Incidence of hip fracture in Saudi Arabia and the development of a FRAX model

Summary A prospective hospital-based survey in representative regions of Saudi Arabia determined the incidence of fractures at the hip. The hip fracture rates were used to create a FRAX® model to facilitate fracture risk assessment in Saudi Arabia. Objective This paper describes the incidence of hip fracture in the Kingdom of Saudi Arabia that was used to characterize the current and future burden of hip fracture, to develop a country-specific FRAX® tool for fracture prediction and to compare fracture probabilities with neighbouring countries. Methods During a 2-year (2017/2018) prospective survey in 15 hospitals with a defined catchment population, hip fractures in Saudi citizens were prospectively identified from hospital registers. The number of hip fractures and future burden was determined from national demography. Age- and sex-specific incidence of hip fracture and national mortality rates were incorporated into a FRAX model for Saudi Arabia. Fracture probabilities were compared with those from Kuwait and Abu Dhabi. Results The incidence of hip fracture applied nationally suggested that the estimated number of hip fractures nationwide in persons over the age of 50 years for 2015 was 2,949 and is predicted to increase nearly sevenfold to 20,328 in 2050. Hip fracture rates were comparable with estimates from Abu Dhabi and Kuwait. By contrast, probabilities of a major osteoporotic fracture or hip fracture from the age of 70 years were much lower than those seen in Abu Dhabi and Kuwait due to higher mortality estimates for Saudi Arabia. Conclusion A country-specific FRAX tool for fracture prediction has been developed for Saudi Arabia which is expected to help guide decisions about treatment

Hirsutism in Saudi females of reproductive age: a hospital-based study

Background: Hirsutism among women of fertile age is commonly seen in clinical practice, but the pattern of the disease in Saudi Arabs has not been studied. The aim of the study was to determine the clinical, biochemical and etiologic features of hirsutism in Saudi females.\ud \ud Methods: 101 Saudi Arab women presenting with hirsutism at King Khalid University Hospital, Riyadh, Saudi Arabia, from 1 January 2000 to 31 December 2005 were prospectively assessed using the recently approved diagnostic guidelines for hyperandrogenic women with hirsutism.\ud \ud Results: Polycystic ovary syndrome (PCOS) was the cause of hirsutism in 83 patients (82%) followed by id­iopathic hirsutism (IH) in 11 patients (11 %). Others causes of hirsutism included late onset congenital adrenal hyperplasia in 4 patients (4%), microprolactinoma in 2 (2%) and Cushing's syndrome in 1 (1%) patient. Age at presentation of PCOS was 24.5±6.6 years (mean±SD) and 51 % of the subjects were obese. Furthermore, 74 (89%) of patients with PCOS had an oligo/anovulatory cycle while the remaining 9 patients (11 %) maintained normal regular menstrual cycle. Luteinizing hormone and total testosterone were significantly higher in patients with PCOS than in those with IH (P<.05).\ud \ud Conclusions: The present data show PCOS to be the commonest cause of hirsutism in our clinical practice and PCOS is prominent amongst young obese females. However, further studies on a larger scale are needed to verify our findings

Graves' disease in Saudi Arabia: a ten-year hospital study

Objective: To determine clinical manifestation and mode of treatment of Graves' disease at King Khalid University Hospital Riyadh, Saudi Arabia.\ud \ud Methods: A retrospective study of all cases of Graves' disease diagnosed at the hospital in the period between January 1995 and December 2004, who received a minimum of two years treatment were included in the study.\ud \ud Results: A total of 194 patients were seen with female: male ratio of 2.9: 1 and mean age of 32 ± 0.9 years. Sixty nine percent of the patients had positive thyroid antibodies. Palpitations, tremors, weight loss and nervousness were the most common presenting manifestations. Forty nine percent of patients were treated with radioiodine, 38% with antithyroid drugs, and 13% underwent subtotal thyroidectomy.\ud \ud Conclusion: Clinical manifestations of Graves' disease in our patients distinctly differed from those reported in the West and Pacific Islanders with notable rarity of pretibial myxoedema and hyperpigmentation respectively. We also noted higher male to female ratio and an increasing utility of radioactive iodine therapy while use of antithyroid drugs and surgery are declining

Treatment of Graves' hyperthyroidism: prognostic factors for outcome

Objectives: To determine whether clinical and biochemical features of Graves' disease at presentation predict response to medical and radioiodine treatment.\ud \ud Methods: We carried out a retrospective 10-year study of 194 consecutive Saudi subjects with Graves’ disease who were treated with antithyroid drugs, radioiodine therapy, or both, between January 1995 and December 2004 at King Khalid University Hospital, Riyadh, Saudi Arabia.\ud \ud Results: At diagnosis, the mean age was 32 +/- 0.9 years. Only 26% of patients had successful outcome after a course of antithyroid medication. None of the clinical or biochemical factors were associated with a favorable outcome of antithyroid treatment. One dose of radioiodine [13-15 mCi (481-555 MBq)] cured hyperthyroidism in 83% of patients. Presence of ophthalmopathy at presentation was shown to be a significant contributing factor to failure to respond to a single dose of radioiodine (odds ratio, 6.4; 95% CI, 1.51-24.4; p<0.01). Failure of radioiodine treatment was also associated with higher serum free T3 concentration at presentation (p=0.003).\ud \ud Conclusions: In patients with Graves’ hyperthyroidism, radioiodine treatment is associated with higher success rate than antithyroid drugs. A dose of 13-15 mCi (481-555 MBq) seems to be practical and effective, and should be considered as first line therapy. Patients with high free T3 concentration and, those with ophthalmopathy at presentation were more likely to fail radioiodine treatment. A higher dose of radioiodine may be advisable in such patients

Surgical management of Graves' hyperthyroidism in Saudi Arabia: a retrospective hospital study

The aim of the study was to determine surgical indication and complication of subtotal thyroidectomy in patients being treated for Graves' disease at King Khalid University Hospital Riyadh Saudi Arabia in the period between January 1996 and December 2005. Twenty-five out of 194 adult patients with Graves' disease had thyroidectomy for hyperthyroidism during the 10-year period representing 13% comprising 11 males and 14 females. Mean age at presentation for all the patients was 28±12 years. Males had higher serum T4 77.7±20.7 than females 49.8±21.9 pmol L-1; p<0.05. Serum T3 levels were similar in both groups 31.9±15.2 for males and 29.4±15.7 pmol L-1 for females, p = NS. Failure of antithyroid and/or radioiodine along with severe ophthalmopathy (52%), patient preference (12%) and large goiter alone (8%) were major indications for thyroidectomy in this group. Permanent remission occurred in 15 patients (60%) following the surgery. Hypothyroidism and relapse were observed in 16 (64%) and 4 (16%) of patients, respectively. One patient (4%) each experienced permanent recurrent laryngeal nerve palsy and hypoparathyroidism. It was concluded that more males than females with severe hyperthyroidism had thyroidectomy and that failure of antithyroid/radioiodine treatment and severe ophthalmopathy were the commonest indications for surgery in patients in patients with Graves' disease while post surgical permanent hypoparathyroidism and recurrent laryngeal nerve palsy were uncommon

Incidence of hip fracture in Saudi Arabia and the development of a FRAX model

A prospective hospital-based survey in representative regions of Saudi Arabia determined the incidence of fractures at the hip. The hip fracture rates were used to create a FRAX® model to facilitate fracture risk assessment in Saudi Arabia. OBJECTIVE: This paper describes the incidence of hip fracture in the Kingdom of Saudi Arabia that was used to characterize the current and future burden of hip fracture, to develop a country-specific FRAX® tool for fracture prediction and to compare fracture probabilities with neighbouring countries. METHODS: During a 2-year (2017/2018) prospective survey in 15 hospitals with a defined catchment population, hip fractures in Saudi citizens were prospectively identified from hospital registers. The number of hip fractures and future burden was determined from national demography. Age- and sex-specific incidence of hip fracture and national mortality rates were incorporated into a FRAX model for Saudi Arabia. Fracture probabilities were compared with those from Kuwait and Abu Dhabi. RESULTS: The incidence of hip fracture applied nationally suggested that the estimated number of hip fractures nationwide in persons over the age of 50 years for 2015 was 2,949 and is predicted to increase nearly sevenfold to 20,328 in 2050. Hip fracture rates were comparable with estimates from Abu Dhabi and Kuwait. By contrast, probabilities of a major osteoporotic fracture or hip fracture from the age of 70 years were much lower than those seen in Abu Dhabi and Kuwait due to higher mortality estimates for Saudi Arabia. CONCLUSION: A country-specific FRAX tool for fracture prediction has been developed for Saudi Arabia which is expected to help guide decisions about treatment.</p

The application of FRAX in Saudi Arabia

Summary 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

The application of FRAX in Saudi Arabia

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.Keywords: FRAX; Fracture risk assessment; Intervention threshold; Osteoporosis