Maintenance Dose of Vitamin D: How Much Is Enough?

BACKGROUND: It is still unclear the ideal vitamin D dosage once the deficiency and insufficiency is treated. Once deficiency was corrected we prospectively treated patients with 2,000 IU of vitamin D3 to check whether this dosage is enough to keep them above the 30 ng/mL of 25-hydroxy-vitamin D (25[OH]D). METHODS: One hundred and thirty-five Saudi Arabian men and women treatment naïve for the vitamin D deficiency and insufficiency were part of this study. History and clinical examination were done to rule out any metabolic bone disease. Weight and height was taken to calculate the body mass index (BMI). Patients who were vitamin D deficient (≥30 ng/mL), a standard treatment of 50,000 IU of vitamin D3 weekly for 3 months, a blood test for the vitamin D levels at the end of 3 months, maintenance dose of 2,000 IU of vitamin D3 for 3 months and a third blood sample after 3 months. RESULTS: The data for 128 patients was available for analysis. The average age was 44.95±12.97 years with the mean BMI of 29.60±2.59 kg/m2. The baseline 25(OH)D level was 13.16±3.30 ng/mL. The increase in the level of 25(OH)D on 50,000 IU weekly was significant from 13.16±3.3 ng/mL to 36.97±4.67 ng/mL (P < 0.001) and then 2,000 IU daily for next 3 months, the level of 25(OH)D dropped top 20.38±5.42 ng/mL (P < 0.001). CONCLUSIONS: Our study indicates that the maintenance dose of 2,000 IU of vitamin D is not enough for patients to keep the 25(OH)D levels above 30 ng/mL.

Stem Cell Therapy for Avascular Necrosis of Femoral Head in Sickle Cell Disease: Report of 11 Cases and Review of Literature

BACKGROUND AND OBJECTIVE: Sickle cell disease (SCD) is quite common in eastern Saudi Arabia and Avascular necrosis of femoral head (ANFH) occurs in 30% of the young patients leading to early joint arthroplasty. This study was conducted to assess the benefits of injection of osteoblasts in the avascular lesions of the head of femur. PATIENTS AND METHODS: A preset technique was used, 10 CC of bone marrow aspiration was performed under local anesthesia and aseptic technique. Osteoblasts were separated from the bone marrow cells. The avascular area was drilled and 10 million osteoblasts were transplanted at the lesion site. Patients were seen in the out patient clinic after two weeks for removal of the suture and addressed the questionnaire and examined for the range of movement. The follow up MRI was performed at 4 months. RESULTS: The average age was 20.2±3.9 years. The mean hemoglobin S was 81.6±4.8 percent. Quality of Life Score for Chronic Hip Disease was assessed and found at 8.6 (1 being the severe limitation and 10 being normal), whereas Harris hip score improved from 41.7±5.1 to 88.93±3.6 (p < 0.001). MRI of pre and post osteoblast implantation showed robust new bone formation and disappearance of the avascular lesions. CONCLUSIONS: The short term results were good and we believe the injection of osteoblast in the avascular lesion of head of femur is a less invasive procedure devoid of any untoward complications and merits such treatment in large patient group with longer follow up.

Genetic Markers for Adolescent Idiopathic Scoliosis on Chromosome 19p13.3 among Saudi Arabian Girls

STUDY DESIGN: Prospective case-controlled study. PURPOSE: This study aimed to assess genetic influence in Saudi Arabian children with adolescent idiopathic scoliosis (AIS). OVERVIEW OF LITERATURE: The genetic locus linked to chromosome 19p for idiopathic scoliosis has been described. A pilot study conducted at King Fahd Hospital of the University, Al-Khobar showed that three microsatellite markers (D19S216, D19S894, and DS1034) of chromosome 19p13.3 were significant in Saudi Arabian females compared with healthy subjects. METHODS: A total of 100 unrelated Saudi Arabian girls treated for AIS, their parents, healthy siblings, and healthy subjects were recruited for genetic analysis of markers on chromosome 19p13.3. After informed consent was obtained from their parents, blood samples were collected and parametric and nonparametric linkage analyses were performed using GENEHUNTER ver. 2.1. Multipoint linkage analysis was used to specify an autosomal dominant trait with a gene frequency of 0.01 and an estimated penetrance of 80% at the genotypic and allelic levels. RESULTS: Five hundred blood samples were collected and analyzed for microsatellite markers (D19S216, D19S894, and DS1034) of chromosome 19p13.3. Comparison among patients, family members, and healthy subjects revealed no significant association between markers and scoliosis at the genotypic level: D19S216 (p=0.21), D19S894 (p=0.37), and DS1034 (p=0.25). However, at the allelic level, a statistically significant association was observed for marker DS1034 (p=0.008), and marker D19S216 showed significance between fathers and patients (p<0.001) compared with patients and mothers. The other two markers, D19S216 (p=0.25) and D19S894 (p=0.17), showed no significant association between patients and mothers. CONCLUSIONS: At the allelic level, marker DS1034 was significantly associated with AIS patients and their fathers. This allelic marker on chromosome 19p13.3 appears to be important in AIS etiology.

Epidemiology of fractures and dislocations among urban communities of eastern Saudi Arabia

Background and Objective: Fractures and dislocations are a signifi cant public health and economic burden for any country, but current knowledge on the basic epidemiology of fractures in Saudi Arabia is very limited. This retrospective analysis was performed to determine the patterns of incidence of traumatic fractures and dislocations in the urban population of the Eastern Province of Saudi Arabia

Materials and Methods: Data were collected on all fractures and dislocations admitted to the orthopaedic wards between January 1, 2004 and December 31, 2009. The inclusion criteria were all patients admitted after trauma. The data collected included was the type of accident, fracture and dislocations sustained, surgery undertaken either emergency or elective, implants used, associated injuries, complications, status of the union of the fracture at the time of the final review and complications

Results: There were 1428 patients with 2056 fractures and dislocations. Five-hundred and eighty-four [40.89%] of the injuries were sustained in road traffic and motorcycle accidents. Lower extremity fractures were 830, upper extremity fractures were 555 and spinal fractures were 323. Of these, 202 [14.4%] patients had dislocations, a majority of which were hip joint dislocations. The overall complication rate was 166 [11.69%] and infections formed the majority. Delayed union occurred in 32, nonunion in 24 and malunion requiring surgery occurred in 17. Twenty-seven [1.31%] of fractures were missed

Conclusions: This analysis shows that road traffi c accidents are still a major cause of trauma in an urban population and lower extremities form the common site of fractures. Fractures and dislocations due to trauma are steadily increasing and the young are the most affected. We believe that injury prevention programs should be made mandatory to limit muskuloskeletal injuries resulting from trauma. In the coming years, the number of these injuries will rise considerably with the increase in population

The Concept of Evolution of Thoracolumbar Fracture Classifications Helps in Surgical Decisions

Since Boehler's sentinel description, a universally acceptable thoracolumber fracture classification has eluded spine surgeons. The concept of the stability of a thoracolumbar injury changed continuously from the two column concept of Holdsworth to the three column theory of Denis. With the advent of sophisticated imaging techniques, improved biomechanical understanding, and in order to meet the high expectations of patients, several classification systems have been forwarded by the stalwarts in the field. Each successive system has contributed significantly to the understanding and prediction of treatment outcome. Load sharing classification by McCormack attempted to rationalize the use of short segment posterior instrumentation. Magerl et al. developed a comprehensive classification system based on progressive morphological damage determined by three fundamental forces: compression, distraction, and axial torque. Vaccaro et al. devised the thoracolumbar injury severity score based on three independent variables: the morphology of the injury, posterior ligamentous complex (PLC) integrity, and neurological status at the time of injury. But, there are limitations to the classification system, especially when magnetic resonance imaging yields a PLC status as indeterminant. In the absence of a universally acceptable classification system, it is important to understand the underlying concepts of the fractures. The author concisely reviews the subject from its inception in the year 1929 to the present day.

Assessment of low vitamin D among Saudi Arabians. Did we overshoot the runway?

To compare the performance of 3 commonly used 25-hydroxyvitamin D [25-OHD] assays among a sample of the Saudi population. This cross-sectional study was carried out between January 2011 and December 2012 at King Fahd Hospital of the University, Al-Khobar, Saudi Arabia. After informed consent, blood samples for measurement of 25-OHD level was extracted from 200 adults. The vitamin D level of each individual were determined using chemiluminescence immunoassay [CLIA], radio-immuno assay [RIA], and liquid chromatography-tandem mass spectrometry [LC-MS/MS] assay. Assays were also compared through commonly used cut-points for classification of vitamin D deficiency. Bias between assays was evaluated using Bland-Altman plots. The average age of patients was 45.7 +/- 16.1 years. A significant difference between the assays was found. The mean 25-OHD levels were highest for the LC-MS/MS [21.65 ng/mL, 95% CI 19.74-23.56], intermediate for RIA [16.607 ng/mL, 95% CI 14.87-18.32], and lowest for CLIA method [13.864 ng/mL, 95% CI 12.109-15.618]. Using 30 ng/mL as a cutoff value, only 6% was found to have normal levels of 25-OHD using CLIA, 9% using RIA, and 22% using LC-MS/MS. Levels of 25-OHD and the prevalence of vitamin D deficiency are dependent on the assay used. The reported high prevalence of hypovitaminosis D among the Saudi population can be partially explained by the use of assays that underestimate vitamin D levels

Fortification with vitamin D: comparative study in the Saudi Arabian and US markets

Vitamin D deficiency is common among Saudi Arabian population. To evaluate the current status of vitamin D fortification and calcium content of commonly consumed food items by the Saudi population and to compare it to US data. Cross-sectional market survey at markets of Eastern Province of Saudi Arabia and State of Illinois, USA. A dietary survey was carried out for the content of calcium and vitamin D on the most commonly consumed food products by the Saudi population which are suppose to be fortified by vitamin D. The survey included different brands of fresh milk, yoghurt, powdered milk, cheese, ready-to-eat breakfast cereals and orange juice. Vitamin D content in the products studied from the Saudi marketplace was compared with the suggested vitamin D content in the same products according to US Code of Federal Regulations recommendations. The overall calcium content in the processed dairy products is generally higher than the content in fresh dairy products. Vitamin D content in the fresh dairy products varied from 40 IU/L to 400 IU/L. None of the cereals or orange juice in Saudi Arabia contain vitamin D supplement. The vitamin D content in the food items from the Saudi marketplace is mostly lower than recommended by the US Code of Federal Regulations. Most commonly consumed food products by Saudi population which are suppose to be fortified by vitamin D either not fortified or contain an amount less than recommended by guidelines set for US marketplace

An epidemiological analysis of the incidence of osteoporosis and osteoporosis-related fractures among the Saudi Arabian population

Osteoporosis is common in Saudi Arabia and the burden of management in an aging population will increase in coming decades. There is still no national policy nor consensus on screening for this silent disease. The objective of this analysis was to determine from the published data the prevalence of osteopenia and osteoporosis in Saudi Arabians, the prevalence of secondary osteoporosis, and the prevalence of osteoporosis-related fractures [ORF]. We also sought to determine the best age to begin and best modality for screening. Data Sources were MEDLINE [1966 to May 2011], EMBASE [1991 to May 2011], the Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews [1952 to May 2011], and the Science Citation Index [1966 to May 2011], published data from the Saudi Medical Journal [1985-2011] and Annals of Saudi Medicine [1985-2011]. We selected English-language articles with at least 100 Saudi individuals. Two authors independently reviewed articles and abstracted data. The authors identified 36 potentially relevant articles, of which 24 met the inclusion criteria. Of 5160 healthy women 50 to 79 years of age [mean, SD: 56.8 [2.7]], 36.6% [6.6%] were osteopenic and 34.0% [8.5%] were osteoporotic. In three studies on males [n=822], the prevalence of osteopenia was 46.3% and osteoporosis 30.7%. Males had a significantly higher frequency of osteopenia in comparison to females [P= < .001 95% CI < -0.0333], The mean age of the patients with secondary osteoporosis was 37.4 [13.5, 18-57] years, with the osteoporosis in 46.4% and osteopenia in 34.1%. In 5 studies of ORF, the incidence of vertebral fractures was between 20%-24%.The currently available literature on Saudi Arabian population suggests that the ideal age for screening for low bone mass among the Saudi population should be earlier [55 years] than the >=65 years in Western countries. Both quatitative ultrasound and dual-energy x-ray absorptiometry could be used for screening. The relatively small number of studies on Saudi Arabians and the different machines used for diagnosis limited the authors ability make conclusions with surety.

Epidemiology of pediatric fractures and dislocations: analysis of in-patients

Fractures and dislocations in a growing child is a concern to parents and hospitals alike because any mismanagement leaves a lifelong disability. There is limited data on epidemiology of fractures in children in Saudi Arabia. To determine the prevalence and pattern of pediatric fractures and dislocation. King Fahd Hospital of the University. Retrospective. All pediatric patients with a skeletal injury admitted to the hospital between 1 January 2004 and 31 December 2009 were included. Data documented included age, sex, type of accident, injury sustained, associated injuries, surgery performed, emergency or elective, type of implant used and any complications. Two hundred fifty-four patients sustained 302 fractures and dislocations. One hundred fifty-nine were boys and 95 were girls. One hundred twenty-four [48.8%] of the injuries were sustained at home and 75 [29.52%] were related to motorized vehicles. Lower extremities were involved in 139 patients, upper extremities in 125 and spinal fractures were seen in 9 patients. Seven patients had dislocations [4 elbows, one hip and 2 ankle joints]. One hundred ninety-four [76.4%] had emergency surgery and the rest of the children had elective procedure. Thirty-nine patients [15.35%] had complications; the majority was repeat procedure and 3 patients had superficial infections. Home accidents and trauma are common in this study; lower extremity fractures were seen in more than 50% of the patients. Admissions due to fractures have increased in the last few years. We believe that community education in injury prevention programs will definitely reduce the skeletal injuries in young population

Influence of vitamin D levels on bone mineral density and osteoporosis

The effects of vitamin D on bone mass remain to be understood. This study was conducted with the objective of evaluating the influence of 25-hydroxyvitamin D [25OHD] levels on bone mineral density [BMD] among Saudi nationals. Cross-sectional study carried out at university hospital from 1 February 2008 to 31 May 2008. Healthy Saudi men and women in the peak bone mass [PBM] age group and those aged >50 years were recruited from the outpatient department of King Fahd University Hospital, Al Khobar, Saudi Arabia, between February 1, 2008, and May 31, 2008. Patient age and sex were documented, and body mass index was calculated. Hematological, biochemical, and serum 25OHD tests were performed. BMD was determined by dual-energy x-ray absorptiometry of the upper femur and lumbar spine. Patients were divided into three groups, based on their 25OHD level. Data from 400 patients were analyzed. Among individuals with a normal 25OHD level, 50% of women and 7% of men in the PBM age group and 26.4% of women and 49.2% of men aged >50 years had low bone mass. In patients with 25OHD insufficiency, 84.2% of women and 88.9% of men in the PBM age group and 83.3% of women and 80% of men aged >50 years had low bone mass. Results for patients with 25OHD deficiency revealed that none of the men and women in the PBM age group or >50 years old had normal BMD. Significant positive correlations between 25OHD level and BMD and significant negative correlations with parathyroid hormone were shown in most of the groups. This study showed that the vitamin D level significantly influences BMD reading among Saudi individuals. Evaluation and treatment of hypovitaminosis D should be considered during management of low bone mass

Are We Missing Osteoporosis-Related Vertebral Fractures in Men?

STUDY DESIGN: Retrospective study. PURPOSE: To assess the prevalence of osteoporosis related spinal fractures among Saudi Arabian males. OVERVIEW OF LITERATURE: Vertebral fractures are the most common complication of osteoporosis and is the first sign in both sexes and only 25 to 30% of radiographically observed vertebral deformities are recognized. METHODS: We analyzed the chest radiographs of consecutive Saudi Arabian men > or = 50 years and who visited the emergency room of King Fahd University Hospital, Al Khobar, Saudi Arabia for a period of 12 months between November 1, 2007 and October 31, 2008. The site and type of fractures were classified as per the semi-quantitative technique. The other data retrieved from the medical records of patients included medications and clinical investigations for osteoporosis. RESULTS: Nine hundred seventy chest radiographs were performed during the study period and 876 radiographs could be analyzed. One hundred fifteen patients (13.1%) had 157 fractures. The mean age was 67.85 +/- 10.1 years. There was more than one fracture in 21 patients (18.2%). The majority of fractures (n = 102, 64.9%) were observed in thoracic spine. Seventy-one (45.2%) fractures were classified as mild, 54 (34.4%) were moderate and 32 (20.4%) were severe. For 26 (22.6%) patients, the report of the radiologist highlighted the fracture. CONCLUSIONS: Saudi Arabian males with osteoporosis continue to be missed despite the high prevalence osteoporosis leading to vertebral fractures. We believe it is important for physicians to identify vertebral fractures early and treat then appropriately before an extremity fracture occurs with high mortality.

Medication administration errors in eastern Saudi Arabia

To assess the prevalence and characteristics of medication errors [ME] in patients admitted to King Fahd University Hospital, Alkhobar, Kingdom of Saudi Arabia. Medication errors are documented by the nurses and physicians standard reporting forms [Hospital Based Incident Report]. The study was carried out in King Fahd University Hospital, Alkhobar, Kingdom of Saudi Arabia and all the incident reports were collected during the period from January 2008 to December 2009. The incident reports were analyzed for age, gender, nationality, nursing unit, and time where ME was reported. The data were analyzed and the statistical significance differences between groups were determined by Students' t-test, and p-values of <0.05 using confidence interval of 95% were considered significant. There were 38 ME reported for the study period. The youngest patient was 5 fays and the oldest 70 years. There were 31 Saudis, and 7 non-Saudi patients involved. The most common error was missed medication, which was seen in 15 [39.5%] patients. Over 15 [39.5%] of errors occurred in 2 units [pediatric medicine, and obstetrics and gynecology]. Nineteen [50%] of the errors occurred during the 3-11 pm shift. Our study shows that the prevalence of ME in our institution is low, in comparison with the world literature. This could be due to under reporting of the errors, and we believe that ME reporting should be made less punitive so that ME can be studied and preventive measures implemented

Arthroscopic joint lavage in osteoarthritis of the knee. Is it effective?

To assess the benefits of arthroscopic washout in osteoarthritis of the knee [OAK]. One hundred and fifty patients who underwent arthroscopic washout for early OAK between January 2001 and December 2006, at the King Fahd University Hospital, Al-Khobar, Kingdom of Saudi Arabia were analyzed. Preoperative assessment of patients included clinical assessment by modified Lequesne grading [MLG], antero-posterior and lateral radiographs of weight bearing of knee joints and the skyline view of the patella, and was graded by Kellegren and Lawrence grading [KLG]. Arthroscopically, the knee joint was graded by Outerbridge classification [OC]. The data were entered in the database and analyzed using the Statistical Package for Social Sciences version 14. One-hundred and seven patients were analyzed. Fifty-five patients were males and 52 were females, with a mean age of 51 +/- 9.3 years. The mean follow up was 39.45 months. Preoperative MLG was 14.2 +/- 4.1, at 6 months it was 7.39, and at 12 months was 7.75 +/- 0.37, which improved from 6 months onwards [p=0.001]. Kellgren and Lawrence grading and OC were significantly lower in younger patients age [>/= 51 years] [p=0.05]. Seventy-one percent of our patients had excellent and satisfactory results, and 12 [11.2%] had no improvement. Arthroscopic joint debridement has benefits in the extent of pain relief and improvement of joint mobility. We believe that this procedure should be carried out in patients with OA for pain relief and delay of definite arthroplasty

Vitamin D levels in healthy men in eastern Saudi Arabia

Studies in 1980s and 1990s indicated that vitamin D levels in the ethnic Saudi Arabian population were low but no studies since that time evaluated vitamin D levels among healthy young or middle-aged Saudi men. Thus, we assessed the serum level of 25-hydroxyvitamin D [25OHD] among healthy Saudi Arabian men living in the Eastern Province. One hundred males aged 25-35 years [the age range of peak bone mass] and 100 males aged 50 years or older were randomly selected and evaluated clinically, including measurement of serum calcium, parathyroid hormone [PTH] and serum 25 OHD levels. Vitamin D deficiency was defined as a serum level of 25 OHD of 20 ng/mL and <30 ng/mL and normal >/= 30 ng/mL. The mean [SD] age of subjects in the younger age group was 28.2 [4.5] years. Twenty-eight [28%] had low 25OHD levels; 10 [10%] subjects were vitamin D deficient with a mean level of 16.6 [3.4] ng/mL and 18[18%] were vitamin D insufficient with a mean level of 25.4 [2.7] ng/mL. In the older age group, the mean age was 59.4 [15.6] years and 37 [37%] had low 25 OHD; 12[12%] subjects were deficient with a mean 25OHD level of 16.7 [3.4] ng/mL and 25[25%] were insufficient with a mean 25OHD level of 25.3 [3.3] ng/mL. The prevalence of vitamin D deficiency among healthy Saudi men is between 28% to 37%. Vitamin D deficiency among young and middle age Saudi Arabian males could lead to serious health consequences if the issue is not urgently addressed

Osteoporosis prophylaxis in patients receiving chronic glucocorticoid therapy

Glucocorticoid-induced osteoporosis [GIOP] is the most common form of secondary osteoporosis, yet few patients receive proper measures to prevent its development. We retrospectively searched prescription records to determine if patients receiving oral prednisolone were receiving prophylaxis or treatment for osteopenia and osteoporosis. Patients who were prescribed > 7.5 milligrams of prednisolone for 6 months or longer during a 6 month period were identified through the prescription monitoring system. Demographic and clinical data were extracted from the patient records, and dual energy x-ray absorptiometry [DEXA] scans were retrieved, when available. Use of oral calcium, vitamin D and anti-resorptives was recorded. One hundred males and 65 females were receiving oral prednisolone for a mean [SD] duration of 40.4 [29.9] months in males and 41.2 [36.4] months in females. Twenty-one females [12.7%] and 5 [3%] males had bone mineral density measured by DEXA. Of those, 10 [47.6%] females and 3 [50%] males were osteoporotic and 11[52.4%] females and 2 [40%] males were osteopenic. Calcium and vitamin D were prescribed to the majority of patients [60% to 80%], but none were prescribed antiresorptive/anabolic therapy. Patients in this study were neither investigated properly nor treated according to the minimum recommendations for the management of GIOP. Physician awareness about the prevention and treatment of GIOP should be a priority for the local health care system

there a relationship between body mass index and serum vitamin D levels?

To evaluate the relationship between vitamin D level and body mass index [BMI] among Saudi Arabian citizens. Four hundred healthy individuals aged >/= 25 years [200 males and 200 females] were included in this cross-sectional study. Subjects were recruited in the period between 1st February 2008 and 31st May 2008 from the medical staff and employees of King Fahd Hospital of the University, Al-Khobar, Kingdom of Saudi Arabia, and from patients attending the endocrinology, orthopedic, and infertility clinics at the same hospital. Clinical evaluation was carried out, and BMI was calculated. Serum 25 hydroxy vitamin D [25OHD], in addition to serum parathyroid hormone levels and calcium chemistry were measured for all subjects. The mean age was 46.5 +/- 14.6 years for males, and 42.6 +/- 15.9 years for females [p=0.01]. Mean BMI was similar in both genders, and the difference in the level of serum 25OHD just reached statistical significance [p=0.04]. Male subjects with vitamin D deficiency were found to be older [p=0.03], and with higher BMI [p=0.01] compared to males with normal 25OHD. Although female subjects with hypovitaminosis D were also older than subjects with normal vitamin D level [p=0.01], BMI was significantly lower in females with vitamin D deficiency [p=0.001]. Obese males are at higher risk of having low 25OHD levels, while obesity in females appears to be protective against vitamin D deficiency in the population studied. We believe that obese male and thin female patients should be appropriately investigated, and treated for vitamin D deficiency

Bone mass measurement using quantitative ultrasound in healthy Saudi women. A cross-sectional screening

To study the prevalence of osteopenia and osteoporosis in healthy Saudi women, a community-based screening was carried out. Three thousand and two hundred sixty-nine women in the young women in peak bone mass [PBM] age group and 3131 in the postmenopausal age [PMA] group were screened using Achilles Insight [GE, USA]. Subjects included in the study were healthy and residents of eastern province. The screening was conducted between January 2006 and December 2007. The study took place in King Fahd University Hospital, Al-Khobar, Kingdom of Saudi Arabia. In the PBM age group, 2090 [63.9%] were normal, 791 [24.2%] were osteopenic and 388 [11.9%] were osteoporotic. Osteopenia was more common in single urban women compared to those who were married and living in rural areas [p<0.01 and p<0.001]. Women with college education had significantly normal bone mass than women with less than high school education [p<0.01]. In the PMA, 948 [30.3%] were osteopenic and 720 [23%] were osteoporotic. Osteopenic was more common in women in urban areas as compared to industrial and the rural areas [p<0.01]. Those women whose education was less than primary had significantly more osteoporosis when compared to women with college education [p<0.001]. In the PBM, 11.9% were osteoporotic and in PMA group 23% were osteoporotic. Factors that influenced the risk for osteopenia and osteoporosis included level of education, number of children, and place of living

Genetic Markers for Idiopathic Scoliosis in Arab Population: A Pilot Study

STUDY DESIGN: Cross-sectional screening. PURPOSE: This study was conducted to determine if there is any association of the three microsatellite markers on chromosome 19p 13.3 in unrelated Saudi Arabian girls who were suffering with adolescent idiopathic scoliosis (AIS) and their healthy siblings. OVERVIEW OF LITERATURE: The genetic influence on the development of familial scoliosis has been previously described, but the genetic influence on AIS still remains unknown. Three microsatellite markers (D19S216, D19S894, and DS1034) of chromosome 19p 13.3 were reported to be significantly associated with familial scoliosis. This cross-sectional screening was carried out in AIS patients and their siblings. METHODS: For eleven Saudi Arabian girls who were treated for AIS and their 11 siblings, we performed a linkage analysis using parametric and nonparametric methods and using GENEHUNTER ver. 2.1. Multipoint linkage analysis was used to specify an autosomal dominant trait with a gene frequency of 0.01 at the genotypic and the allelic levels. One sided Fisher's exact tests were used in the analysis of the contingency tables for the D19S216, D19S894 and DS1034 markers. RESULTS: The analysis between the patient group and the healthy siblings showed that at the genotypic level there was a significant association of the markers and scoliosis (D19S894 [p=0.036], D19S216 [p=0.004], and DS1034 [p=0.013]). Yet at the allelic level, there was no statistically significant association of the markers between the AIS patients and their siblings. CONCLUSIONS: Our pilot study shows that there is a genetic influence between the AIS patients and the siblings. We believe large scale genetic screening is warranted for the patients with AIS to identify beyond any doubt the influence of these markers.