Osteoporosis experts have issued a public warning that vitamin D insufficiency is 'endemic' in the UAE, due to lack of exposure to sunlight and changes in diet, which leads to an increased risk of the debilitating bone disease osteoporosis and associated bone fractures.
The warning was issued by doctors attending the "Optimising Osteoporosis Treatment" Speaker Tour in Dubai and Abu Dhabi, where more than 100 physicians gathered to listen to Professor Erik Fink Eriksen, Professor of Endocrinology and Internal Medicine, Oslo University, Norway, a world expert in osteoporosis, which affects around 30 percent of post-menopausal women and up to seven percent of older men [1].
"Vitamin D insufficiency is endemic across the UAE and the Gulf, almost everyone who walks into my clinic suffers from it. Out of 1,000 patients on my list only eight patients have normal levels of vitamin D, underscoring the fact that this is an important issue that needs to be urgently addressed," revealed Dr. Al Shehhi, Head of Rheumatology at Al Qassimi Hospital, Sharjah, chair of the Dubai meeting.
"Insufficiency in vitamin D is an important issue and one of the major causes of osteomalacia (soft bones) and osteoporosis (fragile bones) both here and across the world. Osteoporosis increases the risk of bone fracture that can severely affect people's mobility, which often means they require hospitalisation and nursing care after discharge, adding extra costs to the healthcare system," added Dr. Mustafa Al Izzi, Head of the Rheumatology Unit at Zayed Military Hospital, Abu Dhabi, chair of the Abu Dhabi meeting.
Vitamin D is essential for bone health as it assists in the absorption of calcium in the body, without which the bones become less dense and fracture easily. Many people do not know they have osteoporosis until they suffer a fracture and undergo a Dual-Energy X-ray Absorptiometry (DEXA) scan to check their bone density.
In the UAE, insufficiency in vitamin D within the local population has become more prevalent in the recent years due to lifestyle changes, which mean Emirati men and women spend less time in the sun and eat fewer foods rich in vitamin D, such as fish and eggs, and calcium which is most commonly consumed in milk.
"The Bedouin lifestyle was mainly outdoors, allowing for plenty of exposure to the sun which is necessary for the manufacture and absorption of vitamin D in the body. People also drank camel's milk every day, providing them with a rich source of calcium which is also needed for bone health," explained Dr. Abdul Rehim Al Suhaili, Head of the Nuclear Medicine Department, Dubai Hospital, who gave a presentation at the Dubai event.
"Now Emiratis spend very little time in the sun, preferring to be inside their homes or shopping malls where the windows prevent penetration of ultraviolet rays. Drinking milk on a daily basis is also much less common than it used to be, adding to the problem of vitamin D insufficiency and poor bone health," commented Dr. Al Suhaili who is also Chairman of the Emirates Osteoporosis Society (EOS).
Delegates attending the presentation heard that treating osteoporosis involves boosting absorption of calcium by the bones using bisphosphonate drugs, which are either taken weekly or monthly orally. However, a new medication, zoledronic acid (Aclasta), which is given via an infusion, only needs to be administered once a year, so helping to improve medication compliance.
Professor Eriksen explained: "The fact that Aclasta is given as a once yearly infusion is appreciated as very convenient by patients. I have personally given this drug to around 300 patients, and find this treatment effective and safe. The reduction in fractures, which is seen after treatment with Aclasta is the most pronounced seen with any bisphosphonate."
"Once yearly administration with Aclasta secures 100 percent compliance with treatment for one year, whereas with oral bisphosphonates only 50 percent of patients attain compliance for one year, obviously the 50 percent who stop treatment get no benefit at all," Professor Eriksen added.
Spending 20 to 30 minutes per day, exposing the lower legs, the lower arms from the elbows and the face to the sun as well as eating sufficient foods containing vitamin D, are both recommended actions for helping to maintain vitamin D levels within the normal range that prevents osteoporosis.
The "Optimising Osteoporosis Treatment" Speaker Tour, sponsored by Novartis, visited Dubai on May 12, Abu Dhabi on May 13 and Muscat on May 15, 2010.