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Prevalence of osteoporosis in Middle Eastsystemic literature review
Mohy Taha, MDAOCID Clinical Research FellowKantonsspital Aarau, Switzerland
10th ECOO14-16 April 2011
2
A medical revolution
• 1958: Foundation of the „Arbeitsgemeinschaft für Osteosynthese / AO“ (Association for the Study of Internal Fixation) in Biel/Switzerland by 13 visionary surgeons
• Revolution in trauma care and treatment of musculoskeletal disorders worldwide
• Principles of osteosynthesis: - established by those pioneers - further developed over the past 50 years- today: golden standard in modern trauma and orthopedic surgery
AO Clinical Investigation & Documentation
Davos, headquarters Dübendorf/Zürich office
Step 1
Idea
Step 2
Planning
Step 3
Implementation
Step 4
Reporting Results
Step 5
Publication
Submission
Revision
Acceptance
Define clinical question and specific aims
Study protocol
Regulatory affairs
Monitoring
Follow-up
Statistics
Clinical Research
Good Clinical Practice (GCP) training
From Cairo to Clinical Research
Leihnhase I, Rozanski M, Harhausen D, Thurman JM, Schmidt OI, Hossini AM, Taha ME, Rittirsch D, Ward PA, Holers VM, Ertel W, Stahel PF. Inhibition of the alternative complement activation pathway in traumatic brain injury by a monoclonal anti-factor B antibody: a randomized placebo-controlled study in mice. J Neuroinflammation. 2007 May 2.
Leinhase I, Holers VM, thurman JM, Harhausen D, Schmidt Ol, Pietzcker M, Taha ME, Rittirsch D, Huber-Land M,Smith WR, Ward PA, Stahel PF. Reduced neuronal cell death after experimental brain injury in mice lacking a functional alternative pathway of complement activation. BMC Neurosci. 2006 Jul 14.
Leinhase I, Schmidt Ol, Thurman JM, Hossini AM, Rozanski M, Taha ME, Scheffler A, John T, Smith WR, Holers VM, Stahel PFPharmacological complement inhibition at the C3 convertase level promotes neuronal survival, neuroprotective intracerebral gene expression, and neurological outcome after traumatic brain injury. Exp Neurol. 2006 Mar 16
Publications
Challenges in osteoporosis: increase in....
• The aging population• Life expectancy in the developing countries• Prevalence of osteoporosis• Burden of osteoporotic fractures• Missing data for the Middle East*
*Maalouf et al. J Musculoskelet Neuronal Interact 2007; 7(2):131-143
The aging population
In Europe, over 65:• 12-17% in 2002• 20-25% by 2025
In developing countries, over 65:• 5.5%• Changes are expected
United Nations world population prospects: the 2002 revision
United Nations World Population Prospects, 2008
Change in life expectancy 1950 - 2045
75% of elders developing countries
2050 !
Towards Age-friendly primary health care; Active ageing series: WHO 2004
hhhgh
Disease of the elderly?
Andrade, Tibia & Fibula fracture, Cruz Azul vs Tecos 12/07/07
Are fragility fractures common?
Age = 50, lifetime risk♀ > risk of breast, ovarian &
uterine cancer♂ > risk of prostate cancer
Age > 50• 1:2 ♀ and 1:5 ♂ will suffer from a
fracture in the remaining life time• 55% have a low bone mass
increased risk of fracture
Johnell et al. Osteoporosis Int., 2005; 16: S3-7
In Europe1
• € 31 billion/year• € 76 billion by 2050
In Middle East, Iran2
• $ 8-16 million/year • 2 million people at risk of fracture
1Kanis and Johnell, Osteoporos Int. 2005; 16 Suppl 2:S3-72Larijani B, 1st International Osteoporosis Seminar in Iran. Teheran, Iran; 2004
Burden of osteoporotic fractures
Orthopedic Surgeons?
• Fx often 1st indication for Osteoporosis1
• 1st (only) to meet fracture patients1
• 80% (2737/3422) don’t measure theBMD after 1st fx2
• 75% (2310/3422) lack appropriate knowledge about osteoporosis2
1 Bouxsein et al. J Am Acad Ortho Surg. 2004; 12:385-952 Dreinhöfer et al. Osteoporos Int 2005; 16:S44-S54
A systemic literature review
Objective:
• Identify
• Review
• Summarize literature on the prevalence of osteoporosis in the Middle East
• Identify literature on the incidence of fragility fractures
• Bahrain
• Egypt
• Iran
• Iraq
• Jordan
• Kuwait
• Lebanon
• Libya
• Palestine
• Oman
• Saudi Arabia
• Syria
• Tunisia
• UAE
Middle East?
Inclusion criteria:• Research in the mentioned 14 countries• Population > 18 years
Sources:• Medline / EMBASE / Ovid• Local osteoporosis societies• WHO• Non/locally published data
Keywords: • Disease• Location• Epidemiology
Materials & methods
Disease:• (Osteoporosis OR Osteopenia OR Osteopenic OR Osteoporotic OR
bmd OR bone mineral density)AND
Location:• (“Middle East” OR Bahrain OR Bahraini OR Egypt OR Egyptian OR Iran
OR Iranian OR Iraq OR Iraqi OR Jordan OR Jordanian OR Kuwait OR Kuwaiti OR Libya OR Libyan OR Palestine OR Palestinian OR Oman OR Omani OR “Saudi Arabia” OR “Saudi Arabian” OR Syria OR Syrian OR Tunis OR Tunisian OR UAE OR “Emirates” OR Emirati)
AND
Epidemiology: • (Incidence OR prevalence)
Search criteria on 03.03.11
Sources in Cairo
• Egyptian Osteoporosis Prevention Society
• Academy of Scientific Research & Technology
• Central library Cairo University
• Central library Ain Shams University
• WHO-EMRO
Literature treasure
• 61/257 articles (Pubmed)
• 13/195 articles (Embase)
• 6 locally published
• 5 WHO (EMRO)
• 85 total articles
• 15 articles (EGY)
WHO criteria for diagnosis of osteoporosisComparison of a patient’s BMD with the mean for normal young adult population
Derived from European & North American postmenopausal women
T-score
Normal -1 and above
Osteopenia -1 to -2.5
Osteoporosis -2.5 and below
Severe osteoporosis
-2.5 and below with fragility fracture
Kanis et al. J Bone Miner Res 1994 ; 9:1137-41
Ancient Egyptians (2687-2191 BC)
• 74 Skeletons• 20-60 years• DXA• Radius, 4th Lumbar, Femur
Zaki et al. Int. J. Osteoarchaeol. 2009 19: 78-89
Osteopenia %
Osteoporosis %
Males (43) 18.6 9.3
Females (31) 22.5 16.1
Authors # patients Age (mean) Method Osteo-penia
Osteo-porosis
Referencepopulation
Rashed et al(2011)
18000 60-80 (66.1) DXA 53.7 30.9 --
Hussein et al(2009)
71 22-48 (34) U-Sono 16.9 1.4 INT
Moussa et al(2003)
2886 35-89 (--) DXA 55.7 12.5 EGY
Taha et al(2003)
1000 18-89 (47.3) U-Sono 17.6 47.4 INT
Al-Bahnasy(2003)
5587 40-65 (--) DXA 9.5 12.9 INT
Nahia(2003)
1200 40-66 (--) CT -- 10 INT
Rashed et al(2000)
1243 20-84 (--) DXA 34.7(43.7) 11.2(25.4) EGY(INT)
El-Husseiny et al (2000)
1190 20-89 (54.1) DXA -- 22.3 --
31177
osteopenia
26.9 %
osteoporosis
18.6 %
Osteoporosis in Women
Osteoporosis in Postmenopausal women
Authors # patients Age (mean) Method Osteo-penia
Osteo-porosis
Reference
Rashed et al(2011)
18000 60-80 (66.1) DXA 53.7 30.9 --
Moussa et al(2003)
2886 35-89 DXA 55.7 12.5 EGY
20886
osteopenia
53.9 %
osteoporosis
28.4 %
Osteoporosis in Men
Authors # patients Age (mean) Method Osteo-penia
Osteo-porosis
Reference
Al-Gendi et al(2007)
100 30-65 (44.7) U-Sono 26 11 EGY
Salem et al(2000)
55 20-89 (54.9) DXA -- 41.8 --
155
osteopenia
26 %
osteoporosis
21.9 %
Can we compare Egypt to US/Europe?
Rashed et al. The Bone Mineral Density of the Egyptian Reference Women, 2002
Can we compare Middle East countries?
Rashed et al. The Bone Mineral Density of the Egyptian Reference Women, 2002
Challenges
• Diff. methods• Diff. locations & values• Osteoporotic according to which location?• Missing absolute numbers• Upper & lower limits of age groups• Reference population• Osteopenic patients• Values of the control group in 2ry osteoporosis• Retrospective design• Repetition of results
• Quantify the size of the problem in the Middle East
• Recognize research deficits
• Identify research opportunities in the region
• Experience in literature reviews
Benefits
February-March 2011:• Searching • Collection of full articles
April 2011:• Reading • Data extraction
May-June 2011: • Analysis• Summary• Preparing manuscript
Timetable
Questions?
B. Calman, 83 years old yoga instructor, Australia, THE SUN NEWS 05/2009
Exercise helps fighting osteoporosis!