, Saudi Arabia
| | - Malak N K Khattak
- Chair for Biomarkers of Chronic Diseases, Riyadh Biochemistry Department, College of Science, King Saud University, 11451, Riyadh, Saudi Arabia
| | - Naji Aljohani
- Obesity, Endocrine and Metabolism Center, King Fahad Medical City, Faculty of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, 11525, Saudi Arabia
| | - Yousef Al-Saleh
- Chair for Biomarkers of Chronic Diseases, Riyadh Biochemistry Department, College of Science, King Saud University, 11451, Riyadh, Saudi Arabia; College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia; Department of Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Mohammed Y Al-Harbi
- Diabetes Centers and Units Administration, Ministry of Health, Riyadh, Saudi Arabia
| | - Shaun Sabico
- Chair for Biomarkers of Chronic Diseases, Riyadh Biochemistry Department, College of Science, King Saud University, 11451, Riyadh, Saudi Arabia
| | - Majed S Alokail
- Chair for Biomarkers of Chronic Diseases, Riyadh Biochemistry Department, College of Science, King Saud University, 11451, Riyadh, Saudi Arabia
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Effects of a 2-Week 5000 IU versus 1000 IU Vitamin D3 Supplementation on Recovery of Symptoms in Patients with Mild to Moderate Covid-19: A Randomized Clinical Trial. Nutrients 2021; 13:nu13072170. [PMID: 34202578 PMCID: PMC8308273 DOI: 10.3390/nu13072170] [Citation(s) in RCA: 98] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/15/2021] [Accepted: 06/21/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Vitamin D deficiency has been associated with an increased risk of COVID-19 severity. This multi-center randomized clinical trial aims to determine the effects of 5000 IU versus 1000 IU daily oral vitamin D3 supplementation in the recovery of symptoms and other clinical parameters among mild to moderate COVID-19 patients with sub-optimal vitamin D status. STUDY DESIGN AND SETTING A total of 69 reverse transcriptase polymerase chain reaction (RT-PCR) SARS-CoV-2 positive adults who were hospitalized for mild to moderate COVID-19 disease were allocated to receive once daily for 2 weeks either 5000 IU oral vitamin D3 (n = 36, 21 males; 15 females) or 1000 IU oral vitamin D3 (standard control) (n = 33, 13 males; 20 females). Anthropometrics were measured and blood samples were taken pre- and post-supplementation. Fasting blood glucose, lipids, serum 25(OH)D, and inflammatory markers were measured. COVID-19 symptoms were noted on admission and monitored until full recovery. RESULTS Vitamin D supplementation for 2 weeks caused a significant increase in serum 25(OH)D levels in the 5000 IU group only (adjusted p = 0.003). Within-group comparisons also showed a significant decrease in BMI and IL-6 levels overtime in both groups (p-values < 0.05) but was not clinically significant in between-group comparisons. Kaplan-Meier survival analysis revealed that the 5000 IU group had a significantly shorter time to recovery (days) than the 1000 IU group in resolving cough, even after adjusting for age, sex, baseline BMI, and D-dimer (6.2 ± 0.8 versus 9.1 ± 0.8; p = 0.039), and ageusia (loss of taste) (11.4 ± 1.0 versus 16.9 ± 1.7; p = 0.035). CONCLUSION A 5000 IU daily oral vitamin D3 supplementation for 2 weeks reduces the time to recovery for cough and gustatory sensory loss among patients with sub-optimal vitamin D status and mild to moderate COVID-19 symptoms. The use of 5000 IU vitamin D3 as an adjuvant therapy for COVID-19 patients with suboptimal vitamin D status, even for a short duration, is recommended.
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Elsalmawy AA, Al-Ali NS, Yaghi Y, Assaggaf H, Maalouf G, Sadat-Ali M, Zaher E, Saghieh S, Mahmoud A, Taher M. Middle East experience from the Asia And Latin America Fracture Observational Study (ALAFOS): Baseline characteristics of postmenopausal women with osteoporosis using teriparatide. J Int Med Res 2021; 48:300060520940855. [PMID: 32762404 PMCID: PMC7557781 DOI: 10.1177/0300060520940855] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE We aimed to describe the baseline clinical characteristics and fracture history of patients taking teriparatide in routine clinical practice in the Middle East (ME) subregional cohort of the Asia and Latin America Fracture Observational Study (ALAFOS). METHODS Herein, we report baseline clinical characteristics of patients who were prescribed teriparatide (20 µg/day, subcutaneous injection) in four participant ME countries (Saudi Arabia, United Arab Emirates, Kuwait, and Lebanon). RESULTS The ME cohort included 707 patients mean (SD) age 69.3 (11.6) years. Mean (SD) bone mineral density (BMD) T-scores at baseline were -3.13 (1.28) for lumbar spine, -2.88 (0.94) for total hip, and -2.65 (1.02) for femoral neck. Osteoporotic fractures after age 40 years were reported in 45.8% (vertebral fracture 14.4%, hip fracture 18.4%) and comorbidities in 57.4% of patients. Before starting teriparatide, 19.9% of patients took other osteoporosis medications. The median (Q1; Q3) EuroQoL 5-Dimension 5-Level visual analog scale score for perceived overall health status was 70 (50; 80). Mean (SD) worst back pain in the previous 24 hours was 4.0 (3.2) using a 10-point numeric rating scale. CONCLUSION This analysis indicated that in ME countries, teriparatide is usually prescribed to patients with low BMD and high comorbidities, with prior fractures.
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Affiliation(s)
| | | | | | | | - Ghassan Maalouf
- Musculoskeletal Department, Bellevue Medical Center - Faculty of Medicine of Saint Joseph University, Mansourieh, Lebanon
| | - Mir Sadat-Ali
- College of Medicine, Imam Abdulrahamn Bin Faisal University, Dammam and King Fahad University Hospital, Al Khobar, Saudi Arabia
| | - Essam Zaher
- FRCSED, FIAS, CCSRT, MS (TR) Ahmadi Hospital Kuwait, Al Ahmadi, Kuwait
| | - Said Saghieh
- American University of Beirut Medical Centre, Beirut. Lebanon
| | | | - Mohamed Taher
- Eli Lilly and Company, Dubai Healthcare City, Dubai, United Arab Emirates
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Iolascon G, de Sire A, Curci C, Paoletta M, Liguori S, Calafiore D, Gimigliano F, Moretti A. Osteoporosis guidelines from a rehabilitation perspective: systematic analysis and quality appraisal using AGREE II. Eur J Phys Rehabil Med 2021; 57:273-279. [PMID: 33650841 DOI: 10.23736/s1973-9087.21.06581-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION People affected by osteoporosis and fragility fractures often report disability and poor health-related quality of life. Albeit rehabilitation has a crucial role in older people, post-menopausal women and other subjects with high risk of fragility fractures, the rehabilitation perspective has been poorly investigated in the available guidelines for osteoporosis. The aim of this systematic review was to systematically evaluate the quality of guidelines for osteoporosis from a rehabilitation perspective. EVIDENCE ACQUISITION On May 2020, we performed a systematic search on medical literature of all guidelines published in the last 10 years on PubMed, Pedro, and international guideline databases. The study selection was based on key terms "exercise," "physical activity" or "rehabilitation." All authors independently assessed the methodological quality through the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, consisting of six domains (scope, stakeholder involvement, rigor and development, clarity of presentation, applicability, editorial independence). EVIDENCE SYNTHESIS Out of 331 documents retrieved, a total of 34 guidelines were selected after the screening phases. Twenty (58.8%) high quality guidelines were reported. According to AGREE II instrument, a mean score of 78.1±21.8% was reported for "scope and purpose" domain; for stakeholder involvement, the mean score was 58.1±22.1%; the rigor of development was good (mean score of 61.3±27.3%); for clarity of presentation the mean score was 79.4±20.3%; the applicability was poor (mean score of 30.9±25.2%); for editorial independence the mean score was 75.1±24.6%. Rehabilitation recommendations for osteoporotic patients were reported in 21 (61.8%) of the selected guidelines. CONCLUSIONS This is the first systematic analysis evaluating quality of the guidelines for osteoporosis using AGREE II instrument. Starting from a state of the art of the currently available evidence, we could conclude that therapeutic exercise at moderate to high intensity is encouraged by several guidelines for the management of people with osteoporosis and fragility fractures. More than half of guidelines were of high-quality. However, most guidelines are lacking specific indications about exercise features. This study might support the implementation of a rehabilitation perspective in the guidelines for osteoporotic patients.
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Affiliation(s)
- Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Alessandro de Sire
- Department of Medical and Surgical Sciences, University of Catanzaro "Magna Grecia", Catanzaro, Italy -
| | - Claudio Curci
- Section of Neuromotor Rehabilitation, Department of Neuroscience, ASST Carlo Poma, Mantua, Italy
| | - Marco Paoletta
- Department of Medical and Surgical Specialties and Dentistry, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Sara Liguori
- Department of Medical and Surgical Specialties and Dentistry, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Dario Calafiore
- Section of Neuromotor Rehabilitation, Department of Neuroscience, ASST Carlo Poma, Mantua, Italy
| | - Francesca Gimigliano
- Department of Mental and Physical Health and Preventive Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Antimo Moretti
- Department of Medical and Surgical Specialties and Dentistry, Luigi Vanvitelli University of Campania, Naples, Italy
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Almazrou SH, Alsubki LA, Alsaigh NA, Aldhubaib WH, Ghazwani SM. Assessing the Quality of Clinical Practice Guidelines in the Middle East and North Africa (MENA) Region: A Systematic Review. J Multidiscip Healthc 2021; 14:297-309. [PMID: 33603389 PMCID: PMC7881789 DOI: 10.2147/jmdh.s284689] [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: 10/07/2020] [Accepted: 12/18/2020] [Indexed: 01/09/2023] Open
Abstract
Aim Clinical practice guidelines (CPGs) have progressively become a popular tool for making optimal clinical decisions. The literature shows that the poor quality of CPGs can form a barrier against adhering to them, resulting in a suboptimal level of healthcare. The objective of this systematic review is to evaluate the quality of CPGs in the Middle East and North Africa (MENA) region using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) Instrument. Methods The authors searched in the MEDLINE and EMBASE databases through the Ovid interface on May 25, 2019. Keywords relating to CPGs and MENA countries were combined using Boolean search operators. The search was not limited to specific diseases. The quality of guidelines was appraised by two reviewers independently using the AGREE II Instrument. Discrepancies within a group were resolved through the involvement of a principle investigator. Results A total of 61 CPGs were appraised. These guidelines were mainly from Saudi Arabia, and the most covered disease topic was cancer. Among the six domains of the AGREE II Instrument, CPGs scored the highest on clarity of presentation (mean 82%), while the lowest score was granted to the rigor of development domain (mean 28%). This indicates substantial deficiencies in reporting the developmental processes of CPGs and the resources used for the synthesis of evidence. Conclusion From this review, it was found that the number of retrieved guidelines published in the MENA region is limited considering the large geographical area of the MENA region. The main domains that have higher quality scores were clarity of presentation and scope and purpose, whereas domains with the lowest scores were rigor of development and applicability. The authors’ findings will help policymakers identify areas for improvement in CPGs, which can lead them to implement strategies such as the training of individuals and recruitment of international experts to ultimately develop high-quality CPGs.
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Affiliation(s)
- Saja H Almazrou
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Layan A Alsubki
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Norah A Alsaigh
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Wadha H Aldhubaib
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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Kim JH, Seo BK, Baek YH. Quality assessment of traditional and conventional medicine clinical practice guidelines for osteoporosis. Medicine (Baltimore) 2021; 100:e24559. [PMID: 33592911 PMCID: PMC7870180 DOI: 10.1097/md.0000000000024559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 12/14/2020] [Accepted: 01/11/2021] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT Numerous studies have reported the variable quality of clinical practice guidelines (CPGs) across various domains. The aim of this study was to systematically assess the quality, methodology, and consistency of recently developed traditional and conventional medicine CPGs that focus on the management of osteoporosis and provide helpful recommendations for patients with osteoporosis.From June 2020 to July 2020, CPGs with osteoporosis targeting any age were systematically retrieved. All CPGs of traditional and conventional medicine related to the assessment and diagnosis, management, and clinical therapeutic and pharmacological recommendations with osteoporosis were eligible for inclusion in this study. The excluded documents included guidelines without recommendations, secondary publications derived from CPGs, consensus statements, or consensus conferences based on the opinion of panelists, systematic reviews, editorials, clinical trials, and single-author documents. The quality of CPGs was independently examined by three assessors using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. AGREE II consists of 6 domains; scope and purpose, stakeholder involvement, rigor of development, clarity of presentation, applicability, and editorial independence. Consequently, selected CPGs were graded as recommended (A), recommended with modifications (B), or not recommended (C), and the specific treatments and preventive recommendations in the CPGs were summarized.The quality of the 15 CPGs assessed varied across the AGREE II domains. The overall quality ranged from 3.0 to 6.0 out of 7. The domain that had the highest scores were "clarity of presentation," with a mean value of 69.0% (range 46%-83%); "editorial independence" had the lowest score of 30.2% (range 0%-75%). The conventional CPGs focused on pharmacological treatments, calcium and vitamin D intake, and prevention, while the traditional CPGs consistently emphasized on herbal medicine and non-pharmaceutical treatment and management.Further development of CPGs will require improvement in domains where low item scores have been obtained in the quality assessment in this present study. Further research is needed on alternative modalities for osteoporosis, especially complementary approaches, and higher quality CPGs are needed to facilitate evidence-based clinical practice.
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Affiliation(s)
- Jung-Hyun Kim
- Department of Acupuncture and Moxibustion, Kyung Hee University Hospital, Gangdong 892, Dongnam-ro, Guangdong-gu
| | - Byung-Kwan Seo
- Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul, Republic of Korea
| | - Yong-Hyeon Baek
- Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul, Republic of Korea
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Vitamin D Metabolites and Sex Steroid Indices in Postmenopausal Women with and without Low Bone Mass. Metabolites 2021; 11:metabo11020086. [PMID: 33535639 PMCID: PMC7912789 DOI: 10.3390/metabo11020086] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/24/2021] [Accepted: 01/29/2021] [Indexed: 01/10/2023] Open
Abstract
While the independent roles of vitamin D and sex hormones in skeletal health are well established, the associations of vitamin D and its metabolites to sex hormones and their indices are less investigated. In this observational study, clinical information of 189 Saudi postmenopausal women aged ≥50 years old [N = 80 with normal bone mineral density (BMD), aged 53.3 ± 7.7 years with body mass index (BMI)= 34.1kg/m2 ± 5.8, and N = 109 with low BMD (T-score −1.0 to −2.5), aged 57.0 ± 8.2 years, BMI = 32.4kg/m2 ± 6.2] was extracted from an existing capital-wide osteoporosis registry in Riyadh, Saudi Arabia. Data included were BMD scores, serum total 25(OH)D, sex hormones, and bone turnover markers which were measured using commercially available assays. Age- and BMI-adjusted comparisons revealed significantly higher parathyroid hormone (PTH) levels as well as significantly lower testosterone and bioavailable testosterone in the low BMD group than the normal BMD group (p-values 0.04, 0.02, and 0.03, respectively). Stepwise linear regression showed that circulating testosterone levels accounted for 9.7% and 8.9% of the variances perceived in bioavailable 25(OH)D and free 25(OH)D, respectively (p < 0.01), independent of other sex hormones, sex hormone indices, and bone turnover markers. Our study suggests that androgens are significantly associated with non-conventional vitamin D metabolites and these associations may have clinical relevance in assessing risk for low BMD and osteoporosis in Arab postmenopausal women.
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Mettawi AS, Soliman SS, Taha ME. Clinician's guide for the management and research of osteoporosis in North African men: a guidelines comparison, a cost-effectiveness analysis, and a local algorithm. Arch Osteoporos 2020; 15:159. [PMID: 33037516 DOI: 10.1007/s11657-020-00830-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 09/28/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED A local management algorithm and practice recommendations for the management of osteoporosis in Egyptian males were developed after assessing the applicability of current international recommendations and the cost effectiveness of local drugs. A systematic review and sensitivity analyses augmented the quality of the research efforts. PURPOSE Osteoporosis affects both men and women; however, no local recommendations for the condition are available for the male population. Therefore, this study was undertaken to produce recommendations for men based on the applicability of current international recommendations and the cost effectiveness of local drugs. METHODS The International Osteoporosis Foundation website, EMBASE, and SUMSEARCH-2 databases were searched to identify all guidelines that included recommendations for males. Regional and international guidelines were then appraised using the Advancing Guideline Development, Reporting, and Evaluation in Healthcare-II tool. A cost-effectiveness analysis was conducted using the perspective of an uninsured patient, international outcomes, and local costs. Recommendations were then formulated using the Grading of Recommendations Assessment, Development and Evaluation guidelines, and symbolic representations. RESULTS Twenty-six guidelines were found. Only one of the guidelines focused entirely on males, with the remainder making inferences based on recommendations for females. Six regional guidelines were mainly of low quality. Alendronate was considered to be the most cost-effective drug, while teriparatide was found to be unaffordable. CONCLUSION Recommendations for men with osteoporosis are based on that of women, and the topic lacks exploration in the Middle East. International recommendations and other guidelines were evaluated and adopted to create guidance for the management of osteoporosis in men for application in Egypt.
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Affiliation(s)
- Ahmed S Mettawi
- Faculty of life sciences and education (FLSE), University of South Wales (USW), Llantwit Rd, Pontypridd, CF37 1DL, UK.
| | - Saeed S Soliman
- Department of Family Medicine, Kasralainy School of Medicine, Cairo University, Cairo, Egypt
| | - Mohy E Taha
- Department of Orthopaedics and Trauma Surgery, Basel University Hospital, Basel, Switzerland
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Characteristics and outcomes of osteoporotic hip fractures: treatment gaps in a tertiary care center in Riyadh, Saudi Arabia. Aging Clin Exp Res 2020; 32:1689-1695. [PMID: 31643073 DOI: 10.1007/s40520-019-01377-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 10/05/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Hip fracture is the most clinically devastating and economically important complication of osteoporosis. Pain, suffering, loss of mobility and independence are some of the devastating consequences of hip fractures. The present study aimed to determine the main characteristics and outcomes of patients with osteoporotic hip fracture and treatment gaps at King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia. METHODS This is a single-center, retrospective cohort study analyzing charts of patients > 45 years who were admitted for hip fracture secondary to low-grade trauma from 2008 to 2012. RESULTS A total of 264 patients (50.4% males and 49.6% females) were included. The most common fracture types were trochanter (49%) and femoral neck (46%). History of falls was documented in 115 (43.6%) patients. Bone mineral density (BMD) was assessed in only 41 (15.5%) patients. Majority underwent surgery (92%). Surgical complications occurred in 15 (5.7%) patients and medical complications in 21 (7.9%) patients. Vitamin D and calcium were the most common medications, but given only to 45 (17%) patients. Bone mineral density (BMD) assessment was significantly more frequent post-surgery than pre-surgery (p = 0.03). Very few patients received osteoporosis-specific therapy. F ollow-up revealed that 62 (23.5%) patients died 1 year after surgery. CONCLUSION These present findings warrant urgent reassessment of clinical care and treatments provided to patients with osteoporotic hip fractures to prevent recurrent fractures. The introduction of Fracture Liaison Service (FLS) in institutions caring for patients with hip fractures as internationally recommended will definitely change the current status of care.
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Banjabi AA, Li AJ, Kumosani TA, Yousef JM, Kannan K. Serum concentrations of perfluoroalkyl substances and their association with osteoporosis in a population in Jeddah, Saudi Arabia. ENVIRONMENTAL RESEARCH 2020; 187:109676. [PMID: 32485360 DOI: 10.1016/j.envres.2020.109676] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 05/05/2020] [Accepted: 05/11/2020] [Indexed: 06/11/2023]
Abstract
Human exposure to poly- and perfluoroalkyl substances (PFASs) is widespread and has received considerable attention in recent years due to their link with adverse health outcomes, including bone health. Nevertheless, no earlier studies have reported serum PFAS concentrations, and their association with incident osteoporosis in populations in Saudi Arabia. In this clinical case-control study, serum samples collected from 208 individuals (n = 100 cases and n = 108 controls) aged 40-89 years from Jeddah, Saudi Arabia, were analyzed for 17 PFASs. Unconditional logistic regression was used to calculate odds ratios (ORs) for association between serum PFAS concentrations and osteoporosis, stratified by gender, age, serum calcium and vitamin D, previous history of fractures and thyroid disorders. Perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS), perfluorobutanoic acid (PFBA), perfluorononanoic acid (PFNA), perfluorohexane sulfonic acid (PFHxS), perfluoro-n-pentanoic acid (PFPeA) and perfluoroundecanoic acid (PFUnDA) were detected in >80% of serum samples analyzed. PFOS (overall median concentration: 5.08 ng/mL), PFHxS (1.49 ng/mL), PFOA (1.33 ng/mL) and PFNA (0.55 ng/mL) accounted for 94% and 80% of the total serum PFASs concentrations in cases and controls, respectively. Serum PFOA, PFNA and PFUnDA concentrations increased with age in Saudi women. Results from the crude models showed that individuals in the 2nd, 3rd and 4th quartiles of serum PFAS concentrations had 2.3-96-fold increase in odds of diagnosis for osteoporosis compared with those in the 1st quartile (rank order: PFUnDA > PFOA > PFNA > PFOS > PFHxS). Our results suggest that exposure to PFOA, PFOS, PFNA, PFHxS and PFUnDA was associated with osteoporosis in this sample of adult Saudi population.
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Affiliation(s)
- Abeer A Banjabi
- Biochemistry Department, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Adela Jing Li
- Wadsworth Center, New York State Department of Health, Albany, NY, 12201, USA
| | - Taha A Kumosani
- Biochemistry Department, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia; Production of Bio-products for Industrial Applications Research Group, King Abdulaziz University, Jeddah, Saudi Arabia; Experimental Biochemistry Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Jehad M Yousef
- Biochemistry Department, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia; Experimental Biochemistry Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia; Biochemistry Department, College of Science, University of Jeddah, Jeddah, Saudi Arabia
| | - Kurunthachalam Kannan
- Biochemistry Department, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia; Wadsworth Center, New York State Department of Health, Albany, NY, 12201, USA; Experimental Biochemistry Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia; Department of Pediatrics, New York University School of Medicine, New York, NY, 10016, USA; Department of Environmental Medicine, New York University School of Medicine, New York, NY, 10016, USA.
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Al-Saleh Y, Al-Daghri NM, Sabico S, Alessa T, Al Emadi S, Alawadi F, Al Qasaabi S, Alfutaisi A, Al Izzi M, Mukhaimer J, Suhaili AR, Reginster JY, Sulimani R. 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). Arch Osteoporos 2020; 15:109. [PMID: 32700153 DOI: 10.1007/s11657-020-00778-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/25/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED 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.
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Affiliation(s)
- Yousef Al-Saleh
- Chair for Biomarkers of Chronic Diseases, College of Science, King Saud University, PO Box 2455, Riyadh, 11451, Kingdom of Saudi Arabia.,College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, 22490, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, 11481, Saudi Arabia.,Department of Medicine, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, 14611, Saudi Arabia
| | - Nasser M Al-Daghri
- Chair for Biomarkers of Chronic Diseases, College of Science, King Saud University, PO Box 2455, Riyadh, 11451, Kingdom of Saudi Arabia.
| | - Shaun Sabico
- Chair for Biomarkers of Chronic Diseases, College of Science, King Saud University, PO Box 2455, Riyadh, 11451, Kingdom of Saudi Arabia
| | - Thamer Alessa
- Division of Endocrinology, Diabetes and Metabolism, Jaber Al-Ahmad Hospital, Kuwait City, Kuwait
| | - Samar Al Emadi
- Department of Medicine, Hamad General Hospital, Doha, Qatar
| | | | | | | | | | | | | | - Jean-Yves Reginster
- Chair for Biomarkers of Chronic Diseases, College of Science, King Saud University, PO Box 2455, Riyadh, 11451, Kingdom of Saudi Arabia.,Department of Public Health, Epidemiology and Health Economics, University of Liège, 4000, Liège, Belgium
| | - Riad Sulimani
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Aziziyeh R, Garcia Perlaza J, Saleem N, Sadat-Ali M, Elsalmawy A, McTavish RK, Duperrouzel C, Cameron C. The burden of osteoporosis in Saudi Arabia: a scorecard and economic model. J Med Econ 2020; 23:767-775. [PMID: 32122190 DOI: 10.1080/13696998.2020.1737536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objectives: Aging populations are contributing to an increased volume of osteoporotic fractures. The goals of this study were to (1) develop a scorecard on epidemiological burden, policy framework, service provision, and service uptake for osteoporosis in Saudi Arabia and (2) estimate the direct costs of managing osteoporotic fractures in Saudi Arabia.Methods: Osteoporosis data specific to Saudi Arabia were collected through a systematic literature review and surveys with osteoporosis experts. The data were used to build a scorecard, as done previously for the European Union and select Latin American countries. The scorecard applied traffic light colour coding to identify areas of risk in Saudi Arabia's management of osteoporosis. The data were also used to parameterize a burden of illness model. The model estimated the direct medical costs of fractures among adults aged 50-89 years in Saudi Arabia. The model included hospitalization, testing, hip fracture surgery, and drug costs.Results: In Saudi Arabia, the Ministry of Health was aware of impending increases in the number of fractures and had prioritized osteoporosis on the national agenda. Accordingly, reimbursement restrictions for osteoporosis diagnosis and treatment were minimal. However, a national fracture registry and unified system for monitoring care were not in operation. This represents a critical gap in care that will continue to contribute to the underdiagnosis and undertreatment of osteoporosis if not addressed. In total, 174,225 osteoporosis-related fractures were estimated to occur in Saudi Arabia in 2019, with an annual cost of SR2.38 billion ($636 million USD; $1.55 billion PPP). Hospitalization was the primary cost driver.Conclusions: In 2019, Saudi Arabia was expected to incur SR2.38 billion ($636 million USD; $1.55 billion PPP) in costs owing to 174,225 osteoporosis-related fractures. The establishment of a national fracture registry and implementation of fracture liaison services will be paramount to reducing the fracture burden.
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Affiliation(s)
| | | | | | - Mir Sadat-Ali
- School of Medicine, King Fahd Hospital, Al Khobar, Saudi Arabia
| | - Abdulaziz Elsalmawy
- Department of Trauma and Orthopedic Surgery, Al Noor Specialized Hospital Makkah, An Naseem, Mecca, Saudi Arabia
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Duan BL, Mao YR, Xue LQ, Yu QY, Liu MY. Determination of vitamin D and analysis of risk factors for osteoporosis in patients with chronic pain. World J Clin Cases 2020; 8:2150-2161. [PMID: 32548145 PMCID: PMC7281063 DOI: 10.12998/wjcc.v8.i11.2150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 04/10/2020] [Accepted: 04/30/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Vitamin D deficiency is common in patients with chronic pain and healthy people, but the difference between the two has not been reported; thus, whether there is a relationship between vitamin D deficiency and chronic pain remains to be confirmed. Osteoporosis is a common disease in chronic pain disorders. Understanding the relationship between vitamin D and osteoporosis will provide a basis for the rational supplementation of vitamin D to prevent osteoporosis, and to understand the risk factors of bone mass change to provide a new treatment plan for early prevention of osteoporosis.
AIM To determine 25 hydroxy vitamin D (25OHD) level in patients with chronic pain to clarify its clinical significance. The relationship between vitamin D and bone mineral density (BMD) and the risk factors for bone mass change were also evaluated.
METHODS In this study, 184 patients with chronic pain were included in the study group, and 104 healthy individuals who underwent routine health checkups during the same period were included in the control group. 25OHD level was detected in both groups by enzyme-linked immunosorbent assay. According to the BMD test results, the patients in the study group were further classified into three subgroups: Normal BMD group, reduced BMD group, and osteoporosis group. Age, sex, ethnicity, living altitude, body mass index, 25OHD level, parathyroid hormone (PTH), calcium (Ca) and phosphorus levels were analyzed statistically in both groups.
RESULTS The vitamin D level in the study group was lower than that in the control group at 53.8% vs 57.7%, with no significant difference between the two groups. The proportion of patients with severe vitamin D deficiency in the study group was higher than that in the control group. The mean age was greater in the osteoporosis subgroup, and the youngest in the normal BMD subgroup. Vitamin D level in the osteoporosis subgroup was lower than that in the other two subgroups, and was not specific for the diagnosis of bone mass reduction and osteoporosis. The above results were analyzed statistically and showed significant differences (P < 0.05). There was a positive correlation between age and BMD in patients with chronic pain (R = 0.567, P < 0.001). Age, PTH and Ca were risk factors for bone mass reduction, while age, ethnicity and altitude were risk factors for osteoporosis.
CONCLUSION Vitamin D deficiency is a common phenomenon in patients with chronic pain, and severe vitamin D deficiency is not uncommon. Vitamin D level is not a risk factor for bone mass reduction and osteoporosis. Bone mass reduction is correlated with age, PTH and Ca, while osteoporosis is correlated with age, ethnicity and altitude.
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Affiliation(s)
- Bao-Lin Duan
- Department of Pain, Qinghai Provincial People’s Hospital, Xining 810000, Qinghai Province, China
| | - Yuan-Rong Mao
- Department of Pain, Qinghai Provincial People’s Hospital, Xining 810000, Qinghai Province, China
| | - Li-Qi Xue
- Department of Pain, Qinghai Provincial People’s Hospital, Xining 810000, Qinghai Province, China
| | - Qing-Yuan Yu
- Department of Pain, Qinghai Provincial People’s Hospital, Xining 810000, Qinghai Province, China
| | - Mei-Yi Liu
- Department of Pain, Qinghai Provincial People’s Hospital, Xining 810000, Qinghai Province, China
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Al Hamam NM, Al-Moaibed GF, Alfayez EH, Alfayez EH, Al-Mubaddil MS, Alramadhan NA. Prevalence and risk factors for osteoporotic fracture among adults with comorbidities in Al-Ahsaa, Saudi Arabia. J Family Med Prim Care 2020; 9:877-882. [PMID: 32318438 PMCID: PMC7114042 DOI: 10.4103/jfmpc.jfmpc_982_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 01/06/2020] [Accepted: 01/13/2020] [Indexed: 12/15/2022] Open
Abstract
Background and Aims Little is known about the prevalence of osteoporotic fracture, its sociodemographic correlates, and its comorbid conditions among the adult population of the Kingdome of Saudi Arabia (KSA). Hence, the present work aimed to assess the prevalence of adults at high risk of osteoporotic fracture in the presence of its known risk factors. As well, to determine the most commonly associated comorbidities of osteoporosis in Saudi Arabia. Methods A cross-sectional study was performed among 518 Saudi adults aged over 45 years in Al-Ahsaa city, KSA. The Arabic version of the fracture risk assessment FRAX without bone mineral density (BMD) was presented in an online questionnaire. Results The 10-year risk for major osteoporotic fracture was found in 50.81% of the participants; 23.48% of them were at high risk and 25.71% at moderate risk. Also, 26.27% of the respondents were at high risk of hip fracture. Significant correlates of osteoporotic fractures included female gender (P = 0.003), old age (P = 0.000), age at menopause (P = 0.000), low body mass index (BMI; P = 0.000), previous fracture (P = 0.000), alcohol consumption (P = 0.000), positive family history (P = 0.000), corticosteroids (P = 0.000), rheumatoid arthritis (P = 0.000), thyroid hyperactivity (P = 0.000), gonadal insufficiency (P = 0.000), chronic liver disease (P = 0.000), nutritional, or gestational disease (P = 0.000). Conclusion More than a third of the surveyed population had osteoporosis, which was associated with many sociodemographic and clinical characteristics. Therefore, early interventions for osteoporosis and the prevention of other comorbidities may improve the outcome of osteoporosis.
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Affiliation(s)
- Naif M Al Hamam
- Orthopedic Consultant, College of Medicine, King Faisal University, Al Ahsaa City, Saudi Arabia
| | - Ghusoon F Al-Moaibed
- Medical Intern, College of Medicine, King Faisal University, Al Ahsaa City, Saudi Arabia
| | - Emad H Alfayez
- Medical Intern, College of Medicine, Najran University, Najran City, Saudi Arabia
| | - Eman H Alfayez
- Medical Student, College of Medicine, Alfarabi Colleges, Riyadh, Saudi Arabia
| | | | - Narjes Ali Alramadhan
- Medical Student, College of Medicine, King Faisal University, Al Ahsaa City, Saudi Arabia
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Beshyah SA, Al-Saleh Y, El-Hajj Fuleihan G. Management of osteoporosis in the Middle East and North Africa: a survey of physicians' perceptions and practices. Arch Osteoporos 2019; 14:60. [PMID: 31175470 DOI: 10.1007/s11657-019-0609-y] [Citation(s) in RCA: 5] [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: 04/30/2019] [Accepted: 05/21/2019] [Indexed: 02/03/2023]
Abstract
UNLABELLED We surveyed 573 physicians in the Middle East regarding osteoporosis management. Sixty percent had access to, but were not in charge of, densitometry reporting. Screening for secondary causes was common; 62% were aware of FRAX®; less than half used it. Medications were accessible, and most participants had concerns regarding bisphosphonates. Barriers to care were identified. INTRODUCTION The 2011 IOF Middle East Osteoporosis Audit highlighted major care gaps in osteoporosis care in the Middle East and North Africa (MENA) region. We investigated osteoporosis management practice patterns in this region. METHODS We mailed an electronic survey to a convenience sample of physicians, explaining the study rationale and methods. It gathered information on physicians' profiles, availability and utilization of resources, risk assessment, and management. RESULTS Five hundred seventy-three responses were obtained from the United Arab Emirates (UAE, 36%), Saudi Arabia (KSA, 25%), Lebanon (14%), and others (25%). Endocrinology was the single most represented specialty. Sixty percent of participants had access to densitometers, but treating physicians were not in charge of densitometry reading. Screening for vitamin D deficiency and secondary contributors to osteoporosis was frequently implemented. Although two-thirds of professionals were aware of FRAX®, only 42% used it, either because of lack of know how or of a country specific calculator. Almost all (96.0%) had access to oral and 68.9% to intravenous bisphosphonates, and over half to teriparatide (46.4%) and denosumab (45.0%). Most participants (92%) were aware of concerns regarding side effects of bisphosphonates, and this changed the management in the majority (73%). Important barriers to osteoporosis care were lack of osteoporosis awareness among physicians, patients, and cost of treatment. CONCLUSIONS This first look at physicians' practice patterns on the diagnosis and treatment of osteoporosis in the MENA region underscores the pressing need for an official call for action, at all levels, to address this large care gap.
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Affiliation(s)
- Salem A Beshyah
- Clinical Research and Metabolic Medicine, Dubai Medical College, Dubai, United Arab Emirates.
| | - Yousef Al-Saleh
- Department of Medicine, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ghada El-Hajj Fuleihan
- Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, Scholars in HeAlth Research Program (SHARP), American University of Beirut, Beirut, Lebanon
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Chen CH, Elsalmawy AH, Ish-Shalom S, Lim SJ, Al-Ali NS, Cunha-Borges JL, Yang H, Casas N, Altan L, Moll T, Gurbuz S, Brnabic AJM, Burge RT, Marin F. Study description and baseline characteristics of the population enrolled in a multinational, observational study of teriparatide in postmenopausal women with osteoporosis: the Asia and Latin America Fracture Observational Study (ALAFOS). Curr Med Res Opin 2019; 35:1041-1049. [PMID: 30474449 DOI: 10.1080/03007995.2018.1552576] [Citation(s) in RCA: 9] [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] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To describe the study design and baseline patient characteristics of the Asia and Latin America Fracture Observational Study (ALAFOS) to better understand the profile of patients receiving teriparatide during the course of routine clinical practice in Asia, Latin America, the Middle East and Russia. METHODS Prospective, observational, non-interventional study in postmenopausal women with osteoporosis who are prescribed teriparatide for up to 24 months, according to local medical standards, with a 12 month post-treatment follow-up. MEASURES Demographics, risk factors for osteoporosis and fractures, history of fracture, prior osteoporosis medications, comorbidities, physical function, back pain and quality of life (QoL). RESULTS In total 3031 postmenopausal women (mean age 72.5 years) recruited at 152 sites in 20 countries were analyzed; 62.9% had a history of fragility fracture after age 40 (33.0% of patients with spinal, 14.2% with hip fractures). The mean (SD) bone mineral density T-scores at baseline were -3.06 (1.40) and -2.60 (1.05) at the lumbar spine and femoral neck, respectively. At entry, 43.7% of patients were naïve to prior osteoporosis treatments; 40.5% of patients reported ≥1 fall in the past year. The median (Q1; Q3) EuroQoL Visual Analog Scale (EQ-VAS) for perceived overall health status was 60 (50; 80). The mean (SD) worst back pain Numeric Rating Scale in the last 24 hours was 4.6 (3.3). CONCLUSIONS Our data indicates that patients who were prescribed teriparatide in the ALAFOS participant countries had severe osteoporosis, high prevalence of fractures, disabling back pain and poor QoL. The frequency of patients receiving prior osteoporosis medications was lower than in previous observational studies conducted in other locations.
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Affiliation(s)
- Chung-Hwan Chen
- a Department of Orthopedics , College of Medicine and Kaohsiung Medical University Hospital, Kaohsiung Medical University , Kaohsiung City , Taiwan
| | - Abdulaziz H Elsalmawy
- b Department of Trauma and Orthopedic Surgery , Al Noor Specialized Hospital Makkah , Mecca , Saudi Arabia
| | | | - Seung-Jae Lim
- d Department of Orthopedic Surgery , Sungkyunkwan University School of Medicine , Seoul , South Korea
| | | | - Joao L Cunha-Borges
- f Faculty of Medicine , Universidade Católica de Brasília , Brasilia , Brazil
| | - Huilin Yang
- g Department of Orthopedics , The First Affiliated Hospital of Soochow University , Suzhou , China
| | - Noemí Casas
- h Riesgo de Fractura CAYRE , Bogotá , Colombia
| | - Lale Altan
- i Department of Physical Medicine and Rehabilitation , Uludağ University School of Medicine , Bursa , Turkey
| | - Thomas Moll
- j Lilly Research Center , Windlesham , United Kingdom
| | - Sirel Gurbuz
- k Lilly Research Laboratories , Indianapolis , IN , USA
| | | | - Russel T Burge
- k Lilly Research Laboratories , Indianapolis , IN , USA
- l Winkle College of Pharmacy , University of Cincinnati , Cincinnati , OH , USA
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Hayawi LM, Graham ID, Tugwell P, Yousef Abdelrazeq S. Screening for osteoporosis: A systematic assessment of the quality and content of clinical practice guidelines, using the AGREE II instrument and the IOM Standards for Trustworthy Guidelines. PLoS One 2018; 13:e0208251. [PMID: 30521556 PMCID: PMC6283636 DOI: 10.1371/journal.pone.0208251] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 11/14/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Numerous clinical practice guidelines (CPGs) are published to guide management of osteoporosis. Little is known about their quality or how recommendations have changed over time. OBJECTIVE To systematically assess the quality and content of the guidelines on screening for osteoporosis, using the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool, and the Institute of Medicine (IOM) standards for trustworthy guidelines. METHODS We conducted a systematic search for osteoporosis CPGs published between 2002-2016, using multiple databases and guideline websites. Two reviewers appraised the quality of eligible CPGs using the AGREE II. High quality CPGs were considered if they scored ≥ 60 in four or more domains including the domain for rigor of development. Non-parametric tests were used to test for the change of quality over time. One reviewer assessed the guidelines with IOM standards. We summarized the different evidence grading systems and extracted and compared the recommendations. RESULTS A total of 33 CPGs were identified. The mean scores for AGREE II differed by domain (range: 42% to 71%). CPGs scored higher on domains for clarity of presentation, scope and purpose, and rigor of development. CPGs scored lower on domains for stakeholder involvement, editorial independence and applicability. Assessment of CPGs by IOM standards showed that CPGs scored better on standards for systematic review, establishing evidence foundation and rating strength of recommendation, articulation of recommendation, and establishing transparency. While scored lower on standards for updating, external review, and the development group composition. There was no difference in AGREE II and IOM defined guidelines' quality before and after the introduction of the two tools (P values >0.05). The IOM identified four more guidelines as high quality compared to the AGREE II. Examining these additional guidelines indicated that the two tools may give conflicting results especially for the rigor of development domain. Recommendations in certain areas showed substantial differences between guidelines. CONCLUSION Osteoporosis screening CPGs are of variable quality, and their recommendations often differ. Guideline quality as measured by AGREE II and IOM standards has not improved overtime. Guideline developers should work together to improve the quality and consistency of recommendations to improve the likelihood that their guidelines will be used in practice.
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Affiliation(s)
- Lamia M. Hayawi
- Pallium Canada, Ottawa, ON, Canada
- Bruyère Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Ian D. Graham
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Nursing, Queen’s University, Kingston, ON, Canada
| | - Peter Tugwell
- Bruyère Research Institute, University of Ottawa, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Centre for Global Health, University of Ottawa, Ottawa, ON, Canada
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Aljumah AA, Al Jarallah B, Albenmousa A, Al Khathlan A, Al Zanbagi A, Al Quaiz M, Al-Judaibi B, Nabrawi K, Al Hamoudi W, Alghamdi M, Fallatah H. The Saudi association for the study of liver diseases and transplantation clinical practice guidelines for management of autoimmune hepatitis. Saudi J Gastroenterol 2018; 24:S1-S20. [PMID: 30264737 PMCID: PMC6305081 DOI: 10.4103/sjg.sjg_159_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Abdulrahman A. Aljumah
- Division of Hepatology, Hepatobiliary Sciences and Organ Transplant Center, King Abdulaziz Medical City and King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Badr Al Jarallah
- Department of Medicine, Division of Gastroenterology, Al Qassim University, Al Qassim, Saudi Arabia
| | - Ali Albenmousa
- Department of Gastroenterology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Abdullah Al Khathlan
- Department of Medicine, Division of Gastroenterology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Adnan Al Zanbagi
- Department of Medicine, Division of Gastroenterology, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Mohammed Al Quaiz
- Department of Medicine, Section of Gastroenterology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Bandar Al-Judaibi
- Department of Medicine, University of Rochester, Rochester City, New York State, USA
| | - Khalid Nabrawi
- Department of Internal Medicine, Aseer Central Hospital, Abha, Saudi Arabia
| | - Waleed Al Hamoudi
- Department of Medicine, Division of Gastroenterology, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Alghamdi
- Department of Internal Medicine, King Fahad Military Medical City, Dhahran, Saudi Arabia
| | - Hind Fallatah
- Department of Medicine, Division of Gastroenterology and Hepatology, King Abdulaziz University, Jeddah, Saudi Arabia
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Zareef TA, Jackson RT, Alkahtani AA. Vitamin D Intake among Premenopausal Women Living in Jeddah: Food Sources and Relationship to Demographic Factors and Bone Health. J Nutr Metab 2018; 2018:8570986. [PMID: 29750126 PMCID: PMC5884207 DOI: 10.1155/2018/8570986] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 12/12/2017] [Accepted: 12/28/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Saudi women depend on food sources to maintain their serum 25(OH) D concentrations because covering by traditional clothing and time spent indoors limit their sun exposure. Little is known about vitamin D intake and its main food sources in Saudi Arabia. In addition, the association between vitamin D and calcium intake and bone mineral density (BMD) in young women is not well researched. OBJECTIVES To assess the adequacy of vitamin D intake among Saudi women as compared to the estimated average requirements (EARs), to identify dietary vitamin D sources, to examine potential determinants of vitamin D intake, and to assess bone health and the association of calcium and vitamin D intake with BMD. METHODS This cross-sectional study was conducted in 257 premenopausal women aged 20-50 years in Jeddah, Saudi Arabia. Dietary vitamin D and calcium were assessed by the Semiquantitative Food Frequency Questionnaire. BMD was measured using dual-energy X-ray absorptiometry (DXA) in a subset of women (n=102) at the lumbar spine and femur neck. RESULTS Sixty-five percent of women were below the EAR for vitamin D, and 61% fell below the EAR for calcium. Dairy products, supplements, and fish contributed most to vitamin D intake. Increased age was an independent determinant of sufficient vitamin D intake (p < 0.001). The prevalence of osteopenia was 33% in the lumbar spine and 30% in the femur neck. There was a significant positive association between calcium intake and BMD at the lumbar spine (p=0.043) after controlling for body mass index and energy intake. Vitamin D intake was not significantly different between women with low and normal bone mass. CONCLUSION Premenopausal women in Jeddah have insufficient vitamin D and calcium intakes. Public health strategies to improve nutrition in young women are needed, and expanding fortification programs to include all dairy products would be useful.
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Affiliation(s)
- Tahani A. Zareef
- Department of Nutrition and Food Science, University of Maryland, College Park, MD 20742, USA
| | - Robert T. Jackson
- Department of Nutrition and Food Science, University of Maryland, College Park, MD 20742, USA
| | - Abdulkareem A. Alkahtani
- Department of Nuclear Medicine, King Abdulaziz Medical City, Jeddah, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
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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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42
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Abstract
The substantial increase in the burden of non-communicable diseases in general and osteoporosis in particular, necessitates the establishment of efficient and targeted diagnosis and treatment strategies. This chapter reviews and compares different tools for osteoporosis screening and diagnosis; it also provides an overview of different treatment guidelines adopted by countries worldwide. While access to dual-energy X-ray absorptiometry to measure bone mineral density (BMD) is limited in most areas in the world, the introduction of risk calculators that combine risk factors, with or without BMD, have resulted in a paradigm shift in osteoporosis screening and management. To-date, forty eight risk assessment tools that allow risk stratification of patients are available, however only few are externally validated and tested in a population-based setting. These include Osteoporosis Self-Assessment Tool; Osteoporosis Risk Assessment Instrument; Simple Calculated Osteoporosis Risk Estimation; Canadian Association of Radiologists and Osteoporosis Canada calculator; Fracture Risk Assessment Calculator (FRAX); Garvan; and QFracture. These tools vary in the number of risk factors incorporated. We present a detailed analysis of the development, characteristics, validation, performance, advantages and limitations of these tools. The World Health Organization proposes a dual-energy X-ray absorptiometry-BMD T-score ≤ -2.5 as an operational diagnostic threshold for osteoporosis, and many countries have also adopted this cut-off as an intervention threshold in their treatment guidelines. With the introduction of the new fracture assessment calculators, many countries chose to include fracture risk as one of the major criteria to initiate osteoporosis treatment. Of the 52 national guidelines identified in 36 countries, 30 included FRAX derived risk in their intervention threshold and 22 were non-FRAX based. No universal tool or guideline approach will address the needs of all countries worldwide. Osteoporosis screening and management guidelines are best tailored according to the needs and resources of individual counties. While few countries have succeeded in generating valuable epidemiological data on osteoporotic fractures, to validate their risk calculators and base their guidelines, many have yet to find the resources to assess variations and secular trends in fractures, the performance of various calculators, and ultimately adopt the most convenient care pathway algorithms.
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Affiliation(s)
- Ghada El-Hajj Fuleihan
- Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, Division of Endocrinology and Metabolism, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Marlene Chakhtoura
- Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, Division of Endocrinology and Metabolism, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jane A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nariman Chamoun
- Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, Division of Endocrinology and Metabolism, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Hammad LF, Benajiba N. Lifestyle factors influencing bone health in young adult women in Saudi Arabia. Afr Health Sci 2017; 17:524-531. [PMID: 29062349 PMCID: PMC5637039 DOI: 10.4314/ahs.v17i2.28] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
AIM To analyze risk factors leading to osteopenia and osteoporosis among young female students. METHODS Quantitative Ultrasonography measurements were performed in the calcaneal region of 101 young Saudi females. Dietary habits, exercising and sun exposure were assessed using questionnaires. The association between the different studied factors was assessed by Pearson test and multiple linear regression model. RESULTS Participants diagnosed with either osteopenia or osteoporosis (>33%.) showed significant higher soft drinks consumption, reduced exercise, limited intake of milk and dairy products, calcium and vitamin D supplementation compared to the healthy group. Multiple regression analysis showed that T-score and Z-score were negatively associated with soft drink intake and positively associated with exercising, milk and dairy products consumption, and calcium and vitamin D supplementation use (p <0.05). CONCLUSION High soft drink intake, lack of exercising and limited calcium and vitamin D supplementation are the combined lifestyle factors leading to osteopenia and osteoporosis among young Saudi females. These findings might serve as a basis of nutrition education intervention to promote healthy bones among this population.
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Affiliation(s)
- Lina F Hammad
- Department of Radiological Sciences, College of Applied Medical Sciences King Saud University, Riyadh, Saudi Arabia
| | - Nada Benajiba
- Clinical Nutrition Program — Department of Health Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
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Kanis JA, Harvey NC, Cooper C, Johansson H, Odén A, McCloskey EV. A systematic review of intervention thresholds based on FRAX : A report prepared for the National Osteoporosis Guideline Group and the International Osteoporosis Foundation. Arch Osteoporos 2016; 11:25. [PMID: 27465509 PMCID: PMC4978487 DOI: 10.1007/s11657-016-0278-z] [Citation(s) in RCA: 254] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 06/16/2016] [Indexed: 02/03/2023]
Abstract
UNLABELLED This systematic review identified assessment guidelines for osteoporosis that incorporate FRAX. The rationale for intervention thresholds is given in a minority of papers. Intervention thresholds (fixed or age-dependent) need to be country-specific. INTRODUCTION In most assessment guidelines, treatment for osteoporosis is recommended in individuals with prior fragility fractures, especially fractures at spine and hip. However, for those without prior fractures, the intervention thresholds can be derived using different methods. The aim of this report was to undertake a systematic review of the available information on the use of FRAX® in assessment guidelines, in particular the setting of thresholds and their validation. METHODS We identified 120 guidelines or academic papers that incorporated FRAX of which 38 provided no clear statement on how the fracture probabilities derived are to be used in decision-making in clinical practice. The remainder recommended a fixed intervention threshold (n = 58), most commonly as a component of more complex guidance (e.g. bone mineral density (BMD) thresholds) or an age-dependent threshold (n = 22). Two guidelines have adopted both age-dependent and fixed thresholds. RESULTS Fixed probability thresholds have ranged from 4 to 20 % for a major fracture and 1.3-5 % for hip fracture. More than one half (39) of the 58 publications identified utilised a threshold probability of 20 % for a major osteoporotic fracture, many of which also mention a hip fracture probability of 3 % as an alternative intervention threshold. In nearly all instances, no rationale is provided other than that this was the threshold used by the National Osteoporosis Foundation of the USA. Where undertaken, fixed probability thresholds have been determined from tests of discrimination (Hong Kong), health economic assessment (USA, Switzerland), to match the prevalence of osteoporosis (China) or to align with pre-existing guidelines or reimbursement criteria (Japan, Poland). Age-dependent intervention thresholds, first developed by the National Osteoporosis Guideline Group (NOGG), are based on the rationale that if a woman with a prior fragility fracture is eligible for treatment, then, at any given age, a man or woman with the same fracture probability but in the absence of a previous fracture (i.e. at the 'fracture threshold') should also be eligible. Under current NOGG guidelines, based on age-dependent probability thresholds, inequalities in access to therapy arise especially at older ages (≥70 years) depending on the presence or absence of a prior fracture. An alternative threshold using a hybrid model reduces this disparity. CONCLUSION The use of FRAX (fixed or age-dependent thresholds) as the gateway to assessment identifies individuals at high risk more effectively than the use of BMD. However, the setting of intervention thresholds needs to be country-specific.
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Affiliation(s)
- John A Kanis
- Centre for Metabolic Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK.
- Institute of Health and Ageing, Australian Catholic University, Melbourne, Australia.
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Helena Johansson
- Centre for Metabolic Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
| | - Anders Odén
- Centre for Metabolic Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
| | - Eugene V McCloskey
- Centre for Metabolic Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
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Bellavia D, Costa V, De Luca A, Maglio M, Pagani S, Fini M, Giavaresi G. Vitamin D Level Between Calcium-Phosphorus Homeostasis and Immune System: New Perspective in Osteoporosis. Curr Osteoporos Rep 2016:10.1007/s11914-016-0331-2. [PMID: 27734322 DOI: 10.1007/s11914-016-0331-2] [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] [Indexed: 12/19/2022]
Abstract
Vitamin D is a key molecule in calcium and phosphate homeostasis; however, increasing evidence has recently shown that it also plays a crucial role in the immune system, both innate and adaptive. A deregulation of vitamin D levels, due also to mutations and polymorphisms in the genes of the vitamin D pathway, determines severe alterations in the homeostasis of the organism, resulting in a higher risk of onset of some diseases, including osteoporosis. This review gives an overview of the influence of vitamin D levels on the pathogenesis of osteoporosis, between bone homeostasis and immune system.
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Affiliation(s)
- Daniele Bellavia
- Innovative Technology Platforms for Tissue Engineering, Theranostics and Oncology, Rizzoli Orthopaedic Institute, Via Divisi, 83, 90100, Palermo, Italy
| | - Viviana Costa
- Innovative Technology Platforms for Tissue Engineering, Theranostics and Oncology, Rizzoli Orthopaedic Institute, Via Divisi, 83, 90100, Palermo, Italy
| | - Angela De Luca
- Innovative Technology Platforms for Tissue Engineering, Theranostics and Oncology, Rizzoli Orthopaedic Institute, Via Divisi, 83, 90100, Palermo, Italy
| | - Melania Maglio
- Laboratory of Biocompatibility, Technological Innovations and Advanced Therapies, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Stefania Pagani
- Laboratory of Preclinical and Surgical Studies, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Milena Fini
- Laboratory of Biocompatibility, Technological Innovations and Advanced Therapies, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Gianluca Giavaresi
- Innovative Technology Platforms for Tissue Engineering, Theranostics and Oncology, Rizzoli Orthopaedic Institute, Via Divisi, 83, 90100, Palermo, Italy.
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Al-Faris NA. High Prevalence of Vitamin D Deficiency among Pregnant Saudi Women. Nutrients 2016; 8:77. [PMID: 26861386 PMCID: PMC4772041 DOI: 10.3390/nu8020077] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 01/17/2016] [Accepted: 01/28/2016] [Indexed: 12/25/2022] Open
Abstract
Vitamin D deficiency has emerged as a public health problem worldwide due to its important role in health and disease. The present work is intended to examine prevalence of vitamin D deficiency among pregnant Saudi women and related risk factors. A cross-sectional study was carried out at King Fahad Medical City in Riyadh, Saudi Arabia. Serum 25-hydroxy vitamin D (25(OH)D) was measured by enzyme-linked immunosorbent assay in 160 pregnant women during the first trimester of pregnancy. Socio-demographic, lifestyle and maternal characteristics were collected and vitamin D intake was assessed using a 24-h dietary recall. Weight and height were measured using standardized methods. Vitamin D deficiency (25(OH)D < 50 nmol/L) and insufficiency (25(OH)D = 50–74 nmol/L) were reported in 50% and 43.8% of the study sample, respectively. Median serum 25(OH)D concentration was 49.9 nmol/L. Adequate vitamin D intake (≥600 IU/day) was reported among only 8.1% of pregnant women. Age group, educational level, sun exposure frequency and daytime and daily practice of exercise were significantly associated with vitamin D status. Overall, vitamin D deficiency was common among pregnant Saudi women in Riyadh. Steps should be taken to address the current situation, including increased sunlight exposure, consumption of fatty fish, and vitamin D supplements.
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Affiliation(s)
- Nora A Al-Faris
- Nutrition and Food Science Department, College of Home Economics, Princess Nourah Bint Abdulrahman University, P.O. Box 27938, Riyadh 11427, Saudi Arabia.
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