Vitamin D and Bone in Saudi Arabia

Summary

Few studies have been published examining BMD in healthy Saudi females. Ghannam et al (1999) measured bone mineral density (BMD) at the lumbar spine and the proximal femur in 321 Saudi females aged 10-50 years to establish normative data in Saudi females and to compare these data with their USA counterparts. This study concluded that BMD in healthy Saudi females was significantly lower than those USA females. The authors attributed this finding to increased number of pregnancies and longer duration of lactation together with prevalent vitamin D deficiency. El-Desouki et al (1999) estimated the prevalence of osteopenia and osteoporosis in postmenopausal Saudi women aged 50-80 years. The results showed only (29%) of subjects (802 postmenopausal) are normal, whereas (31%) are osteopenic and (40%) were osteoporotic at the lumbar spine. The conclusion of both these studies indicate that osteopenia and osteoporosis are common among postmenopausal Saudi women and their bone densities are lower than that in their USA counterparts. There is evidence of a high level of fracture in urbanized communities. Al-Nuaim et al reviewed case records of Saudi residents of Riyadh city who were 40 years or older and who were admitted to local hospitals over a period of 12 months (July 1990-1991) with diagnosed with proximal femur fracture (PFF). The incidence of PFF for male and female patients over the age of 50 years was 71 and 100 respectively with a female: male ratio 1: 4. Ardawi et al (2004) determined the reference values of bone mineral density in healthy Saudis of both sexes in Jeddah area (Western region) and compared with US / Northern European / Lebanese reference data. They found that the prevalence of osteoporosis in the Saudi population (50-79 years) at the lumbar spine and total femur using the manufacturers vs. Saudi reference data was 38.3 %-47.7 % vs. 30.5 % - 49.6 % and 6.3 -7.8 % vs. 1.2 - 4.7 % respectively. Few studies have been conducted examining the association between diet and bone health in Middle East countries and data are urgently needed on (1) the extent of vitamin D deficiency in the Saudi population and (2) the effect of poor vitamin D status on bone health.

Project Status : November 2008

The data collection of 212 premenopausal and postmenopausal Saudi women is now complete. The vitamin D measurements have been analysed and all the women who participated in this study have been shown to be vitamin D deficient with extensive osteopenia amongst the women. Further analysis of the data is underway, particularly looking at dietary factors affecting bone health. Dr Sawsan Khoja has made several presentations at national and international conferences and full papers are being prepared for peer-review publication. Mrs Maryam Al-Ghamdi's study is now underway examining ~300 boys and girls living in the city of Jeddah. Blood samples have been collected and bone density measurements have been taken. Analysis of the data is currently underway with a view to abstract publication in due course.

Project Objectives

The principal objectives of the studies currently running in Saudi Arabia are as follows:

Determine indices of bone health (namely lumbar spine and femoral neck bone mineral density as measured by DXA and calcaneal bone mass as measured by (BUA) in Saudi Arabian women and young boys and girls.

Examine the extent of osteopenia and osteoporosis in young and old age groups.

Assess the impact of non-dietary life style risk factors on indices of bone health.

Assess dietary intake in terms of both “ quality ” and “ quantity” in Saudi Arabian women and determine the extent of nutrient insufficiency / deficiency of key bone health nutrients.

Examine the effect of dietary intake on indices of bone health.

Determine the status of vitamin D and its metabolites and specifically examine the extent of vitamin D deficiency / insufficiency in Saudi younger and older women and boys and girls.

Assess the effect of vitamin D status on indices of bone health, namely bone mass and bone metabolism in both populations group.

Results and Findings

A number of key abstracts and papers are currently being prepared by Dr Sawsan Khoja and Mrs Maryam Al-Ghamdi from KAAU, Saudi Arabia. Sawsan was successful in obtaining her Doctorate from the Joint Supervision Programme between the University of Surrey and KAAU, Saudi Arabia. Maryam is currently studying for her PhD in the area of vitamin D deficiency in boys and girls.

Abstracts published to date:

Khoja SO, Khan JA., Maimani ARA., Lanham-New SA. Influence of diet on bone health in Saudi Arabian women. In: Nutritional Aspects of Osteoporosis (6th International Symposium on Nutritional Aspects of Osteoporosis, Switzerland). Eds B. Dawson--Hughes, P Burckhardt and RP Heaney. Challenges of Modern Medicine. Elsevier Science 2007; ICS 1297; pp205-211.

Khoja SO., Khan JA., Maimani ARA., New SA. Absence of milk in the diet is associated with higher bone resorption in postmenopausal Saudi Arabian women. Proceedings of the Nutrition Society 2005 (Abstract).