Main Article Content

Mir Sadat-Ali
Ali W Almomen
Hussain K AlOmar
Sultan A AlAlwan
Abid H Gullenpet
Fawaz M AlAnii


Osteoporosis, common, among


Background and Objectives
Osteoporosis was reported to be common among the Saudi Arabian population. In the last decade there have been no reports related to the male osteoporosis in Saudi Arabian citizens. The objective of this study was to find the hospital-based prevalence of male osteoporosis and the associated diseases.

This is a retrospective study between January 2014 and December 2016 in which all patients who were referred for DEXA (Dual Energy X-ray Absorptiometry) scan to the radiology department of the King Fahd Hospital of the University, AlKhobar were included. Patient’s demographic data were collected from the medical records. Patients who were younger than 50 and those who had a fragility fracture were excluded from the analysis. From the Picture Archiving and Communication System (PACS, Siemens AG, Erlangen, Germany) the readings of the DEXA were collected. Associated diseases of the patients were also extracted from the QuadruMed Data Base. The data was entered in the database and analyzed using SPSS Inc. version 19 and p value of <0.05 was considered significant.

Four hundred and fifty-five patients had a DEXA scan during the study period. Three hundred and seventy- one (81.5%) were ≥50 years. The average was 65.33±9.85 years (range 50–97). On the basis of Spinal T score, 222 (59.8%) were osteoporotic with the Spinal T score of <−3.58±0.88, while, with Hip T score 120 (32.3%) were osteoporotic with T score of <−3.24±0.59. Thirty-six (9.7%) had a normal DEXA of spine and 74(19.9%) of patients had normal DEXA when the Hip T score was taken into consideration. Patients could be divided into 4 groups based on their diseases; they were on treatment for cardiac disease 106 (28.5%), Diabetes mellitus 95 (25.7%), osteoarthritis 141 (38%) and respiratory disease 29 (7.8%). Based on the Spinal T score osteoporosis was observed in 61/106 (57.5%) patients with cardiac disease, 62/95 (65.3%) in diabetics, in osteoarthritis 83/141 (58.9%) and 16/29 (55.1%) in patients with respiratory system diseases. Majority of the patients had vitamin D3 analysis and were most of the patients were in the deficiency range. From 222 (59.83%) patients who were diagnosed to have osteoporosis only 108 (48.64%)

were on appropriate treatment for osteoporosis.

This study finds that the prevalence of osteoporosis in Saudi Arabian males is higher than in the western world and has increased in the last decade. The authors believe a more determined effort is needed to lower the screening age for osteoporosis and report the observations. This will allow a consensus to be reached regarding the frequency of osteoporosis in Saudi Arabian males and implement appropriate measures to limit its growth.


Download data is not yet available.
Abstract 380 | PDF Downloads 397


1. NIH Consensus Development Panel on OsteoporosisPrevention, Diagnosis, and Therapy. Osteoporosis prevention, diagnosis, and therapy. JAMA. 2001;285:785–95.
2. Kanis JA, Melton LJ 3rd, Christiansen C, et al. The diagnosis of osteoporosis. J Bone Miner Res 1994;9:1137–41.
3. Siris ES, Miller PD, Barrett-Connor E, et al. Identification and fracture outcomes of undiagnosed low bone mineral density in postmenopausal women: results from the National Osteoporosis Risk Assessment. JAMA2001;286:2815–22.
4. Compston J, Cooper A, Cooper C, et al. UK clinical guideline for the prevention and treatment of osteoporosis. Arch Osteoporos 2017 Dec;12(1):43. doi: 10.1007/s11657-017-0324-5. Epub 2017 Apr 19.
5. Canalis, E, Bilezikian, JP, Angeli A, et al. Perspectives on glucocorticoid-induced osteoporosis. Bone2004;34:593–98.
6. Compston J, Reid DM, Boisdron J, et al. Recommendations for the registration of agents for prevention and treatment of glucocorticoid-induced osteoporosis: an update from the Group for the Respect of Ethics and Excellence in Science. Osteoporos Int 2008;19: 1247-50.
7. Burge R, Dawson-Hughes B, Solomon DH, et al. Incidence and economic burden of osteoporosis-related fractures in the United States, 2005-2025. J Bone Miner Res 2007 Mar;22(3):465–75.
8. von Friesendorff M, McGuigan FE, Besjakov J, et al. Hip fracture in men-survival and subsequent fractures: a cohort study with 22-year follow-up. J Am Geriatr Soc 2011 May;59(5):806–13.
9. Watts NB, Adler RA, Bilezikian JP, et al. Osteoporosis in men: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2012;97:1802–22.
10. Silva DR, Coelho AC, Dumke A, et al. Osteoporosis prevalence and associated factors in patients with COPD: a cross-sectional study. Respir Care 2011;56(7):961–68.
11. Morden NE, Sullivan SD, Bartle B, et al. Skeletal health in men with chronic lung disease: rates of testing, treatment, and fractures. Osteoporos Int 2011;22(6):1855–62.
12. Shen C, Deng J, Zhou R, et al. Relation between bone mineral density, bone loss and the risk of cardiovascular disease in a Chinese cohort. Am J Cardiol 2012;110(8):1138–42.
13. Castaño-Betancourt MC, Rivadeneira F, Bierma-Zeinstra S, et al. Bone parameters across different types of hip osteoarthritis and their relationship to osteoporotic fracture risk. Arthritis Rheum. 2013;65(3): 693–700.
14. Seeman E, Melton LJ 3rd, O’Fallon WM, Riggs BL. Risk factors for spinal osteoporosis in men. Am J Med 1983;75: 977–83.
15. Sadat-Ali M, Al-Habdan IM, Al-Turki HA, et al. An epidemiological analysis of the incidence of osteoporosis and osteoporosis-related fractures among the Saudi Arabian population. Ann Saudi Med 2012 Nov-Dec;32(6):637–41.
16. Ardawi MS, Maimany AA, Bahksh TM, et al. Bone mineral density of the spine and femur in healthy Saudis. Osteoporos Int 2005 Jan;16(1):43–55.
17. Sadat-Ali M, AlElq A. Osteoporosis among male Saudi Arabs: a pilot study. Ann Saudi Med 2006 Nov-Dec;26(6):450–4.
18. El-Desouki MI, Sulimani RA. High prevalence of osteoporosis in Saudi men. Saudi Med J 2007 May;28(5):774–7.
19. Melton 3rd LJ, Chrischilles EA, Cooper C et al. How many women have osteoporosis. J Bone Miner Res 1992;7:1005–1010.
20. Frost M, Wraae K, Abrahamsen B, et al. Osteoporosis and vertebral fractures in men aged 60-74 years. Age Ageing. 2012 Mar;41(2):171–7.
21. Tenenhouse A, Joseph L, Kreiger N, et al. Estimation of the prevalence of low bone density in Canadian women and men using a population-specific DXA reference standard: the Canadian Multicentre Osteoporosis Study (CaMos). Osteoporos Int 2000;11:897–4.
22. Choi YJ, Oh HJ, Kim DJ et al. The prevalence of osteoporosis in Korean adults aged 50 years or older and the higher diagnosis rates in women who were beneficiaries of a national screening program: the Korea National Health and Nutrition Examination Survey 2008-2009. J Bone Miner Res 2012 Sep;27(9):1879–86.
23. Looker AC, Orwoll ES, Johnston CC Jr, et al. Prevalence of low femoral bone density in older U.S. adults from NhaNES III. J Bone Miner Res 1997;12:1761–68.
24. Siddiqui NA, Shetty KR, Duthie EH Jr. Osteoporosis in older men: discovering when and how to treat it. Geriatrics 1999;54:20.
25. US Census Bureau. The older population in the United States. Available at:
26. Ensrud, K., Parimi, N., Fink, H, et al. Estimated GFR and risk of hip fracture in older men: comparison of associations using cystatin C and creatinine. Am J Kidney Dis 2014;63:31–39.
27. NOF. America’s Bone Health: The State of Osteoporosis and Low Bone Mass in Our Nation. Washington, DC: National Osteoporosis Foundation; 2002.
28. Amin S, Achenbach SJ, Atkinson EJ, et al. Trends in fracture incidence: a population-based study over 20 years. J Bone Miner Res 2014 Mar;29(3):581–9.
29. Sadat-Ali M, Al-Omran A, Al-Bakr W, et al. established osteoporosis and gaps in the management: review from a teaching hospital. Ann Med Health Sci Res 2014 Mar;4(2):198–201.
30. Jennings LA, Auerbach AD, Maselli, J et al. Missed opportunities for osteoporosis treatment in patients hospitalized for hip fracture. J Am Geriatr Soc 2010;58:650–7.
31. Hajcsar EE, Hawker G, Bogoch ER. Investigation and treatment of osteoporosis in patients with fragility fractures. CMAJ 2000 Oct 3;163(7):819–22.
32. Hartholt KA, Oudshoorn C, Zielinski SM, et al. The epidemic of hip fractures: are we on the right track? PLoS One 2011;6(7):e22227. doi: 10.1371/journal. pone. 0022227. Epub 2011 Jul 25.
33. Oudshoorn C, Hartholt KA, Zillikens MC et al.Emergency department visits due to vertebral fractures in the Nether-lands, 1986-2008: steep increase in the oldest old, strong association with falls.Injury 2012 Apr;43(4):458–61.
34. Tuzun S, Eskiyurt N, Akarirmak U et al. Turkish Osteoporosis Society.Osteoporos. Incidence of hip fracture and prevalence of osteoporosis in Turkey: the FRACTURK study. Osteoporos Int 2012 Mar;23(3):949–55.
35. The Middle East & Africa Regional Audit: Epidemiology, costs & burden of osteoporosis in 2011. International Osteoporosis Foundation; 2011. Available at:
36. Hagino H, Katagiri H, Okano T, et al. Increasing incidence of hip fracture in Tottori Prefecture, Japan: trend from 1986 to 2001. Osteoporos Int 2005;16:1963–8.
37. Koh LK, Saw SM, Lee JJ, et al. National Working Committee on Osteoporosis. Hip fracture incidence rates in Singapore 1991-1998. Osteoporos Int 12:311–18.
38. Sambrook PN, Seeman E, Phillips SR, et al. Prevent-ing osteoporosis: outcomes of the Australian Fracture Prevention Summit. Med J Aust 2002;176 Suppl: S1.
39. Sadat-Ali M, Al-Dakheel DA, Azam MQ, et al. Reassessment of osteoporosis-related femoral fractures and economic burden in Saudi Arabia. Arch Osteoporos. 2015;10:37. doi: 10.1007/s11657-015-0240-5. Epub 2015 Oct 22. PMID: 26494131.
40. Bubshait D, Sadat-Ali M. Economic implications of osteoporosis related femoral fractures in the Saudi Arabian society. Calcif Tissue Int 2007 Dec;81(6):455–8.
41. AlSulaimani R. Saudi National Hip Fracture Registry (SAFE). Personal communication 2017.