Avicenna - Volume 2010, Issue 1

Background: Although results from prior publications have indicated that normative bone mineral density (BMD) in Saudi Arabian women is significantly lower than their North American and European counterparts, there has been no systematic attempt to study these differences across the age-spectrum.

Objectives: To explore these issues in more detail, a new Saudi Arabian normative BMD dataset was systematically derived from patient data at King Faisal Specialist Hospital & Research Centre in Riyadh. Changes in mean BMD were studied with respect to both age and years-since-menopause.

Methods: A retrospective analysis of BMD was carried out among 858 Saudi Arabian women who had undergone routine dual-energy x-ray absorptiometry. In addition to the usual patient details collected at each scan, information from questionnaires summarizing the patient’s medical, lifestyle and menopause history was also used to identify a subset of 179 presumed-normal women.

Results: The normative BMD results for the L2-L4 AP-spine scans agree very closely with published data describing Jeddah women and indicate that during their postmenopausal years, the BMD of an average Saudi Arabian woman drops from a premenopausal plateau (i.e. peak bone mass) of 1.14 g cm⁻², to a residual postmenopausal plateau of 0.92 g cm⁻². The time-constant for this loss is 4.64 years.

Conclusions: We conclude that the average BMD of normal Saudi Arabian women is approximately 0.1 g cm⁻² lower than European women across the entire adult age-range, but that the extent and rate of postmenopausal bone loss appears to lie within the normal European range. This suggests that osteoporosis is first manifested in young adults.

Congenital heart defects (CHD) have a complex etiology in which environmental factors play a key role. High altitude has already been established as a risk factor. Data from the CHD Registry in Riyadh were used to explore the impact of altitude throughout the Kingdom, including the mountain ranges of the south-west; 2,787 Saudi Arabian CHD cases were studied from 104 different cities and villages. Altitude was estimated using a geographical information system. The CHD “burden” was estimated by normalizing the number of CHD cases according to the city population. Cities at both the highest and the lowest altitudes displayed an increased CHD burden, indicating that CHD burden in Saudi Arabia is impacted by at least two different environmental factors — high altitude and coastal proximity. There is also an indication of a separate south-western influence which may reflect a unique cultural or genetic factor.