Guidelines for fracture risk assessment and management of osteoporosis in postmenopausal women and men above the age of 50 in Qatar.

We present comprehensive guidelines for osteoporosis management in Qatar. Formulated by the Qatar Osteoporosis Association, the guidelines recommend the age-dependent Qatar fracture risk assessment tool for screening, emphasizing risk-based treatment strategies and discouraging routine dual-energy X-ray scans. They offer a vital resource for physicians managing osteoporosis and fragility fractures nationwide. PURPOSE: Osteoporosis and related fragility fractures are a growing public health issue with an impact on individuals and the healthcare system. We aimed to present guidelines providing unified guidance to all healthcare professionals in Qatar regarding the management of osteoporosis. METHODS: The Qatar Osteoporosis Association formulated guidelines for the diagnosis and management of osteoporosis in postmenopausal women and men above the age of 50. A panel of six local rheumatologists who are experts in the field of osteoporosis met together and conducted an extensive review of published articles and local and international guidelines to formulate guidance for the screening and management of postmenopausal women and men older than 50 years in Qatar. RESULTS: The guidelines emphasize the use of the age-dependent hybrid model of the Qatar fracture risk assessment tool for screening osteoporosis and risk categorization. The guidelines include screening, risk stratification, investigations, treatment, and monitoring of patients with osteoporosis. The use of a dual-energy X-ray absorptiometry scan without any risk factors is discouraged. Treatment options are recommended based on risk stratification. CONCLUSION: Guidance is provided to all physicians across the country who are involved in the care of patients with osteoporosis and fragility fractures.

Peripheral Spondyloarthritis Presenting with Fever and Severe Systemic Inflammatory Response Mimicking Infection: A Case Series and Literature Review.

Objective: To describe four peripheral spondyloarthritis patients presenting with fever and severe systemic inflammatory response mimicking infection. Methods: Between 2017 and 2019, four patients with the final diagnosis of peripheral spondyloarthritis had atypical presentation of fever and severe systemic inflammatory response requiring hospital admission and extensive workup. Results: We reported four patients who were admitted to the hospital for fever and arthritis. They all had laboratory tests of the severe systemic inflammatory response (leukocytosis, thrombocytosis, high ESR, and high CRP) concerning infection. They underwent extensive workup for infectious causes, including septic arthritis, which came back negative. Other rheumatic diseases that are known to present with fever such as adult-onset Still's disease, reactive arthritis, and crystal arthritis were all excluded. The final diagnosis of spondyloarthritis was made during their follow-up: three patients with peripheral spondyloarthritis and one with psoriatic arthritis. All patients received conventional DMARDs (methotrexate and sulfasalazine) and two patients received tumor necrosis factor inhibitors in addition to conventional DMARDs to control their disease. Conclusion: We observed a subgroup of peripheral spondyloarthritis patients presenting with fever and severe systemic inflammatory response requiring hospitalization. Recognition of this subgroup is important and should be considered once an infection is ruled out.

Epidemiology of hip fracture in Qatar and development of a country specific FRAX model.

Hip fracture data were retrieved from electronical medical records for the years 2017-2019 in the State of Qatar and used to create a FRAX® model to facilitate fracture risk assessment. Hip fracture rates were comparable with estimates from Saudi Arabia, Abu Dhabi, and Kuwait but fracture probabilities varied due to differences in mortality. OBJECTIVE: This paper describes the epidemiology of osteoporotic fractures in the State of Qatar that was used to develop the country-specific fracture prediction FRAX® tool. METHODS: Hip fracture data were retrieved from electronic medical records for the years 2017-2019 in the State of Qatar. The age and sex specific incidence of hip fracture in Qatari residents and national mortality rates were used to create a FRAX® model. Fracture probabilities were compared with those from neighboring countries having FRAX models. RESULTS: Hip fracture rates were comparable with estimates from Saudi Arabia, Abu Dhabi and Kuwait. In contrast, probabilities of a major osteoporotic fracture or hip fracture were lower in Qatar than in Kuwait but higher than those in Abu Dhabi and Saudi Arabia due to differences in mortality. CONCLUSION: The FRAX model should enhance accuracy of determining fracture probability among the Qatari population and help guide decisions about treatment.

Incidence rate of osteoporotic hip fracture in Qatar.

The incidence rate of osteoporotic hip fracture is essential to formulate a national fracture risk assessment tool (FRAX). In this epidemiological study, the incidence rate of osteoporotic hip fracture in Qatar was comparable to that in regional countries, and lower than that in North America and European countries. PURPOSE: Estimate the annual incidence rate (IR) of osteoporotic hip fractures (OHF) in Qatar from January 2017 to December 2019. METHODS: Hamad Medical Corporation is a government-based tertiary medical institute. Hip fractures were captured by using the International Classification of Diseases-10 hip fracture codes. The patient records were reviewed retrospectively to identify fracture mechanisms. The observed census in 2017 and the estimated censuses of 2018 and 2019 were used to calculate the age-sex-specific annual IR of OHF in the population aged ≥ 40 years. The world population in 2010 was used to calculate the age-adjusted standardized IR in the population aged ≥ 50 years. RESULTS: In total, 458 hip fractures were identified; 75 (16.4%) were due to high-energy trauma, and 9 (2%) were pathological hip fractures. The total number of OHF was 374 (81.7%). OHF was slightly higher in men (215, 57.5%). The median age (IQR) of the patients was 69 years (56-78 years). In 2017, 2018, and 2019, the age-adjusted standardized IR of OHF per 100,000 with the corresponding 95% CI was 141.7 (141.1-142.2), 140.8 (140.2-141.3), and 162.7 (162.0-163.2) for the whole Qatar population; 154.2 (153.6-154.7), 105.2 (104.7-105.7), and 176.6 (175.9-177.1) for Qataris; and 134.8 (134.3-135.4), 183.9 (183.3-184.6), and 160.4 (159.8-161.0) for non-Qataris, respectively. CONCLUSION: The annual age-adjusted standardized IR of OHF per 100,000 inhabitants aged ≥ 50 years in Qatar was comparable to that in regional countries, and lower than that in North America and European countries.

Increased Fracture Risk After Bariatric Surgery: a Case-Controlled Study with a Long-Term Follow-Up.

PURPOSE: Bariatric surgeries are common procedures due to the high prevalence of obesity. This study aimed to investigate whether bariatric surgery increases fracture risk. MATERIAL AND METHODS: It was a case-controlled study. Patients who underwent bariatric surgery during 2011 and 2012 were matched for age (± 5 years) and gender to patients on medical weight management during the same period with a ratio of 1:2. The index date was defined as the date of bariatric surgery for both groups. The subject's electronic medical records were reviewed retrospectively to identify fractures documented by radiology during January 2020. RESULTS: Randomly selected 403 cases were matched to 806 controls with a median age of 36.0 years (IQR 14.0) and 37.0 years (IQR 14.0), respectively. Seventy per cent of the cohort were females. Eighty per cent received sleeve gastrectomy, and the remaining (17%) underwent gastric bypass. The mean duration of follow-up was 8.6 years. The fracture rate was higher in the surgical group as compared to the controls (9.4% vs 3.5%) with a crude odds ratio of 2.71 (95% CI 1.69-4.36). The median duration for time to fracture was 4.17 years for the surgical group and 6.09 years for controls (p-value = 0.097). The most common site of fractures was feet, followed by hands. Apart from a few wrist fractures, there was no typical osteoporotic sites fracture. CONCLUSION: Subjects who underwent bariatric procedures had more non-typical osteoporotic site fractures affecting mainly feet and hands, and fractures tend to occur earlier as compared to controls.

Posterior Reversible Encephalopathy Syndrome (PRES) in Rheumatic Autoimmune Disease.

Posterior reversible encephalopathy syndrome (PRES) is a clinical-radiological entity with many causes. The primary abnormality is cerebral vasogenic oedema. Here we describe the management of five patients with PRES syndrome who presented to our hospital. LEARNING POINTS: Posterior reversible encephalopathy syndrome (PRES) presents with cerebral vasogenic oedema.PRES resolves when blood pressure is controlled.Patients with a history of autoimmune disorder who present with confusion may have PRES.