1-15 post menopausal osteoporosis in egypt current status- dr. rashed

8/14/2019 1-15 Post Menopausal Osteoporosis in Egypt Current Status- Dr. Rashed

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Post Menopausalost MenopausalOsteoporosis insteoporosis inEgyptgypt

Current StatusCurrent Status


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OsteoporosisOsteoporosis


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1 out of 8 Europeans over the age of 50 will fracture their1 out of 8 Europeans over the age of 50 will fracture theirspinesspines

3.5 billion euro/year in hospital healthcare alone3.5 billion euro/year in hospital healthcare alone Excludes outpatient and rehabilitation costsExcludes outpatient and rehabilitation costs

500,000 hospital bed nights/year500,000 hospital bed nights/year Expected to double in the next 50 years with the ageingExpected to double in the next 50 years with the ageing

populationpopulation

In 1999, the healthcare cost for treating fractures associatedIn 1999, the healthcare cost for treating fractures associatedwith osteoporosis in both Europe and the United States waswith osteoporosis in both Europe and the United States was$27,000 million$27,000 million

Devastating Impact ofevastating Impact ofOsteoporosissteoporosis


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MenopausalenopausalOsteoporosissteoporosisTheThe CostCost Of The Disease IsOf The Disease Is GreatGreat,,

BothBoth

FromFrom HumanitarianHumanitarian ApproachApproach

And TheAnd The FinancialFinancial Prospective.Prospective.


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Bone fracture withone fracture withminimal traumainimal trauma Is the feared end point ofIs the feared end point of



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Problems ofroblems ofDiagnosisiagnosis


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In 1995 The WHO stressedn 1995 The WHO stressedthe Importance of threehe Importance of threesilent diseases that dontilent diseases that dontmanifest any symptomsanifest any symptomsexcept after major tissuexcept after major tissuedamage has occurredamage has occurred. HypertensionHypertension HypercholesterolemiaHypercholesterolemia


Silent EpidemicsSilent Epidemics


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8%

42%

15%

19%

23%

48%17%

27%

15%

0 10 20 30 40 50

UK

Spain

Mexico

Lebanon

Jordan

Italy

Germany

FranceCanada

Brazil

Australia

Womens Understanding of Their OwnRisk is Alarmingly Low

Percent (%)

0 - 48% of women were aware of their risk prior totheir diagnosis with osteoporosis

0%

0%


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Doctors Areoctors AreConstrained By Lack ofonstrained By Lack ofResourcesesources 75% of physicians consider the access to75% of physicians consider the access to

screening tools inadequatescreening tools inadequate

83% of physicians say level of health care83% of physicians say level of health carecoverage is inadequatecoverage is inadequate

20% say lack of time limit their screening20% say lack of time limit their screening

capabilitiescapabilities


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Lot of people suffer dueot of people suffer dueto the hesitancy witho the hesitancy withwhich many physicianshich many physicianscurrently approach theurrently approach thesilent epidemic ofilent epidemic ofOsteoporosissteoporosis


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Our Patientsur Patients18000

Egyptian

Postmenopausal ladies

11096Rural

6904Urban


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CAIROAIROMeet Halfaeet HalfaEl Ahrazl AhrazShebin El Komhebin El KomKom Berra.om Berra.El bagour.l bagour.

MansouraansouraTalkhaalkhaBerkenerkenBeni Swiefeni SwiefSedsedsEl Fashnl FashnEl Menyal MenyaMaghaghaaghaghaBayahoayaho


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Parametersarametersinvestigatednvestigated Body: Height & weightBody: Height & weight

Family income.Family income.

Level of education.Level of education.

Physical exercise.Physical exercise.

Smoking.Smoking.

BMD.BMD.

Fractures.Fractures.


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They were allhey were allAge 60-80 years

Ambulatory

Signed an informed Consent

At least 5 years postmenopausal


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Osteoporosis of thesteoporosis of theLumbar Spineumbar Spine

T-score -4


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Osteoporosis of thesteoporosis of theFemur Neckemur Neck

T-score -2.7


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Assessment ofssessment ofFracturesractures

Radiologically performedRadiologically performed


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ResultsResults Th d tTh d t


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The mean age and age atThe mean age and age at

menopause and theirmenopause and their

distributiondistribution

Age Value

Mean age (years) 66.1 4.6 years

Age at menopause 50.8 0.87

Age < 65 years 6786 37.3%

Age > 65 years 11214 62.3%


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The percentage of level of educationThe percentage of level of education

Level of education No. (%)

Less than a preparatory school

including Illiterates (%)

12528 69.6

High-school (Preparatory-Secondary) graduate (%)

3105 17.25

University Graduates (%) 2367 13.15

69.60%

17.25%13.15%

0.00%

20.00%

40.00%

60.00%

80.00%

Less than a preparatory school including Illiterates (%)

High-school (Preparatory-Secondary) graduate (%)

University Graduates (%)


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The mean height and weightThe mean height and weight

Mean SD

Weight (Kg) 73.53 3.68

Height (Cm) 154.6 5.8

Average weight gain since age of25 years

21.95 5.8

Average height at age of 25 (cm) 157.5 1.14

73.53

154.6

21.95

157.5

-10

10

30

50

70

90

110

130

150

170

Mean

Weight (Kg)

Height (Cm)

Average weight gain since age of 25 years

Average height at age of 25 (cm)


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Repartition of the Participants (total 18000)Repartition of the Participants (total 18000)

according to their BMD statusaccording to their BMD status

Normal Osteopenic Osteoporotic

% % %

Femoral Neck2772 15.4% 9666 53.7% 5562 30.9%

LumbarSpine

7128 39.6% 6894 38.3% 3978 22.1%

Both Sites 1089 6.05% 11178 62.1% 5724 31.8%

309

1073

618

793765

442

121

1243

636

0

200

400

600

800

1000

1200

1400

Femoral Neck Lumbar Spine Both Sites

Normal Osteopenia Osteoporosis


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The prevalence of vertebral fractures atThe prevalence of vertebral fractures at

baselinebaseline

Normal Osteopenic Osteoporotic All

No. % No. % No. % No. %

1-3 fracture 90 8.26% 630 5.63% 1134 19.8% 1854 10.3%

>3 fractures 9 0.82% 45 0.402% 252 4.4% 306 1.7%

All Fractures 99 9.09% 675 6.03% 1386 24.2% 2160 12%

Total number 1089 11187 2772 15048

10

70

126

1

5

28

11

75

154

0

20

40

60

80

100

120

140

160

1-3 fractures > 3 fractures

Normal Osteopenic Osteoporotic


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Distribution of Smoking History in urban and ruralDistribution of Smoking History in urban and rural

populationspopulations

Urban Rural Total 2 p

Smoking

Current 198 234 432 0.01 0.996

Previous 360 441 801

Negative 7578 9198 16761

Total 8136 9864 18000


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Distribution of smoking status andDistribution of smoking status and

BMD among Urban and RuralBMD among Urban and Rural

populationspopulationsSmoking Normal Osteopenia Osteoporosis 2 P

Current Urban 90 72 36 0.049 0.98

Rural 72 81 36

Previous Urban 108 171 81 0.054 0.975

Rural 126 207 108

Negative Urban 297 4815 2223 0 0.998

Rural 360 5841 2997


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Distribution of monthly income in relation toDistribution of monthly income in relation to

BMD in urban and rural populationsBMD in urban and rural populations


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Distribution of Exercise in urban and ruralDistribution of Exercise in urban and rural

populationspopulations

Urban Rural Total 2 p

Exercise

Positive 3411 4131 7542 0 0.957

Negative 4725 5733 10458

Total 8136 9864 18000


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Access to Treatmentccess to TreatmentAccess to Treatment

0%

2%4%

6%

8%

10%

12%

14%

16%

18%

20%

Cairo

Mee

tHal

fa

ElAhr

az

Sh

ebin

ElK

om

Kom

Ber

ra

ElBag

our

Man

sour

a

Talk

ha

BerK

een

Beny

Swe

ifSe

ds

ElFas

hn

ElM

enya

Mag

hagh

a

ElBay

aho

Access to Treatm


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Women Understandingomen UnderstandingAbout Osteoporosisbout OsteoporosisWomen Understandin

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Cairo

Mee

tHal

fa

ElAhr

az

S

hebi

nEl

Kom

Kom

Ber

ra

ElBag

our

Man

sour

a

Talk

ha

BerK

een

Beny

Swe

ifSe

ds

ElFas

hn

ElM

enya

Mag

hagh

a

ElBay

aho

Women

Understanding


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Number of Dexaumber of DexaMachinesachinesNumber of DEXA

0

20

40

60

80

100

120

140

160

Cairo Shebin El Kom Mansoura Beny Sweif El MenyaNumber of

1-15 post menopausal osteoporosis in egypt current status- dr. rashed

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