Management of osteoporosis in the Middle East and North Africa: a survey of physicians’ perceptions and practices

Abstract

Summary: We surveyed 573 physicians in the Middle East regarding osteoporosis management. Sixty percent had access to, but were not in charge of, densitometry reporting. Screening for secondary causes was common; 62% were aware of FRAX®; less than half used it. Medications were accessible, and most participants had concerns regarding bisphosphonates. Barriers to care were identified. Introduction: The 2011 IOF Middle East Osteoporosis Audit highlighted major care gaps in osteoporosis care in the Middle East and North Africa (MENA) region. We investigated osteoporosis management practice patterns in this region. Methods: We mailed an electronic survey to a convenience sample of physicians, explaining the study rationale and methods. It gathered information on physicians’ profiles, availability and utilization of resources, risk assessment, and management. Results: Five hundred seventy-three responses were obtained from the United Arab Emirates (UAE, 36%), Saudi Arabia (KSA, 25%), Lebanon (14%), and others (25%). Endocrinology was the single most represented specialty. Sixty percent of participants had access to densitometers, but treating physicians were not in charge of densitometry reading. Screening for vitamin D deficiency and secondary contributors to osteoporosis was frequently implemented. Although two-thirds of professionals were aware of FRAX®, only 42% used it, either because of lack of know how or of a country specific calculator. Almost all (96.0%) had access to oral and 68.9% to intravenous bisphosphonates, and over half to teriparatide (46.4%) and denosumab (45.0%). Most participants (92%) were aware of concerns regarding side effects of bisphosphonates, and this changed the management in the majority (73%). Important barriers to osteoporosis care were lack of osteoporosis awareness among physicians, patients, and cost of treatment. Conclusions: This first look at physicians’ practice patterns on the diagnosis and treatment of osteoporosis in the MENA region underscores the pressing need for an official call for action, at all levels, to address this large care gap. © 2019, International Osteoporosis Foundation and National Osteoporosis Foundation.