Prevalence of postmenopausal osteoporosis in Morocco: a systematic review and meta-analysis.

INTRODUCTION: This systematic review and meta-analysis was conducted as part of the update of Moroccan recommendations for the management of postmenopausal osteoporosis. Its aim was to estimate the prevalence of postmenopausal osteoporosis in Morocco, based on available bibliographic data. METHODS: We conducted a systematic search of the Medline/PubMed, Scopus, and Embase databases to identify articles published between January 2000 and January 2024. We included all observational studies reporting the prevalence of osteoporosis in postmenopausal women in Morocco. Two reviewers independently contributed to the study selection and data extraction. We assessed the risk of bias in the included studies using the Joanna Briggs Institute tool. Statistical analyses were performed using Stata with the Freeman-Tukey double arcsine transformation. Heterogeneity was assessed using the I2 test statistic. Meta-regression analysis was used to investigate the effect of the date on the prevalence. Publication bias was assessed by DOI plots and the LFK index. RESULTS: An electronic search found a total of 161 citations from the databases. After excluding the irrelevant articles, 17 eligible studies were included. This meta-analysis included 5097 postmenopausal women. The pooled prevalence of postmenopausal osteoporosis was 32% (95% CI 28-36). Heterogeneity was statistically significant (I2 = 89.67%). There was no significant difference between subgroup analyses performed by risk of bias and sample size. The prevalence rate was significantly higher in 2006-2012 (36%; 95% CI 31-42; I2 = 88.7%; p < 0.001) than in 2013-2019 (27%; 95% CI 22-32; I2 = 85.9%; p < 0.001). Meta-regression showed that the prevalence of osteoporosis decreases very slightly (0.016% per year). This decrease becomes nonsignificant if only studies with a low risk of bias are included in the meta-regression (coefficient - 7.77, p = 0.667, I2 0%). No publication bias was detected in this meta-analysis. CONCLUSION: Our results indicate that postmenopausal osteoporosis is prevalent in Morocco, which is a developing country; however, the prevalence of this disease is aligned with that of industrialized countries.

Study of Body Composition by Biphotonic X-ray Absorptiometry in a Moroccan Female Population, an Indicator of Obesity?

INTRODUCTION: Our purpose was to study the body composition in a healthy female Moroccan adult group, and to help physicians to evaluate nutritional status. MATERIALS AND METHODS: Five hundred and nineteen healthy women aged from 20 to 80 years were included in the study. Bone mineral density at the hip and lumbar spine and the body composition parameters were measured by dual-energy X-ray absorptiometry: fat mass (FM), fat-free mass (FFM), and percentage (%) of body fat. The FFM index (FFMI) and the FM index (FMI) were calculated. We analyzed the population by age and body mass index (BMI) defined groups. RESULTS: The mean age of the population was 53.14 ± 13.69 years with an average BMI of 29.30 ± 5.04 kg/m2. Means of FM and FFM were 33.93 ± 9.18 kg and 36.91 ± 5 kg, respectively, with FM and FFMI of 13.65 ± 3.66 kg/m2 and 14.85 ± 1.91 kg/m2, respectively. The % FM, FFM, and their corresponding indices increased with age; a statistically significant difference was observed between the 20 and 39 age categories and the two other categories. The BMI category analysis showed that FFMI and FMI increased in obese women with a statistically significant difference between the four groups. Age and BMI were correlated significantly with the different parameters. CONCLUSION: This is the first Moroccan study to present body composition indexes in healthy Moroccan female adults. These reference values may be useful for the clinical evaluation of body composition and nutritional status.

Résumé Introduction:Notre objectif était d'étudier la composition corporelle dans un groupe adulte marocain féminin en bonne santé et d'aider les médecins à évaluer l'état nutritionnel.Matériaux et méthodes:Cinq cent dix-neuf femmes en bonne santé âgées de 20 à 80 ans ont été incluses dans l'étude. La densité minérale osseuse à la hanche et la colonne vertébrale lombaire et les paramètres de composition corporelle ont été mesurées par absorptiométrie à double énergie X: masse grasse (FM), masse sans graisse (FFM) et pourcentage (%) de graisse corporelle. L'indice FFM (FFMI) et l'indice FM (FMI) ont été calculés. Nous avons analysé la population par des groupes définis par l'âge et l'indice de masse corporelle (IMC).Résultats:L'âge moyen de la population était de 53,14 ± 13,69 ans avec un IMC moyen de 29,30 ± 5,04 kg / m2. Les moyennes de FM et de FFM étaient de 33,93 ± 9,18 kg et 36,91 ± 5 kg, respectivement, avec FM et FFMI de 13,65 ± 3,66 kg / m2 et 14,85 ± 1,91 kg / m2, respectivement. Le% FM, FFM et leurs indices correspondants ont augmenté avec l'âge; Une différence statistiquement significative a été observée entre les 20 et 39 catégories d'âge et les deux autres catégories. L'analyse de la catégorie IMC a montré que l'IFMI et l'IFM ont augmenté chez les femmes obèses avec une différence statistiquement significative entre les quatre groupes. L'âge et l'IMC étaient corrélés de manière significative avec les différents paramètresConclusion:il s'agit de la première étude marocaine à présenter des indices de composition corporelle chez des adultes marocains sains. Ces valeurs de référence peuvent être utiles pour l'évaluation clinique de la composition corporelle et de l'état nutritionnel.

Shoulder capsulitis: What relation with diabetes mellitus in a moroccan population?

Introduction: Shoulder capsulitis (SC) is a common musculoskeletal complication in patients with diabetes. It can be particularly disabling. It is often overlooked by clinicians. The aim of this study is to evaluate the prevalence of retractile capsulitis and to identify the risk factors in a population of Moroccan diabetic patients. Materials and Methods: We realised a cross-sectional study including patients with diabetes mellitus (DM). We recorded the demographic and diabetic characteristics of our patients. SC and vascular complications were assessed by clinical and para-clinical investigations. The prevalence of SC was calculated. The factors associated with SC were evaluated by suitable statistical tests. Results: Three hundred and Sixty-five patients were included; 84.9% had Type 2 DM (T2DM). The mean age of the participants was 52.6 ± 13.6. Shoulder capsulitis was present in 12.6% of patients. In statistical analysis, age >50 years (P = 0.001), T2DM (P = 0.03), duration of progression >10 years (P = 0.03), dyslipidemia (P = 0.013) and macrovascular complications (P = 0.009) were associated with an increased frequency of SC. Conclusion: This study shows that the prevalence of SC is higher in diabetic patients. Therefore, inclusion of this pathology in the global management of the diabetic patient is necessary.

Résumé Introduction: la capsulite rétractile de l'épaule (CR) est une complication musculo-squelettique fréquente chez les patients diabétiques. Elle peut être particulièrement invalidante. Elle est souvent méconnue par les cliniciens. Cette étude a pour objectif d'évaluer la prévalence de la capsulite rétractile et d'identifier les facteurs de risque dans une population de patients diabétiques marocains. Methodes: Une étude transversale incluant des patients diabétiques. Nous avons enregistré les caractéristiques démographiques et les caractéristiques du diabète de nos patients. La CR et les complications vasculaires ont été évalués par des examens cliniques et para cliniques. La prévalence de la CR a été calculée, ensuite les facteurs associés à la CR ont été évalués par des tests statistiques adaptés. Resultat: 365 patients ont été inclus ; 84.9 % avaient un diabète de type 2. L'âge moyen des participants était de 52.6 ±13.6. Une capsulite de l'épaule était présente chez 12,6 % des patients. Dans l'analyse statistique, l'âge supérieur à 50 ans (P=0,001), le diabète de type 2 (P=0.03), la durée d'évolution >10 ans (P=0.03), la dyslipidémie (P=0.013) et les complications macro vasculaires (P=0.009) étaient associées à une fréquence accrue de la capsulite rétractile. Conclusion: cette étude montre que la prévalence de la CR est plus élevée chez les patients diabétiques. D'où la nécessité d'inclure cette pathologie dans la prise en charge globale du patient diabétique, et de la même manière, réaliser un dépistage de diabète chez les patients souffrant d'un capsulite rétractile. Mots clés: diabète sucré, complications musculo squelettiques, capsulite rétractile.

Cachexia Prevalence in a Population of Moroccan Women with Rheumatoid Arthritis.

Objective: To assess body composition in women with rheumatoid arthritis (RA) compared to healthy controls, to calculate the prevalence of rheumatoid Cachexia (RC), and to identify the associated factors. Methods: We conducted a case-control study on 112 female patients with RA according to the 2010 American College of Rheumatology/European League Against Rheumatism classification criteria for RA; and 224 age-matched healthy women. Body composition (BC) and bone mineral density (BMD) scans were obtained using Dual-energy X-ray absorptiometry (DXA). RC was defined by a fat-free mass index (FFMI) below the 10th percentile and a fat mass index (FMI) above the 25th percentile compared with the control group. We conducted a comparison between RA patients and healthy controls then a multiple regression analysis was conducted where the dependant variable is the presence of RC. Results: RC prevalence was 42.85% while the mean body mass index (BMI) was the same in both groups. RA patients had a higher FM and lower FFM comparing to healthy controls. In our population, 78.60% of patients were on methotrexate and 12.50% on anti TNF therapy. Comparison between patients with and without RC showed that patients with RC have a higher proportion of erosive arthritis and of active disease. Regression logistic analysis showed that RC was significantly associated to erosive arthritis and active disease (OR at 33.31 (8.42-131.70) and 8.98 (1.64-49.20) respectively), independently of age, erythrocyte sedimentation rate, C-reactive protein, disease duration, steroid cumulative dose and biologic Disease-Modifying Anti-Rheumatic Drugs(bDMARDs) use. Conclusion: Our study showed that almost half of our RA patients have RC, even with a high BMI.

Hodgkin Lymphoma Mimicking Lumbar Spine Tuberculosis.

INTRODUCTION: The clinical manifestations of Hodgkin lymphoma (HL) can closely mimic spine and lymph node tuberculosis (TB). Case Description. A 48-year-old man was initially treated for retroperitoneal lymph nodes TB, and this diagnosis was made without bacteriological and histopathological confirmation. After four months of regular therapy for TB, he did not improve and was admitted to our department for lumbar spine pain. We first made diagnosis of tuberculous spondylodiscitis, and anti-TB treatment was strengthened. But, after three weeks of hospitalization, his condition worsened clinically with onset of swelling of the left supraclavicular lymph node. So, after surgical excision and anatomopathological examination of the lymph node, the diagnosis of nodular sclerosis classic Hodgkin lymphoma was made. He was treated by chemotherapy, and his condition improved significantly after the first 2 cycles of chemotherapy. CONCLUSION: Repeated investigations may be helpful in establishing a correct diagnosis and starting an effective treatment in this highly curable disease.

Correlation genotype-phenotype: MEFV gene mutations and Moroccan patients with rheumatoid arthritis.

Introduction: rheumatoid arthritis (RA) is a systemic autoimmune disease primarily affecting the joints. Arthritic disorders are associated with mutations of the Mediterranean fever (MEFV) gene. The aim of this study is to show whether MEFV mutations will be involved in the pathogenesis of RA, to explore the frequency of these mutations and to study the genotype-phenotype correlation between mutations in this gene and a cohort of Moroccan patients with rheumatoid arthritis (RA). Methods: the present study included 100 patients with RA and 200 control group (CG) who were unrelated individuals from the same ethnic. All patients were tested for auto-antibodies: cyclic citrullinated peptide (ACPA/anti-CCP2), rheumatoid factor (RF) and were analyzed by Sanger Sequencing of the 2 and 10 exons of MEFV gene (hot-spot according to the literature). Results: we detected 13 missense variants already MEFV gene mutation reported in the literature (S154T, G222A, G230L, L611H, L695A, M694V, I720M, A737L, P758S, L709A, T732A, G687A and P743L). Carrier rates of MEFV gene mutations were 24/100 (24%) for the RA group and 4/200 (4%) for CG. In the RA group, we observed that no man has presented with MEFV mutation. In the RA group, while gender, BMI, RF and ACPA were significantly higher in the mutation carrier group than those of the non-carrier group (p<0.01). The level of C-reactive protein and HAQ were slightly elevated in the carrier group but not significant. No other significant differences were observed between patients with MEFV mutations and those without MEFV mutations. Conclusion: the results of this study suggest that MEFV gene mutations appear to be an aggravating factor severity of RA and consequently, patients with RA might be screened for MEFV gene mutations in countries where FMF is frequent. We report also that our study is the first one in our country Morocco.

Extra-Articular Manifestations in Patients with Ankylosing Spondylitis: Baseline Characteristics from the RBSMR Study.

Objectives: To describe and analyse the prevalence of extra-articular manifestations (EAMs) including acute anterior uveitis (AAU), psoriasis and inflammatory bowel disease (IBD) in patients with ankylosing spondylitis (AS) in the Moroccan registry of biological therapies in rheumatic diseases RBSMR (Registre des Biothérapies de la Société Marocaine de Rhumatologie). Methods: A cross-sectional, multicentre and analytical study based on the RBSMR database, which included 170 AS. Incidence rates for the development of AAU, psoriasis and IBD were calculated, and risk factors were analysed. Results: Prevalence of EAMs in AS was 13.5%, 4.7% and 11.2% for AAU, psoriasis and IBD respectively. No significant differences were found while establishing a comparison of the prevalence of these EAMs between AS patients with and without peripheral arthritis. Interestingly, AAU was the most common EAM, and was positively associated in multivariable regression with family history of spondyloarthritis (OR= 7.21, CI 95%: 2.23-23.24). Conclusions: AAU was the leading EAM in patients with AS included in the Moroccan biotherapy registry (RBSMR) and it was associated with family history of spondyloarthritis.

Achilles Tendon Xanthoma and Cholestanol Revealing Cerebrotendinous Xanthomatosis: A New Case Report.

Cerebrotendinous xanthomatosis (CTX) is an autosomal recessive lipid storage disease rarely reported in Africa. Therefore, we report a Moroccan first case report of CTX. A 20-year-old woman was presented in our department for bilateral swelling of the posterior aspect of ankles and the anterior aspect knees with gait disturbances evolving since the age of 7. The patient was the first child of consanguineous marriage. She had bilateral cataracts and developmental delay. Laboratory findings revealed that the plasma cholestanol level was remarkably elevated, and plasma and urine bile alcohol levels were elevated. MRI of ankles showed a bilateral diffuse thickening of the Achilles tendon with hypointense in T1 and heterogeneous hypersignal in T2 with spots in hypersignal in T1 and T2. Brain MRI revealed bilateral and symmetrical T2 hypersignal of dentate nuclei, without white matter signal alterations or cerebral or cerebellar atrophy. A biopsy obtained of the Achilles swelling with a histological study showed an aspect of tendon xanthoma. Hence, the diagnosis of CTX was made. MRI, especially brain MRI, plays an important role in the diagnosis of CTX.

Leflunomide-Induced Hidradenitis Suppurativa.

Hidradenitis suppurativa is an inflammatory disease of the pilosebaceous unit with a chronic intermittent course and a devastating effect on quality of life. Rare reports of drug-induced hidradenitis suppurativa exist. We report on 2 women on follow-up for rheumatoid arthritis, who presented hidradenitis suppurativa after different periods of treatment with leflunomide and who improved few weeks after discontinuation of the medication.

Relationship between vertebral fracture prevalence and abdominal aortic calcification in women with rheumatoid arthritis.

OBJECTIVES: Vertebral fracture assessment (VFA)-detected abdominal aortic calcification (AAC) has been validated as an indicator of increased risk of vertebral fractures (VFs) in other populations but this relationship in rheumatoid arthritis (RA) is unclear. We assess the prevalence of AAC on VFA scans and its potential relationship with prevalent VFs in a cohort of RA women. METHODS: We enrolled 250 women with RA. VFA images, and scans of the lumbar spine and proximal femur were obtained using dual-energy x-ray absorptiometry. The presence/severity of VFs and AAC were carried out using validated approaches. RESULTS: AAC was detected in 95 of 250 (38%) eligible subjects and 83 (33.2%) had at least one VF. Significantly subjects with VFs had a higher AAC score (3.4 ± 3.8 versus 0.7 ± 1.4; p˂0.001) and higher prevalence of AAC than those without VFs (65% versus 26%; P˂0.001). The group with VFs tended to be older, had more menopausal women, and lower lumbar spine and total hip BMD than those without VF. They also had a long-standing disease and high DAS 28-CRP, a great steroid cumulative dose, and a high prevalence of rheumatoid factor (RF). In multivariate analyses, a significant association was noted between prevalent VFs and age of patients, RA disease activity, presence of densitometric osteoporosis, RF, and VFA-detected AAC, whereas there was no significant association with steroid cumulative dose and disease duration. CONCLUSION: VFA is a convenient tool for the diagnosis of VFs and AAC. In this cohort, VFA-detected AAC was independently associated with prevalent VFs.