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Disease burden of osteoporosis and other non-communicable diseases in Lebanon

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Abstract

Summary

Osteoporosis is more common than most feared non-communicable diseases in the Middle East. This justifies the need to place osteoporosis as a health priority in the region.

Introduction

Osteoporosis is a common disease associated with severe debilitating consequences. The objective of this study is To evaluate and compare disease burden from osteoporosis and other non-communicable diseases (NCDs) in Lebanon.

Methods

We assessed the prevalence of osteoporosis and other NCDs, such as obesity, diabetes, hypertension, dyslipidemia, and cardiovascular diseases, based on a published population-based study of Lebanese ≥ 65 years. We compared incidence rates of hip fractures and major osteoporotic fractures (MOF) (spine, hip, humerus, and forearm) to the five commonest cancers in women ≥ 50 years. Rates were based on the national hip fracture and cancer registry data, provided by the Lebanese Ministry of Public Health. MOF incidence rates were derived from national hip fracture incidence rates and MOF/hip fractures incidence rate ratios from the literature.

Results

Over 70% of elderly Lebanese had osteoporosis defined by densitometric criteria or prevalent morphometric vertebral fractures. This by far exceeded the prevalence of other NCDs, such as hypertension (53%), diabetes (21%), dyslipidemia (31%), and cardiovascular diseases (30%). Morphometric vertebral fractures (grades 2 and 3) were present in 19% of women and 12% of men. The incidence rates for MOF were 1.6 times greater than those for breast cancer, and 7.4–9.9 folds higher than those for the next commonest cancers of the lungs, colon, and ovaries. Hip fracture incidence rates were lower than those of breast cancer but were 2.1–2.8 folds higher than those of the above-mentioned cancers.

Conclusion

This first of its kind study in the Middle East demonstrates that osteoporosis is a common disease, more common than most feared NCDs. Our findings are comparable to those in western populations and justify placing osteoporosis on the top of NCDs’ priority list in our country and possibly the region.

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References

  1. Horton R (2013) Non-communicable diseases: 2015 to 2025. Lancet 381(9866):509–510. https://doi.org/10.1016/S0140-6736(13)60100-2

    Article  PubMed  Google Scholar 

  2. World Health Organization (2018) Noncommunicable diseases. https://wwwwhoint/news-room/fact-sheets/detail/noncommunicable-diseases Accessed 27 May 2019 2019

  3. World Health Organization (2018) Noncommunicable diseases (NCD) country profiles, Lebanon. https://www.who.int/nmh/countries/lbn_en.pdf?ua=1. Accessed 27 May 2019

  4. Rahim HFA, Sibai A, Khader Y, Hwalla N, Fadhil I, Alsiyabi H, Mataria A, Mendis S, Mokdad AH, Husseini A (2014) Non-communicable diseases in the Arab world. Lancet 383(9914):356–367. https://doi.org/10.1016/S0140-6736(13)62383-1

    Article  PubMed  Google Scholar 

  5. Johnell O, Kanis JA (2004) An estimate of the worldwide prevalence, mortality and disability associated with hip fracture. Osteoporos Int 15(11):897–902. https://doi.org/10.1007/s00198-004-1627-0

    Article  CAS  PubMed  Google Scholar 

  6. Cauley JA (2013) Public health impact of osteoporosis. J Gerontol A Biol Sci Med Sci 68(10):1243–1251. https://doi.org/10.1093/gerona/glt093

    Article  PubMed  PubMed Central  Google Scholar 

  7. Irani AD, Poorolajal J, Khalilian A, Esmailnasab N, Cheraghi Z (2013) Prevalence of osteoporosis in Iran: a meta-analysis. J Res Med Sci 18(9):759–766

    PubMed  PubMed Central  Google Scholar 

  8. El-Hajj Fuleihan GA, Med Gemma; Nauroy, Laetitia (4Y) The Middle East & Africa regional Audit: epidemiology, costs & burden of osteoporosis in 2011. International Osteoporosis Foundation (IOF)

  9. Kanis JA, Delmas P, Burckhardt P, Cooper C, Torgerson D (1997) Guidelines for diagnosis and management of osteoporosis. Osteoporos Int 7(4):390–406. https://doi.org/10.1007/BF01623782

    Article  CAS  PubMed  Google Scholar 

  10. Cauley JA, Wampler NS, Barnhart JM, Wu L, Allison M, Chen Z, Hendrix S, Robbins J, Jackson RD (2008) Incidence of fractures compared to cardiovascular disease and breast cancer: the Women’s Health Initiative Observational Study. Osteoporos Int 19(12):1717–1723. https://doi.org/10.1007/s00198-008-0634-y

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Baddoura R, Arabi A, Haddad-Zebouni S, Khoury N, Salamoun M, Ayoub G, Okais J, Awada H, El-Hajj Fuleihan G (2007) Vertebral fracture risk and impact of database selection on identifying elderly Lebanese with osteoporosis. Bone 40(4):1066–1072. https://doi.org/10.1016/j.bone.2006.11.016

    Article  PubMed  Google Scholar 

  12. Sibai AM, Nasser W, Ammar W, Khalife MJ, Harb H, El-Hajj Fuleihan G (2011) Hip fracture incidence in Lebanon: a national registry-based study with reference to standardized rates worldwide. Osteoporos Int 22(9):2499–2506. https://doi.org/10.1007/s00198-010-1468-y

    Article  CAS  PubMed  Google Scholar 

  13. Ballane G, Cauley JA, Arabi A, El-Hajj Fuleihan G (2013) Chapter 27 - geographic variability in hip and vertebral fractures. In: Marcus R, Feldman D, Dempster DW, Luckey M, Cauley JA (eds) Osteoporosis, 4th edn. Academic Press, San Diego, pp 623–644. https://doi.org/10.1016/B978-0-12-415853-5.00027-3

    Chapter  Google Scholar 

  14. Saad RK, Harb H, Bou-Orm IR, Ammar W, El-Hajj Fuleihan G (2019) Secular trends of hip fractures in Lebanon, 2006 to 2017: implications for clinical practice and public health policy in the Middle East region. doi:https://doi.org/10.1002/jbmr.3870

  15. Ministry of Public Health RoL (2005) National Cancer Registry. https://moph.gov.lb/en/Pages/2/19523/national-cancer-registry. Accessed 27 May 2019

  16. Central Administration of Statistics (2007) Household living conditions survey Lebanon: Presidency of Council of Ministers. http://www.cas.gov.lb/index.php/housing-characteristics-en

  17. Kanis JA, Melton LJ III, Christiansen C, Johnston CC, Khaltaev N (1994) The diagnosis of osteoporosis. J Bone Miner Res 9(8):1137–1141. https://doi.org/10.1002/jbmr.5650090802

    Article  CAS  PubMed  Google Scholar 

  18. Kanis JA, Burlet N, Cooper C, Delmas PD, Reginster J-Y, Borgstrom F, Rizzoli R, Clinical obotESf, Osteoporosis EAo, Osteoarthritis (2008) European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 19(4):399–428. https://doi.org/10.1007/s00198-008-0560-z

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. The International Society for Clinical Densitometry (2013) Official positions of the ISCD http://www.iscd.org/documents/2013/07/2013-iscd-official-positions-adult.pdf/

  20. Looker AC, Orwoll ES, Johnston JRCC, Lindsay RL, Wahner HW, Dunn WL, Calvo MS, Harris TB, Heyse SP (1997) Prevalence of low femoral bone density in older U.S. adults from NHANES III. J Bone Miner Res 12(11):1761–1768. https://doi.org/10.1359/jbmr.1997.12.11.1761

    Article  CAS  PubMed  Google Scholar 

  21. Genant HK, Grampp S, Glüer CC, Faulkner KG, Jergas M, Engelke K, Hagiwara S, van Kuijk C (1994) Universal standardization for dual X-ray absorptiometry: patient and phantom cross-calibration results. J Bone Miner Res 9(10):1503–1514. https://doi.org/10.1002/jbmr.5650091002

    Article  CAS  PubMed  Google Scholar 

  22. Grigoryan M, Guermazi A, Roemer FW, Delmas PD, Genant HK (2003) Recognizing and reporting osteoporotic vertebral fractures. Eur Spine J 12 Suppl 2(Suppl 2):S104–S112. https://doi.org/10.1007/s00586-003-0613-0

    Article  Google Scholar 

  23. Statistics department at the Lebanese Ministry of Public Health (MOPH) (2012-2017) Statistical bulletin of the Lebanese Ministry of Public Health Lebanon. https://moph.gov.lb/en/Pages/8/327/statistical-bulletins

  24. Kanis JA, Oden A, Johnell O, Jonsson B, de Laet C, Dawson A (2001) The burden of osteoporotic fractures: a method for setting intervention thresholds. Osteoporos Int 12(5):417–427. https://doi.org/10.1007/s001980170112

    Article  CAS  PubMed  Google Scholar 

  25. Centre for Metabolic Bone Diseases UoS, UK FRAX Fracture Risk Assessment Tool. https://www.sheffield.ac.uk/FRAX/index.aspx

  26. Kanis JA, Odén A, McCloskey EV, Johansson H, Wahl DA, Cooper C, Epidemiology obotIWGo, Life Qo (2012) A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int 23(9):2239–2256. https://doi.org/10.1007/s00198-012-1964-3

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Kanis JA, Hans D, Cooper C, Baim S, Bilezikian JP, Binkley N, Cauley JA, Compston JE, Dawson-Hughes B, El-Hajj Fuleihan G, Johansson H, Leslie WD, Lewiecki EM, Luckey M, Oden A, Papapoulos SE, Poiana C, Rizzoli R, Wahl DA, McCloskey EV, Initiative TFotF (2011) Interpretation and use of FRAX in clinical practice. Osteoporos Int 22(9):2395–2411. https://doi.org/10.1007/s00198-011-1713-z

    Article  CAS  PubMed  Google Scholar 

  28. El-Hajj Fuleihan G, Chakhtoura M, Cauley JA, Chamoun N (2017) Worldwide fracture prediction. J Clin Densitom 20(3):397–424. https://doi.org/10.1016/j.jocd.2017.06.008

    Article  PubMed  Google Scholar 

  29. Dean AS KM, Soe, MM (2013) OpenEpi: Open Source Epidemiologic Statistics for Public Health, Version 3. www.OpenEpi.com

  30. Wade SW, Strader C, Fitzpatrick LA, Anthony MS, O’Malley CD (2014) Estimating prevalence of osteoporosis: examples from industrialized countries. Arch Osteoporos 9(1):182. https://doi.org/10.1007/s11657-014-0182-3

    Article  CAS  PubMed  Google Scholar 

  31. El-Hajj Fuleihan G, Baddoura R, Awada H, Salam N, Salamoun M, Rizk P (2002) Low peak bone mineral density in healthy Lebanese subjects. Bone 31(4):520–528. https://doi.org/10.1016/S8756-3282(02)00845-1

    Article  CAS  PubMed  Google Scholar 

  32. Wright NC, Looker AC, Saag KG, Curtis JR, Delzell ES, Randall S, Dawson-Hughes B (2014) The recent prevalence of osteoporosis and low bone mass in the United States based on bone mineral density at the femoral neck or lumbar spine. J Bone Miner Res 29(11):2520–2526. https://doi.org/10.1002/jbmr.2269

    Article  PubMed  PubMed Central  Google Scholar 

  33. Kado DM, Browner WS, Palermo L, Nevitt MC, Genant HK, Cummings SR (1999) Vertebral fractures and mortality in older women: a prospective study. Study of Osteoporotic Fractures Research Group. Arch Intern Med 159(11):1215–1220

    Article  CAS  Google Scholar 

  34. Grados F, Marcelli C, Dargent-Molina P, Roux C, Vergnol JF, Meunier PJ, Fardellone P (2004) Prevalence of vertebral fractures in French women older than 75 years from the EPIDOS study. Bone 34(2):362–367. https://doi.org/10.1016/j.bone.2003.11.008

    Article  CAS  PubMed  Google Scholar 

  35. Pluijm SM, Tromp AM, Smit JH, Deeg DJ, Lips P (2000) Consequences of vertebral deformities in older men and women. J Bone Miner Res 15(8):1564–1572. https://doi.org/10.1359/jbmr.2000.15.8.1564

    Article  CAS  PubMed  Google Scholar 

  36. Sibai AT, Rania, Mahfoud Ziyad, Chaaya, Monique; Hwalla, Nahla (2009) Non-communicable Diseases and Behavioral Risk Factor Survey. Comparison of estimates based on cell phone interviews with face to face interviews

  37. Zabetian A, Keli HM, Echouffo-Tcheugui JB, Narayan KMV, Ali MK (2013) Diabetes in the Middle East and North Africa. Diabetes Res Clin Pract 101(2):106–122. https://doi.org/10.1016/j.diabres.2013.03.010

    Article  PubMed  Google Scholar 

  38. Alnohair S (2014) Obesity in gulf countries. Int J Health Sci 8(1):79–83. https://doi.org/10.12816/0006074

    Article  Google Scholar 

  39. Nasrallah MP, Nakhoul NF, Nasreddine L, Mouneimne Y, Abiad MG, Ismaeel H, Tamim H (2017) Prevalence of diabetes in greater Beirut area: worsening over time. Endocrine Practice 23(9):1091–1100. https://doi.org/10.4158/ep171876.or

    Article  PubMed  Google Scholar 

  40. Saquib N, Saquib J, Alhadlag A, Albakour MA, Aljumah B, Sughayyir M, Alhomidan Z, Alminderej O, Aljaser M, Al-Mazrou A (2017) Chronic disease prevalence among elderly Saudi men. Int J Health Sci 11(5):11–16

    Google Scholar 

  41. National Center for Health Statistics (2018) Data Briefs. https://www.cdc.gov/nchs/products/databriefs.htm

  42. Cooper C, Cole ZA, Holroyd CR, Earl SC, Harvey NC, Dennison EM, Melton LJ, Cummings SR, Kanis JA (2011) Secular trends in the incidence of hip and other osteoporotic fractures. Osteoporos Int 22(5):1277–1288. https://doi.org/10.1007/s00198-011-1601-6

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Ballane G, Cauley JA, Luckey MM, Fuleihan Gel H (2014) Secular trends in hip fractures worldwide: opposing trends East versus West. J Bone Miner Res 29(8):1745–1755. https://doi.org/10.1002/jbmr.2218

    Article  PubMed  Google Scholar 

  44. Kulhánová I, Bray F, Fadhil I, Al-Zahrani AS, El-Basmy A, Anwar WA, Al-Omari A, Shamseddine A, Znaor A, Soerjomataram I (2017) Profile of cancer in the Eastern Mediterranean region: `he need for action. Cancer Epidemiol 47:125–132. https://doi.org/10.1016/j.canep.2017.01.009

    Article  PubMed  Google Scholar 

  45. Shamseddine A, Saleh A, Charafeddine M, Seoud M, Mukherji D, Temraz S, Sibai AM (2014) Cancer trends in Lebanon: a review of incidence rates for the period of 2003-2008 and projections until 2018. Popul Health Metrics 12(1):4. https://doi.org/10.1186/1478-7954-12-4

    Article  Google Scholar 

  46. Silverman SL, Delmas PD, Kulkarni PM, Stock JL, Wong M, Plouffe L Jr (2004) Comparison of fracture, cardiovascular event, and breast cancer rates at 3 years in postmenopausal women with osteoporosis. J Am Geriatr Soc 52(9):1543–1548. https://doi.org/10.1111/j.1532-5415.2004.52420.x

    Article  PubMed  Google Scholar 

  47. Singer A, Exuzides A, Spangler L, O'Malley C, Colby C, Johnston K, Agodoa I, Baker J, Kagan R (2015) Burden of illness for osteoporotic fractures compared with other serious diseases among postmenopausal women in the United States. Mayo Clin Proc 90(1):53–62. https://doi.org/10.1016/j.mayocp.2014.09.011

    Article  PubMed  Google Scholar 

  48. Badra M, Mehio-Sibai A, Zeki Al-Hazzouri A, Abou Naja H, Baliki G, Salamoun M, Afeiche N, Baddoura O, Bulos S, Haidar R, Lakkis S, Musharrafieh R, Nsouli A, Taha A, Tayim A, El-Hajj Fuleihan G (2009) Risk estimates for hip fracture from clinical and densitometric variables and impact of database selection in Lebanese subjects. J Clin Densitom 12(3):272–278. https://doi.org/10.1016/j.jocd.2009.01.003

    Article  PubMed  Google Scholar 

  49. Salti N, Chaaban J, Raad F (2010) Health equity in Lebanon: a microeconomic analysis. Int J Equity Health 9:11–11. https://doi.org/10.1186/1475-9276-9-11

    Article  PubMed  PubMed Central  Google Scholar 

  50. Akinyemiju T, Ogunsina K, Okwali M, Sakhuja S, Braithwaite D (2017) Lifecourse socioeconomic status and cancer-related risk factors: analysis of the WHO study on global ageing and adult health (SAGE). Int J Cancer 140(4):777–787. https://doi.org/10.1002/ijc.30499

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

AB received training under the Scholars in HeAlth Research Program (SHARP), Fogarty International Center and Office of Dietary Supplements of the National Institutes of Health under Award Number D43 TW009118. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors would like to thank Mr. Ali Hammoudi for his assistance in the figures’ preparation.

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Authors and Affiliations

  1. Calcium Metabolism and Osteoporosis Program, Division of Endocrinology and Metabolism, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon

    A. Bassatne, B. Jaafar & G. El-Hajj Fuleihan

  2. Ministry of Public Health, Beirut, Lebanon

    H. Harb, J. Romanos & W. Ammar

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  1. A. Bassatne
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Appendix

Appendix

figure a

Prevalence of non-communicable diseases among 356 elderly (≥ 60 years) in Lebanon overall and by gender (adapted from Sibai et al. [36]).

Obesity: BMI ≥ 30 kg/ m2, overweight: 25 ≥ BMI <30 kg/m2.

Hypertension: blood pressure ≥ 140/90 mmHg.

Dyslipidemia, diabetes, and cardiovascular diseases (CVD) were self-reported.

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Bassatne, A., Harb, H., Jaafar, B. et al. Disease burden of osteoporosis and other non-communicable diseases in Lebanon. Osteoporos Int 31, 1769–1777 (2020). https://doi.org/10.1007/s00198-020-05433-w

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