Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 
  Users Online: 13114 Home Print this page Email this page Small font sizeDefault font sizeIncrease font size  

 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 10  |  Issue : 3  |  Page : 164-166  

Osteoporosis among bahraini citizens: The first report


1 Presently Consultant Orthopaedic Surgeon, Awali Hospital, Awali, Kingdom of Bahrain; Department of Orthopaedic Surgery, College of Medicine, Imam AbdulRahman Bin Faisal University, Dammam, Saudi Arabia; Previously at University Medical Center, King Abdallah Medical City, Arabian, Gulf University, Dr. Sulaiman AlHabib Hospital, Kingdom of Bahrain
2 Department of Radiology, University Medical Center, King Abdallah Medical City, Arabian Gulf University, Dr. Sulaiman AlHabib Hospital, Kingdom of Bahrain

Date of Submission26-Mar-2019
Date of Decision25-Mar-2020
Date of Acceptance01-Apr-2020
Date of Web Publication11-Jul-2020

Correspondence Address:
Mir Sadat-Ali
Awali Hospital, Baharain Petroleum Company, Southern Governorate, Awali 25555

Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijabmr.IJABMR_102_19

Rights and Permissions
   Abstract 


Background and Objective: Osteoporosis and its complications are increasing as the population is aging world over. Every country needs an initial assessment of prevalence to take appropriate steps in limiting the complications of osteoporosis. The objective of this study was to find the prevalence of osteoporosis in the Kingdom of Bahrain. Methods: We retrospectively reviewed dual-energy X-ray absorptiometry scans of patients who underwent scans for the diagnosis of osteoporosis between January 2016 and December 2017 at the University Medical Center, King Abdullah Medical City, Dr. Sulaiman AlHabib Hospital, Kingdom of Bahrain. The data were collected from the picture archiving and communication system for the study period. Patients' medical records were reviewed for the investigations and treatment ordered. The data were entered into the database and analyzed using SPSS Inc., version 19. Results: A total of 205 patients with an average age of 58.39 ± 12.12 years were included in the study. There were 185 (90.25%) females and 20 (9.75%) males. Seventy-nine (38.5%) were osteoporotic based on the T score of either at the hip (−<2.61 ± 1.08) or the spine (−<3.26 ± 0.78), with a mean age of 60.8 ± 13.1 years. Seventy-two (91.1%) of the osteoporotic patients were female and 42 (58.4%) were ≥65 years. Patients who were osteoporotic were significantly older withP < 0.001. There were 9 patients (4.39%) who had osteoporosis-related fractures. Conclusions: This study indicates that the prevalence of osteoporosis is common among Bahraini citizens. As the country's total population is <1.2 million, it will not be difficult to target the ≥65-year-old men and women in early diagnosis and treatment to prevent osteoporosis-related fractures.

Keywords: Bahrain, fragility fractures, osteopenia, osteoporosis


How to cite this article:
Sadat-Ali M, Mattar ME. Osteoporosis among bahraini citizens: The first report. Int J App Basic Med Res 2020;10:164-6

How to cite this URL:
Sadat-Ali M, Mattar ME. Osteoporosis among bahraini citizens: The first report. Int J App Basic Med Res [serial online] 2020 [cited 2020 Aug 4];10:164-6. Available from: http://www.ijabmr.org/text.asp?2020/10/3/164/289465




   Introduction Top


Osteoporosis is an aging disease in which the quantity and quality of bone is drastically reduced and patients end up in having a fragility fractures with high mortality and morbidity. The prevalence of osteoporosis varies in a different ethnic population of the Arab-Gulf countries. Reports from Saudi Arabia show the prevalence to be around 33%[1] and Kuwait around 20.2%.[2] The majority of the untreated patients of osteoporosis end up in fragility fractures, which cause high morbidity and mortality.[3],[4] It is estimated that by 2025, in the USA, fragility fractures annually will cost $25 billion.[5] In Europe, the picture looks similar to the USA the annual cost of managing osteoporosis-related fractures expected to rise to €76.7 billion in 2050.[6] In Saudi Arabia, a neighbor of the Kingdom of Bahrain, the incidence of fractures rose from 2.9/1000 of the population in Riyadh[7] to 5.8/1000 in the Eastern Province.[8]

The Kingdom of Bahrain is a country of 1.2 million people; a review of the literature did not reveal a single article published in the English language related to osteoporosis and fragility fractures, and there is a total lack of any epidemiological data from the Kingdom of Bahrain.[9] The objective of this study was to assess the prevalence of osteoporosis among Bahraini population by studying dual-energy X-ray absorptiometry (DXA) scans from a single hospital which will shed some light on the status of osteoporosis in the Kingdom of Bahrain.


   Methods Top


We retrospectively reviewed DXA scans of patients who underwent scans for the diagnosis of osteoporosis between January 2016 and December 2017 at the University Medical Center, King Abdullah Medical City, Dr. Sulaiman AlHabib Hospital, Kingdom of Bahrain. All patients aged ≥55 years and a Bahraini Citizen were included in the analysis. After receiving the institutional review board approval, the data were collected from the GE Healthcare's Centricity picture archiving and communication system (PACS)-IW PACS for the 2-year period. A diagnosis of osteoporosis was made based on low bone mineral density measured by DXA [Table 1]. Patients' medical records were reviewed for the investigations and treatment ordered.
Table 1: World health organization's definition of osteoporosis based on bone mineral density

Click here to view


The software used for the diagnosis was the GE NHANES III software update, and the machine used was General Electric Lunar, Chicago, Illinois, USA. The data was entered in the database and analyzed using Data was analyzed using the Statistical Package for the Social Sciences (SPSS) version 21 for MacBook Pro, Chicago, Illinois.


   Results Top


Two hundred and five patients had a DXA scan during the study period. The average age was 58.39 ± 12.12 years. There were 185 (90.25%) females and 20 (9.75%) males, and the average BMI was 23.2 kg/m2 ± 4.13. Seventy-nine (38.5%) were osteoporotic based on the T score of either at the hip (−<2.61 ± 1.08) or the spine (−<3.26 ± 0.78), with a mean age of 60.8 ± 13.1 years. Thirty-seven (18.48%) had a normal T score at the hip or spine, with a mean age of patients in this group being 53.9 ± 6.41 [Table 2]. Patients who were osteoporotic were significantly older with P < 0.001. Seventy out of 79 patients (88.6%) had osteoporosis at the lumbar spine and 38 (48%) had a T score of <−2.6 at the hips [Figure 1]. [Table 3] gives the details of low bone mass among postmenopausal women. Investigations of Vitamin D level and calcium were performed in 98 (47.8%). The drug management of all osteoporosis patients could not be retrieved as of 2016 and 2017 had written prescriptions were used.
Table 2: Demographic data of patients with dual-energy X-ray absorptiometry scan

Click here to view
Figure 1: The T score at Hip and Lumbar spine

Click here to view
Table 3: Data of postmenopausal women

Click here to view


There were 9 (4.39%) had osteoporosis-related fractures, 5 (55.6%) neck of the femur, 3 (33.4%) vertebral column, and 1 (11.1%) fracture humerus and these are the patients, which were treated with antiresorptives, calcium, and Vitamin D.


   Discussion Top


This study which is probably only reported study on the prevalence of osteoporosis from the Kingdom of Bahrain shows that the prevalence of osteoporosis is 38.5% and only 37 (18.48%) had a normal T score at the hip or spine, indicating that over 81% of the population over the age of 55 years has low bone mass. Compared to the other reports from the region, it is slightly higher. Recently, the prevalence of osteoporosis among Jordanian women was reported to be 13.5%,[10] which is the lowest in the Middle Eastern countries.

As population ages, there is an upsurge in chronic diseases. The Global Burden of Disease Study of 2010 reported that the burden of noncommunicable diseases in the Arab world has increased and is expected to rise further.[11] Osteoporosis is classified as a chronic disease in which bone loss occurs silently and relentlessly till a fracture occurs. The morbidity and mortality of fragility fractures, particularly of hip fractures, is too high. The 1-year mortality in men after a fragility fracture was reported to be 26.8%.[12] Recently Sadat-Ali et al.[13] reported that the mortality after a fragility in the Saudi Arabian population was 30%.

The cost of management of osteoporosis and related complications is spiraling out of hand. In the US alone, the cost of treating osteoporosis-related fractures is expected to be greater than $25.3 billion by 2025.[5] It was reported that direct and indirect costs of osteoporosis-related hip fractures yearly in Saudi Arabia reached Saudi riyals 2.359 billion and is projected that the lifetime costs of this single osteoporosis-related hip fracture by 2025 will reach SR35.0028 billion ($9.34 billion).[8] If the patients are screened earlier and treated appropriately as per the US database of 2011, it will cost $2 billion, and if left untreated, once the fragility fractures are treated, the cost goes eight times to $16 billion.[14]

In recent years, health-care providers are trying to better ways to understand the epidemiology of postmenopausal osteoporosis and to limit the direct and the indirect costs of the disease. Epidemiological research is difficult for osteoporosis as majority of men and women with osteoporosis remain asymptomatic and the number of elderly population runs in millions. The Kingdom of Bahrain stands in a unique position from studying osteoporosis as ≥65-year-old population is around 30,000.[15] If these healthy people can be followed on a regular basis for the diagnosis, management, and incidence of fragility fractures for osteoporosis, much can be learned from this endeavor not only for the Kingdom of Bahrain for the whole region. The regular follow-up of the target population will help in the reduction of the fragility fractures which will limit economic cost and reduce morbidity and mortality. If early-organized steps are not taken to study patients aged ≥65 years for osteoporosis, it will be a lost opportunity.

Our study has limitations that it is retrospective in nature and from a single center, but it gives a definitive prevalence of osteoporosis among Bahraini population for the first time. This will help the health authorities to conduct more studies and to take necessary steps to early diagnose these patients and treat appropriately before a fragility fracture occurs.


   Conclusions Top


Our study shows that osteoporosis is common among Bahraini citizens, planned epidemiological studies need to be done on a national basis which will shed light on the disease pattern in the country which will help in and early steps to target, diagnose, and treat osteoporosis patients will reduce the economic costs, morbidity, and mortality.

Acknowledgment

The authors sincerely thank Staff Nurse Jose Alberto M Acbang and Ms. Ebtisam Hamed AlTaie for collecting and entering the data.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Sadat-Ali M, Al-Habdan IM, Al-Turki HA, Azam MQ. An epidemiological analysis of the incidence of osteoporosis and osteoporosis-related fractures among the Saudi Arabian population. Ann Saudi Med 2012;32:637-41.  Back to cited text no. 1
    
2.
Al-Shoumer KA, Nair V. Prevalence of low bone mass in postmenopausal Kuwaiti women residents in the largest province of Kuwait. Arch Osteoporos 2012;7:147-53.  Back to cited text no. 2
    
3.
Mariconda M, Costa GG, Cerbasi S, Recano P, Aitanti E, Gambacorta M, et al. The determinants of mortality and morbidity during the year following fracture of the hip: A prospective study. Bone Joint J 2015;97-B: 383-90.  Back to cited text no. 3
    
4.
Nazrun AS, Tzar MN, Mokhtar SA, Mohamed IN. A systematic review of the outcomes of osteoporotic fracture patients after hospital discharge: Morbidity, subsequent fractures, and mortality. Ther Clin Risk Manag 2014;10:937-48.  Back to cited text no. 4
    
5.
Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A. Incidence and economic burden of osteoporosis-related fractures in the United States, 2005-2025. J Bone Miner Res 2007;22:465-75.  Back to cited text no. 5
    
6.
Kanis JA, Johnell O. Requirements for DXA for the management of osteoporosis in Europe. Osteoporos Int 2005;16:229-38.  Back to cited text no. 6
    
7.
Al-Nuaim AR, Kremli M, Al-Nuaim M, Sandkgi A. Incidence of proximal femoral fractures in the urbanized community of Saudi Arabia. Calcif Tissue Int 1995;56:536-8.  Back to cited text no. 7
    
8.
Sadat-Ali M, Al-Dakheel DA, Azam MQ, Al-Bluwi MT, Al-Farhan MF, AlAmer HA, et al. Reassessment of osteoporosis-related femoral fractures and economic burden in Saudi Arabia. Arch Osteoporos 2015;10:37.  Back to cited text no. 8
    
9.
The Middle East and Africa Regional Audit. Epidemiology, Costs and Burden Osteoporosis in 2011. Available from: http://www.iofbonehealth.org. [Last accessed on 2019 Jun 03].  Back to cited text no. 9
    
10.
El-Heis MA, Al-Kamil EA, Kheirallah KA, Al-Shatnawi TN, Gharaibia M, Al-Mnayyis A. Factors associated with osteoporosis among a sample of Jordanian women referred for investigation for osteoporosis. East Mediterr Health J 2013;19:459-64.  Back to cited text no. 10
    
11.
12.
Schnell S, Friedman SM, Mendelson DA, Bingham KW, Kates SL. The 1-year mortality of patients treated in a hip fracture program for elders. Geriatr Orthop Surg Rehabil 2010;1:6-14.  Back to cited text no. 12
    
13.
Sadat-Ali M, Alfaraidy M, AlHawas A, Al-Othman AA, Al-Dakheel DA, Tayara BK. Morbidity and mortality after fragility hip fracture in a Saudi Arabian population: Report from a single center. J Int Med Res 2017;45:1175-80.  Back to cited text no. 13
    
14.
Blume SW, Curtis JR. Medical costs of osteoporosis in the elderly Medicare population. Osteoporos Int 2011;22:1835-44.  Back to cited text no. 14
    
15.
General Directorate of Statistics & Population Registry. Available from: http://www.data.gov.bh. [Last accessed on 2018 Sep].  Back to cited text no. 15
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
   Introduction
   Methods
   Results
   Discussion
   Conclusions
    References
    Article Figures
    Article Tables

 Article Access Statistics
    Viewed184    
    Printed16    
    Emailed0    
    PDF Downloaded50    
    Comments [Add]    

Recommend this journal