Haifa A. Al-Turki

Vitamin D levels in healthy men in eastern Saudi Arabia.

Background: Studies in 1980s and 1990s indicated that vitamin D levels in the ethnic Saudi Arabian population were low but no studies since that time have 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. Subjects and Methods : 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 25OHD levels. Vitamin D deficiency was defined as a serum level of 25OHD of ≤20 ng/mL and insufficiency as a serum level between >20 ng/mL and < 30 ng/mL and normal ≥30 ng/mL. Results: 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 25OHD; 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. Conclusions: 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.

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

BACKGROUND AND OBJECTIVES 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. METHODS 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. RESULTS 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%. CONCLUSION 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.

Osteoporosis prophylaxis in patients receiving chronic glucocorticoid therapy.

BACKGROUND AND OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Contraception: attitudes and experiences of Saudi Arabian women.

We carried out a survey to find the contraception practices and experiences of Saudi Arabian females. A preset questionnaire was developed, and married Saudi females were asked to answer the questionnaire. Between July and December 2008, 215 women completed the questionnaire. The average age was 37.6 ± 9.1 years. One hundred and sixty one of the women said they were using contraception. Fifty-nine (36.6%) said they were using oral contraception pills (OCP) and 32 (19.9%) said they were using intra-uterine contraceptive devices (IUCDs). One hundred and twenty-seven (78.8%) of the women were satisfied with the contraception they were using. We found that a majority of Saudi women are using contraception methods but without medical advice.

Effect of smoking on reproductive hormones and semen parameters of infertile Saudi Arabians

Objective: The purpose of this retrospective study is to look into the effect of smoking on semen and hormonal profile of Saudi Arabians attending infertility clinics. Materials and Methods: Medical record numbers of patients who attended infertility clinics and who underwent full assessment were identified rom Quadramed system and out-patient log books between January 2010 and December 2012. The standard protocol of the patients include full history, age, number of years of marriage personal habits of smoking, alcohol consumption, primary or secondary infertility. Standard laboratory tests which were performed, included, complete blood picture, random blood sugar, testosterone, follicle stimulation hormone, luteinizing hormone, prolactin level and semen analysis; volume, count, progressive motility and morphology. The data was entered in the database and analyzed. Results: During the study period, 279 patients attended and infertility clinic and only 258 gave the sample for analysis. The average age of patients in the smoking group was 34.23 ± 7.66 and in the nonsmokers 34.07 ± 7.92 years. Primary infertility was more common in smokers versus nonsmokers P < 0.001 confidence interval (CI)< −44.0705, total serum testosterone level was lower 383.8 ± 239.5 versus 422.5 ± 139.2 ng/dL (0.009 CI< −9.9415), serum prolactin level was higher 18.68 ± 13.28 versus 12.85 ± 12.34 ng/mL (0.001 CI < 8.3794). The average volume of the semen among the smokers was 2.8 ± 1.35 mL and in nonsmokers it was 3.08 ± 0.76 mL (P < 0.008 CI< −0.123). The mean progressive motility in smokers was 31.5 ± 23.1 compared to nonsmokers 40.05 ± 25.43% (0.002 CI< −3.2962) and total sperm count was 119.52 ± 114.12 and 139.71 ± 104.82 million/mL (0.07 CI < 1.4657). Conclusions: This study shows that the effect of smoking is dramatic reduction in the hormonal levels and semen parameters. It is recommended that smoking men undergoing fertility treatment should stop smoking to increase their chances of having offspring.

Genetic influence of candidate osteoporosis genes in saudi arabian population: a pilot study.

Background and Objectives. The purpose of the present study is to find the genes and SNP that influence BMD and postmenopausal Saudi women. Material and Methods. Two-hundred ethnic Saudi Arabian women with a diagnosis of postmenopausal osteoporosis were the subjects of this study. Baseline blood hematology, biochemistry, and bone panel were done. Blood was collected, and three TaqMan-MGB probes were used to analyze SNP variants in ALOX15 (rs7220870), LRP5 (C 25752205 10), and TNFRSF11B (C 11869235 10). Results. The variant of ALOX15 17p13 showed that the BMD of the spine was lower in the AA allele (P value <0.002) and fractures were highest at 50% compared to CC allele. In the TNFRSF11B gene, BMD of the hip and spine was significantly higher in the GG allele and the history of fractures was significantly higher in GG group. With regard to the LRP5 (C 25752205 10) gene, there was no significant difference between allele groups. Conclusion(s). This study shows that the genetic influence of osteoporosis in the Caucasian and Saudi Arabians population is similar. We believe that the same genetic markers that influence osteoporosis in the Caucasian race could be used for further studies in the Saudi Arabian population.

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 ≥ 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.

Genetic influence on circulating vitamin D among Saudi Arabians

Objectives To examine the effect of most common studied single nucleotide polymorphisms (SNP) on serum 25-hydroxyvitamin D (25OHD) levels in Saudi Arabian population. Method A cross-sectional observational study was carried out between July 2014 and October 2015, at King Fahd Hospital of the University (KFHU), Al-Khobar, Kingdom of Saudi Arabia. After informed consent, blood samples from 283 subjects living in the Eastern province were collected for 25-OHD measurement and genetic analysis of SNPs in vitamin D receptor (VDR) [rs2228570 and rs1544410], Cytochrome, P450 family 2 (CYP2R1) [rs10741657 and rs1993116], and Group-specific components (GC) [rs2282679 and rs4588]. Results Vitamin D deficiency was found in 87.6% and insufficiency in 7.7%. The percentages of the different alleles of the 6 SNPs tested ranged between 0-62.5%. There was significant difference between the AA, AG, and GG alleles of VDR rs2228570. The carries of GG allele was associated with increased risks of vitamin D insufficiency (p<0.002) and deficiency (p≤0.005). The CYP2R1 rs10741657 gene showed that AG and GG allele carriers had significant risk of vitamin D deficiency. AG allele (normal versus Insufficiency p<0.02 and normal versus deficiency p<0.08) and GG allele normal versus deficiency (p<0.002) and insufficiency versus deficiency (p<0.001). For group-specific components (GC rs4588), there was only significant difference between the normal and deficiency for the AC allele (p<0.0001). Conclusion The presence of GG allele of the SNP rs2228570 of VDR gene, SNPs rs4588 of GC gene and CYP2R1 rs10741657 gene was associated with vitamin D deficiency.

A review of 33 years (1980–2013) of data indicating a rise in ectopic pregnancy in Saudi Arabia

To assess the trend in ectopic pregnancy (EP) at a single center in Saudi Arabia and to compare the data with those from the rest of Saudi Arabia.

Dehydroepiandrosterone supplementation in women undergoing assisted reproductive technology with poor ovarian response. A prospective case-control study:

Objective The effects of dehydroepiandrosterone (DHEA) supplementation in Saudi Arabian women with poor ovarian response (POR) is presently unknown. The present study aimed to assess the benefits of DHEA supplementation in women undergoing in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). Methods This was a prospective case-control study involving 62 women who were diagnosed with POR and underwent IVF/ICSI between January 2012 and June 2016. The positive influence of DHEA in 34 women, compared with 28 women without supplementation, was defined as improvements in the number of oocytes retrieved, the fertilization rate, the number of grade I embryos generated and the pregnancy rate. Results Both groups were evenly matched for age, body mass index and laboratory test parameters. There were statistically significant differences between the groups with and without DHEA supplementation for oocyte yield (6.35 ± 2.41 versus 3.98 ± 3.2), Grade I embryos generated (55% versus 30%), positive pregnancy rate (21/34 versus 10/28), and live birth rate (18/34 versus 4/28). Conclusion DHEA supplementation in women with POR had a positive effect on hormonal profiles, the quality of the endometrium, the number of oocytes retrieved, the quality of embryos, and the pregnancy and live birth rates.