Increasing trends and significance of hypovitaminosis D: a population-based study in the Kingdom of Saudi Arabia.

UNLABELLED: Vitamin D deficiency is highly prevalent in Saudi Arabia, particularly among young women and is emerging as public health threat of epidemic proportions. Prevalence of severe hypovitaminosis D is expected to rise exponentially without primary intervention. This largest study encompasses extent of vitamin D deficiency and recommendations to reduce significant health care burden. INTRODUCTION: The aim of the study was to determine the prevalence and significance of vitamin D deficiency in Saudi population and to help develop national consensus for its prevention, screening, and management. METHODS: This was a retrospective observational study which involved 10,709 patients, recruited from the Department of Family Medicine and Polyclinic, King Faisal Specialist Hospital and Research Center (KFSH&RC), Saudi Arabia, over a period of 5 years. The endpoints included overall status of vitamin D level and severity of vitamin D deficiency. Serum measurements included 25 hydroxyvitamin D (25(OH)D), parathormone, calcium, phosphate, alkaline phosphatase, albumin levels, eGFR levels, bone mineral density. RESULTS: A total of 10,709 patients were analyzed; 31.4 % were males and 68.6 % were females, with a preponderance of Saudis (68.5 %) compared to non-Saudis (31.5 %). The prevalence of vitamin D deficiency was 83.6 % (31.9 % severe, 32.0 % moderate, and 19.7 % mild), when cut points of less than 25, 50, and 75 nmol/l, respectively, were used. Mean serum 25(OH)D was 44.58 ± 34.80 standard deviation (SD) nmol/l. There was significant difference in severity of vitamin D deficiency stratified by age, gender, and nationality. More females had severe 25(OH)D deficiency compared to males (35.6 vs. 23.7 %, p < 0.000). Severe 25(OH)D deficiency was markedly high among adolescents as compared to other age groups (49.2 vs. 30.9 %, p < 0.000). More Saudis were found to be vitamin D deficient compared to non-Saudis (37.2 vs. 20.3 %, p < 0.000). CONCLUSION: The prevalence of hypovitaminosis D is significantly high among Saudi population, especially among women, despite abundant sunshine. It is a major public health concern and requires a robust health policy for vitamin D supplementation and implementation of dietary public health measures. Vitamin D screening is strongly recommended at an earlier age especially among women and children.

Updated recommendations for the diagnosis and management of osteoporosis: a local perspective.

Postmenopausal osteoporosis and osteoporosis in elderly men are major health problems, with a significant medical and economic burden. Although osteopenia and osteoporosis are more common locally than in the West, fracture rates are generally less than in Western countries. Vitamin D deficiency is common in the region and contributes adversely to bone health. Vitamin D deficiency should be suspected and treated in all subjects with ostopenia or osteoporosis. The use of risk factors to determine fracture risk has been adopted by the World Health Organization and many international societies. Absolute fracture risk methodology improves the use of resources by targeting subjects at higher risk of fractures for screening and management. The King Faisal Specialist Hospital Osteoporosis Working Group recommends screening for women 65 years and older and for men 70 years and older. Younger subjects with clinical risk factors and persons with clinical evidence of osteoporosis or diseases leading to osteoporosis should also be screened. These guidelines provide recommendations for treatment for postmenopausal women and men older than 50 years presenting with osteoporotic fractures for persons having osteoporosis-after excluding secondary causes-or for persons having low bone mass and a high risk for fracture. The Working Group has suggested an algorithm to use at King Faisal Specialist Hospital that is based on the availability, cost, and level of evidence of various therapeutic modalities. Adequate calcium and vitamin D supplement are recommended for all. Weekly alendronate (in the absence of contraindications) is recommended as first-line therapy. Alternatives to alendronate are raloxifene or strontium ranelate. Second-line therapies are zoledronic acid intravenously once yearly, when oral therapy is not feasible or complicated by side effects, or teriparatide in established osteoporosis with fractures.