Diagnosis and management of osteoporosis in Saudi Arabia: 2023 key updates from the Saudi Osteoporosis Society

Abstract

Summary 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.

Dietary Calcium Intake and Osteoporosis Risk in Arab Adults

“…Diagnosis of osteoporosis was undertaken by measuring BMD through a DXA scan of the femoral neck or spine and calculating the T-score. A patient with a T-score of ≤−2.5 (standard deviations, SD, from the mean value of young normal Caucasian women) is classified as having osteoporosis [ 21 , 22 ]. DXA scans were overseen by a qualified technician certified in densitometry, while the machine itself was calibrated using a standard phantom provided by the manufacturer.…”

Associations of bone mineral density with sex hormone-binding globulin (SHBG) and testosterone in middle-aged Saudi men: a cross-sectional study

“…Mean value of Bone mineral density (BMD) measurements were taken at the lumbar spine, left hip, and right hip using DXA (Hologic QDR 2000 Inc., Woltham, MA, USA). A patient with a T-score between -1 to -2.5 (mean value standard deviations, SD) is classified as having osteopenia ( 22 ). The exclusion criteria included men with pre-existing bone diseases other than low BMD or under medications that can affect BMD for at least 6 months.…”

The single point insulin sensitivity estimator (SPISE) is associated with bone health in Arab adults

“…After being printed, the findings of the bone density scan were taken to the CBCD at KSU to have the data entered. The T-scores were used to categorize the individuals into ones with low BMD (T-score < -1.0) and normal BMD (T-score of -1.0 and above), the cut-offs of which were recommended by the World Health Organization [29] and used by the national and regional guidelines to identify the individuals at risk for bone loss [30][31][32].…”