Epidemiology of Osteoporosis in KSA

Guidelines For Prevention AtThe Primary Health Care LevelOSTEOPOROSIS

A. Guidelines for Screening for OsteoporosisB. Guidelines for Detection and Treatment of Underlying Causes of OsteoporosisC. Guideline for Health Education A. Guidelines for Screening for OsteoporosisScreening:

Is the systematic application of the test when it is assumed that people have no symptoms.

Recommendations for Osteoporosis screening: - Osteoporosis is common, costly associated with high morbidity and mortality- Easily detectable and highly treatable - DEXA is safe screening test- Patients can be started on treatment and counselled regrading lifestyle changes Osteoporosis screening at PHCHigh risk or selective screeningWhom to refer for DEXA?All Men and Women 60 years and overWhom to refer for DEXA?Postmenopausal womenMen 50-59 years With one or more of the following: Fragility fracture after age 40 yearsVertebral fracture or low BMD identified on X-rayParental hip fractureHigh alcohol intakeCurrent smokingLow body mass index (less than 18.5 kg/m2)High risk medication use: i.e. prolonged glucocorticoid use)Rheumatoid arthritisOther disorders that lead to bone lossWhom to refer for DEXA?Men and women < 50 yearsWith one or more of the following:HypogonadismFragility fractureHigh risk medication useRheumatoid arthritisChronis inflame conditionsCushing diseasemalabsorption syndromeUncontrolled hyperthyroidismPrimary hyperthyroidismOther disorders associated with rapid bone loss/ fractureHospitals Providing DEXA ScanInside Riyadh CityKing Saud Medical CityKing Salman HospitalAlimam AbdulRahman Elfaisal HospitalOutside Riyadh City:King Khalid Hospital ElmajmaaEldawadmi HospitalB. Guidelines for Detection and Treatment of Underlying Causes of OsteoporosisScreen for and manage the following conditions:Rheumatoid arthritisHypogonadismChronis inflammatory conditionsCushing diseaseMalabsorption syndromePrimary hyperthyroidismHigh alcohol intakeCurrent smoking

C. Guidelines for Health EducationTarget population:All PHC users at all ages

Subjects:Bone-healthy dietPhysical Exercise Bone-healthy dietProvide Health education on the following:

Children (1 18 years)

Adults (19 50 years)

The recommended vitamin D allowance for adults aged 10 50 is 600 IU per day

Elderly ( 50 and above)

Physical Exercise Prevention Initiatives should be directed at the following measures:Optimize nutrition in the youth to achieve high peak bone mass.Encourage adequate intake of calcium and Vitamin D.Identify and treat subjects with Vitamin D deficiency, especially children, females in the reproductive age group, and the elderly.Recommend regular weight bearing exercise.Avoidance of tobacco smoking and excessive alcohol intake.Prevention Assess every postmenopausal woman for risk of osteoporosis, and determine the need for diagnostic tests and prevention /treatment.Early treatment of causes of osteoporosis [e.g. thyrotoxicosis, smoking, hyperparathyroidism, others].Prevention and early treatment of osteoporosis of patients who are receiving high dose steroid therapy, or other drugs that contribute to osteoporosis.

Resources International Osteoporosis Foundation http://www.iofbonehealth.org/Saudi Guidelines for Osteoporosis Prevention and Treatment 2014Guidelines for Prevention and Management of Osteoporosis in Adults at KFSH&RC -20032015 Guidelines for Osteoporosis in Saudi Arabia: Recommendations from the Saudi Osteoporosis Society. Ann Saudi Med 2015; 35(1): 1-12