Journal of Clinical Densitometry
Volume 11, Issue 3 , Pages 383-396 , July 2008

First Update of the Lebanese Guidelines for Osteoporosis Assessment and Treatment

  • Ghada El-Hajj Fuleihan

      Affiliations

    • Calcium Metabolism and Osteoporosis Program, Department of Internal Medicine, American University of Beirut Medical Center
    • Corresponding Author InformationAddress correspondence to: Ghada El-Hajj Fuleihan, Director, Calcium Metabolism & osteoporosis Program, American Univ. of Beirut-Medical Center, P O Box 11-0236, Riad El Solh, Beirut, Lebanon.
    • ,
  • Rafic Baddoura

      Affiliations

    • Division of Rheumatology, Saint Joseph University, Beirut, Lebanon
    • ,
  • Hassane Awada

      Affiliations

    • Division of Rheumatology, Saint Joseph University, Beirut, Lebanon
    • ,
  • Asma Arabi

      Affiliations

    • Calcium Metabolism and Osteoporosis Program, Department of Internal Medicine, American University of Beirut Medical Center
    • ,
  • Jad Okais

      Affiliations

    • Division of Rheumatology, Saint Joseph University, Beirut, Lebanon

Received 12 June 2007 ,Revised 25 February 2008 ,Accepted 25 February 2008.

References 

  1. El-Hajj Fuleihan G, Baddoura R, Awada H, et al. Lebanese guidelines for osteoporosis assessment and treatment. J Med Liban. 2002;50(3):75–125
  2. El-Hajj Fuleihan G, Baddoura R, Awada H, McClung M. Lebanese Guidelines for osteoporosis assessment and treatment. J Clin Densitom. 2005;8:148–163
  3. Compston J. Guidelines for the management of osteoporosis: the present and the future. Osteoporos Int. 2005;16:1173–1176
  4. Baddoura R, Arabi A, Haddad-Zebouni S, et al. Vertebral fracture risk and impact of database selection on identifying elderly Lebanese with osteoporosis. Bone. 2007;40(4):1066–1072
  5. Cummings SR, Black DM, Nevitt MC, et al. Bone density at various sites for prediction of hip fracture. The Study of Osteoporotic Fractures Research group. Lancet. 1993;341:72–75
  6. De Laet CE, Van Hout BA, Burger H, et al. Hip fracture prediction in elderly men and women: validation of the Rotterdam study. J Bone Miner Res. 1998;13:1587–1593
  7. Schott AM, Cormier C, Hans D, et al. How hip and whole body bone mineral density predict hip fracture in elderly women: the EPIDOS prospective study. Osteoporos Int. 1998;8:247–254
  8. Wasnich RD, Ross PD, Hellbrun LK, Vogel JM. Prediction of postmenopausal fracture risk with use of bone mineral measurements. Am J Obstet Gynecol. 1995;153:745–751
  9. Johnell O, Kanis JA, Oden A, et al. Predictive value of BMD for hip and other fractures. J Bone Miner Res. 2005;20:1185–1194
  10. Kanis JA, Johnell O, Oden A, et al. Ten-year probabilities of osteoporotic fractures according to BMD and diagnostic thresholds. Osteoporos Int. 2001;12:989–995
  11. Black DM, Cummings SR, Genant HK, et al. Axial and appendicular bone density predict fractures in older women. J Bone Miner Res. 1992;7:633–638
  12. Melton LJ, Atkinson EJ, O'Fallon WM, et al. Long-term fracture prediction by bone mineral assessed at different skeletal sites. J Bone Miner Res. 1993;8:1227–1233
  13. Marshall D, Johnell O, Wedel H. Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ. 1996;312:1254–1259
  14. Genant H, Grampp S, Gluer C, et al. Universal standardization for dual x-ray absorptiometry: patient and phantom cross-calibration results. J Bone Miner Res. 1994;10:1503–1514
  15. Report of a WHO study group. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. WHO Tech Rep Ser. 1994;843:1–129
  16. Gould SJ. The Mismeasure of Man. New York, USA: W.W. Nortan & Company, Inc.; 1981;
  17. El-Desouki M. Bone mineral density of the spine and femur in the normal Saudi population. Saudi Med J. 1995;16:30–35
  18. Maalouf G, Salem S, Sandid M, et al. Bone mineral density of the Lebanese reference population. Osteoporos Int. 2000;11:756–764
  19. Ardawi MS, Maimany AA, Bahksh TM, et al. Bone mineral density of the spine and femur in healthy Saudis. Osteoporos Int. 2005;16:43–55
  20. Dougherty G, Al-Marzouk N. Bone density measured by dual-energy X-ray absorptiometry in healthy Kuwaiti women. Calcif Tissue Int. 2001;68:225–229
  21. Hammoudeh M, Al-Khayarin M, Zirie M, Bener A. Bone density measured by dual-energy X-ray absorptiometry in Qatari women. Maturitas. 2005;52:319–327
  22. El-Hajj Fuleihan G, Baddoura R, Awada H, et al. Low peak bone mineral density in healthy young Lebanese subjects. Bone. 2002;31(4):520–528
  23. Ghannam NN, Hammani MM, Bakheet SM, Khan BA. Bone mineral density of the spine and femur in healthy Saudi females: relation to vitamin D status, pregnancy, and lactation. Calcif Tissue Int. 1999;65:23–28
  24. Larijani B, Hossein-Nezhad A, Mojtahedi A, et al. Normative data of bone mineral density in healthy population of Tehran, Iran: a cross sectional study. BMC Musculoskelet Disord. 2005;6:38
  25. El Hajj-Fuleihan G, Deeb M. Hypovitaminosis D in a sunny country. N Eng J Med. 1999;340:1840–1841
  26. El-Hajj Fuleihan G, Nabulsi M, Choucair M, et al. Hypovitaminosis D in healthy school children. Pediatrics. 2001;4:1–7
  27. Arabi A, Baddoura R, Awada H, et al. Hypovitaminosis D osteopathy: is it mediated through PTH, lean mass, or is it a direct effect?. Bone. 2006;39:268–275
  28. Mishal AA. Effects of different dress styles on vitamin D levels in healthy young Jordanian women. Osteoporos Int. 2001;12:931–935
  29. Al-Nuaim AR, Kremli M, Al-Nuaim M, Sandgki S. Incidence of proximal femur fracture in an urbanized community in Saudi Arabia. Calcif Tissue Int. 1995;56:536–538
  30. Baddoura R, Awada H, Okais J, et al. An audit of densitometry practice in reference to IOF, NOF and ISCD guidelines. Osteoporos Int. 2006;17(7):1111–1115
  31. Baddoura R, Okais J, Awada H. Incidence fracturaire après 50 ans et implications d'osteoporose dans la population Libanaise. Revue Epidemiol Sante Publique. 2001;49:27–32
  32. Memom A, Popsula WM, Tantawy AY, et al. Incidence of hip fracture in Kuwait. Int J Epidemiol. 1998;27(5):860–865
  33. El-Hajj Fuleihan G, Badra M, Tayim A, et al. Lebanese patients with hip fractures are relatively young, but have osteoporosis. J Bone Miner Res. 2001;(Suppl 1):Abstract M 337
  34. Kanis JA, Delmas P, Buckhardt P, et al. Guidelines for diagnosis and management of osteoporosis on behalf of the European Foundation of Osteoporosis. Osteoporos Int. 1997;7:390–406
  35. Kanis JA, Gluer CC. An update on the diagnosis and assessment of osteoporosis with densitometry. Osteoporos Int. 2000;11:192–202
  36. Genant HK, Wu CY, Van Kuijk C, Nevitt MC. Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res. 1993;8(9):1137–1148
  37. Cauley JA, Zmuda JM, Winiewski SR, et al. Bone mineral density and prevalent vertebral fractures in men and women. Osteoporos Int. 2004;15(1):32–37
  38. Kanis JA, Oden A, Johnell O, et al. The use of clinical risk factors enhances the performance of BMD in the prediction of hip and osteoporotic fractures in men and women. Osteoporos Int. 2007;18(8):1033–1046
  39. Kanis JA, Borgstrom B, De Laet C, et al. Assessment of fracture risk. Osteoporos Int. 2005;16:581–589
  40. Leslie WD, Adler RA, El-Hajj Fuleihan G, et al. Application of the 1994 WHO classification to populations other than postmenopausal Caucasian women: the 2005 ISCD Official Positions. J Clin Densitom. 2006;9(1):22–30
  41. Kanis JA, Johnell O, Oden A, et al. Intervention thresholds for osteoporosis in men and women: a study based on data from Sweden. Osteoporos Int. 2005;16:6–14
  42. Johnell O, Kanis J. Epidemiology of osteoporotic fractures. Osteoporos Int. 2005;16:3–7
  43. Currey J. Sex differences in mechanical properties of bone and bones. Osteoporos Int. 2005;16:S1–S4
  44. Cumming S, Cawthon P, Ensrud K, et al. BMD and risk of hip and non-vertebral fractures in older men: a prospective study and comparison with older women. J Bone Miner Res. 2006;21:1550–1556
  45. De Laet C, Van Hout B, Burger H, et al. Bone density and risk of hip fracture in men and women: cross-sectional analysis. BMJ. 1997;315:221–225
  46. Nguyen T, Sambrook P, Kelly P, et al. Prediction of osteoporotic fractures by postural instability and bone density. BMJ. 1993;303:1111–1115
  47. Kroger H, Lunt M, Reeve J, et al. Bone density reduction in various sites in men and women with osteoporotic fractures at the spine and hip: the European quantification of osteoporosis study. Calcif Tissue Int. 1999;64:191–199
  48. Van der Klift M, De Laet C, McCloskey E, et al. Risk factors for incident vertebral fractures in men and women: the Rotterdam Study. J Bone Miner Res. 2004;19:1172–1180
  49. Orwoll E. Assessing bone density in men. J Bone Miner Res. 2000;15:1867–1870
  50. De Laet C, Van Der Klift M, Hofman A, Pols H. Osteoporosis in men and women: a story about bone mineral density thresholds and hip fracture risk. J Bone Miner Res. 2002;17:2231–2236
  51. Melton LJ, Atkinson E, O'Connor M, et al. Bone density and fracture risk in men. J Bone Miner Res. 1998;13:1915–1923
  52. Binkley N, Bilezikian JP, Kendler DL, et al. International Society for Clinical Densitometry. Official positions of the International Society for Clinical Densitometry and Executive Summary of the 2005 Position Development Conference. J Clin Densitom. 2006;9(1):4–14
  53. Faulkner KG, Von Stetten E, Miller P. Discordance in patient classification using T-scores. J Clin Densitom. 1999;2:343–350
  54. Lofman O, Larsson L, Toss G. Bone mineral density in diagnosis of osteoporosis. Reference population, definition of peak bone mass, and measured site determine prevalence. J Clin Densitom. 2000;3:177–186
  55. Miller P, Njeh C, Jankowski L, Lenchik L. What are the standards by which bone mass measurements at peripheral skeletal sites should be used in the diagnosis of osteoporosis?. J Clin Densitom. 2002;5:S39–S45
  56. Hans DD, Downs RW, Dubouef F, et al. Skeletal sites for osteoporosis diagnosis: the 2005 ISCD Official positions. J Clin Densitom. 2006;9(1):15–21
  57. Kanis JA, Johnell O, Oden A, et al. The use of multiple sites for the diagnosis of osteoporosis. Osteoporos Int. 2006;17(4):527–534
  58. Greenspan SL, Maitland-Ramsey L, Myers E. Classification of osteoporosis in the elderly is dependant on site-specific analysis. Calcif Tissue Int. 1996;58:409–414
  59. Deng HW, Li JL, Li J, et al. Heterogeneity of bone mineral density across skeletal sites and its clinical implications. J Clin Densitom. 1998;1:339–353
  60. Arlot ME, Sornay-Rendu E, Garnero P, et al. Apparent pre- and postmenopausal bone loss evaluated by DXA at different skeletal sites in women: the OFELY cohort. J Bone Miner Res. 1997;12:683–690
  61. Rutt BK, Stebler BG, Cann CE, et al. Whole-body CT scanner for ultraprecise, ultra-accurate determination of bone density. J Comput Assist Tomogr. 1985;9(3):609–610
  62. Rand T, Seidl G, Kianberger F, et al. Impact of spinal degenerative changes on the evaluation of bone mineral density with dual-energy X-ray absorptiometry (DXA). Calcif Tissue Int. 1997;60:430–433
  63. Silverberg SJ, Shane E, De La Cruz L, et al. Skeletal disease in primary hyperparathyroidism. J Bone Miner Res. 1989;4:283–290
  64. Leib ES, Lewiecki EM, Binkley N, Hamdy RC. Official Positions of the International Society for Clinical Densitometry. J Clin Densitom. 2004;7:1–5
  65. National Osteoporosis Foundation . Analyses of the effectiveness and cost of screening and treatment strategies for osteoporosis: a basis for development of practice guidelines. Osteoporos Int. 1998;(Suppl 4):S1–S88
  66. Leslie WD, Tsang JF, Caetano PA, Lix LM, for the Manitoba Bone Density Program . Number of osteoporotic sites and fracture risk assessment: a cohort study from the Manitoba Bone Density Program. J Bone Miner Res. 2007;22(3):476–483
  67. Arabi A, Baddoura R, Awada H, et al. Discriminative ability of dual-energy X-ray absorptiometry site selection in identifying patients with osteoporotic fractures. Bone. 2007;40(4):1060–1065
  68. Lenchick L, Leib ES, Hamdy RC, et al. Executive summary: International Society for Clinical Densitometry Position Development Conference. J Clin Densitom. 2002;5(Suppl):S1–S3
  69. Kanis JA, Barton I, Johnell O. Risedronate decreases fracture risk in patients selected solely on the basis of vertebral fracture. Osteoporos Int. 2004;16:475–482
  70. Blake GM, Patel R, Kanpp KM, Fogelman I. Does the combination of two BMD measurements improve fracture discrimination. J Bone Miner Res. 2003;18:1955–1963
  71. Schuit SC, Van der Klift M, Weel AE, et al. Fracture incidence and association with bone mineral density in elderly men and women: the Rotterdam Study. Bone. 2004;34(1):195–202
  72. Lewis C, Ewing S, Taylor B, et al. Predictors of non-spine fracture in elderly men: the Mr OS study. J Bone Miner Res. 2007;22:211–219
  73. Orwoll E. The Mr Os study; the epidemiology of male skeletal health. Osteoporos Int. 2005;16(Suppl):S1–S5
  74. Lau EM, Leung PC, Kwok T, et al. The determinants of bone mineral density in Chinese men—results from Mr Os (Hong Kong), the first cohort study on osteoporosis in Asian men. Osteoporos Int. 2006;17(2):297–303
  75. Cooper C. Are risk factors for fracture similar in men versus women?. Osteoporos Int. 2005;16(Suppl):S6–S7
  76. De Laet C, Kanis JA, Oden A, et al. Body mass index as a predictor of fracture risk: a meta-analysis. Osteoporos Int. 2005;16:1330–1338
  77. Kanis JA, Johnell O, Oden A, et al. Smoking and fracture risk: a meta-analysis. Osteoporos Int. 2005;16:155–162
  78. Kaptoge S, Armbrecht G, Felsenberg D, et al. When should the doctor order a spine X-ray? Identifying vertebral fractures for osteoporosis care: results from the European Prospective Osteoporosis Study (EPOS). J Bone Miner Res. 2004;19(12):1982–1993
  79. American College of Rheumatology ad hoc committee on glucocorticoid-induced osteoporosis . Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthritis Rheum. 2001;44:1496–1503
  80. Eng-Wong J, Reynolds JC, Venzon D, et al. Effect of raloxifene on bone mineral density in premenopausal women at increased risk of breast cancer. J Clin Endocrinol Metab. 2006;91(10):3941–3946
  81. Love RR, Mazess RB, Barden HS, et al. Effects of tamoxifen on bone mineral density in postmenopausal women with breast cancer. N Engl J Med. 1992;326(13):852–856

PII: S1094-6950(08)00031-0

doi: 10.1016/j.jocd.2008.02.006

Journal of Clinical Densitometry
Volume 11, Issue 3 , Pages 383-396 , July 2008

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