Majed Issa

Epidemiology of hip fractures in Lebanon: A nationwide survey

INTRODUCTION Hip fractures are a reliable indicator of osteoporosis. Despite their importance, few studies have assessed their epidemiology in Lebanon and the Middle East. HYPOTHESES Hip fracture incidence rates in Lebanon approximate those of Northern countries, and show the same characteristics, particularly the exponential increase with age, higher incidence in women, and a recent trend of rate leveling in women but not in men. MATERIALS AND METHODS A national database of hip fracture cases admitted to hospitals in Lebanon in 2007 was created. Crude and age-adjusted incidence rates were calculated at 5-year intervals for individuals over age 50. These rates were also standardized to the 2000 United States population, and compared to those of other countries. Projected incidence rates in Lebanon in 2020 and 2050 were also calculated. RESULTS A total of 1199 patients were included in the study. The crude annual incidence rate in individuals over 50 was 147 per 100,000 individuals, 132 per 100,000 males and 160 per 100,000 females, with a female-to-male ratio of 1.2. The age-standardized annual incidence rates (per 100,000) were 180 in males and 256 in females. Assuming unchanged healthcare parameters, the projected crude incidence rates for people over 50 are expected to reach 174 and 284 per 100,000 in 2020 and 2050 respectively. CONCLUSIONS Lebanese hip fracture rates are lower than Northern countries, but show many similar characteristics such as an exponential increase with age, a higher incidence in women, and clues of a leveling of rates in women but not in men. Numbers are expected to increase substantially in the coming decades. LEVEL OF EVIDENCE Level IV. Epidemiological study.

The Influence of Obesity and Overweight on Hip Bone Mineral Density in Lebanese Women

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Lumbar Spine Bone Mineral Density in Obese, Overweight, and Normal-Weight Lebanese Postmenopausal Women

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Is Obesity Protective Against Vertebral Deformities in Lebanese Women

Vertebral fractures are well known to be the hallmark of osteoporosis (1e5). Vertebral fractures are very common in aging women and can have serious clinical consequences (1e5). Multiple vertebral fractures are associated with morbidity and mortality (1e5). There is no consensus on the exact definition of a vertebral fracture (5). Vertebral morphometry is a quantitative method to identify vertebral fractures based on the measurement of vertebral heights (5). Obesity seems to be protective against hip fractures in elderly subjects (6,7). However, the relation between obesity and vertebral fractures is controversial and seems to be influenced by several factors such as gender and ethnicity (8e12). Recent epidemiologic studies conducted in Lebanon have shown that the incidence of obesity is increasing in an alarming way (13,14). The aim of this study was to explore the relationship between body mass index (BMI) and prevalence of vertebral deformities (anterior wedging) in 2113 Lebanese women aged from 20 to 90 yr. In total, 2113 Lebanese women (607 obese, 834 overweight, and 672 normal weight) whose ages range from 20 to 90 yr participated in this study. Weight and height were measured, and BMI was calculated. Vertebral deformities (anterior wedging) of T4eL4 were determined by morphometric dual-emission X-ray absorptiometry (GE Healthcare Lunar Prodigy, Madison, WI). We defined a vertebral deformity as a ratio of the anterior to posterior heights of !0.8, representing 20% reduction in the height of the anterior portion of a vertebral body relative to the posterior height of that body. The mean age of participants was 61.2 12.5 yr, and mean BMI was 27.6 5.0. In the whole population, the prevalence of having at least 1 vertebral deformity was 27.9%. The prevalence of having at least 1 vertebral deformity was higher ( p ! 0.001) in obese (30.3%) and overweight women (28.8%) compared with normal weight women (18.4%). After adjusting for age, the prevalence of having at least 1 vertebral deformity was not significantly different among the 3 groups (obese, overweight, and normal weight). Using multiple logistic regression analysis, the prevalence of