1. VITAMEN D DEFICIENCY IN SAUDI ARABIA THE SILENT EPIDEMIC
MONA A FOUDA NEEL ,MBBS, MRCP(UK),FRCPE
ASSOCIATE PROFESSOR OF MEDICINE
CONSULTANT ENDOCRINOLOGIST
COLLEGE OF MEDICINE
KING SAUD UNIVERSITY

2. STUDY OF VITAMIN D STATUS AND FACTORS LEADING TO ITS DEFICIIENCY IN SAUDI ARABIA
SALEH SEDRANI ET AL
4078 subjects
The population under study is classified into 3 categories according to vit D nutritional status: deficient ( 5 ng/ml), low (5-10 ng/ml) and adequate ( 10 ng/ml).
The frequency of low 25-OHD concentration (5-10 ng/ml) is high (22% in total children and 20% in total adults) in the Saudi population, while the frequency of vit D deficiency (25-OHD level  5 ng/ml) is 3.4% in total children and 5.5% in total adults. This is true whether the population is urban or rural.
26% of female children of female adults have low vit D status in comparison with 19% and 17% for male children and male adults, respectively.

3. Bone mineral density of the spine and femur in healhy saudi females : relation to vitamin D status, pregnancy, and lactation
N N GHANNAM ETAL calcif Tissue int 1999
321 females
25 vit D nmol/l
Severe hypovitaminosis D (25 OHD less than 20 nmol/l )= 52% Osteoporosis and osteopenia in subjects more than 31=18-41 %, 0-7%

4. Study by El Desouki 2003
Lumbar BMD of 830 postmenopausal Saudis according to age
Category
Number
(%)
BMD + SD
T-Score
Age yrs.
Normal
Osteopenia
Osteoporosis
Low BMD
216
171
124
295 42 33 24 57
- 0.61
- 2.36
- 3.21
Age yrs. 28 69
157
226 11 27 62 89
- 0.71
- 2.41
- 3.4
Age yrs. 3 14 48
95.4
- 0.78
- 2.43
- 3.5
El Desouki. Saudi Med J 2003;Vol. 24 (9)

5. Spine BMD In Postmenopausal Saudis by Age
Category
Number
(%)
BMD SD
T-Score
Age 51-60
Normal
224 37
1.130 (0.05)
-0.55
Osteopenia
218 36
0.978 (0.05)
-1.84
Osteoporosis
164 27
0.793 (0.07)
-3.40
Total
606
100
0.952 (0.15)
-2.06
Low BMD
382 63
Age 61-70 18 7
1.100 (0.03)
-0.84 80 32
0.970 (0.05)
-1.93
152 61
(0.07)
-3.56
250
0.704 (0.11)
-2.27
232 93
Age 71-80 3 4
1.149 (0.07)
-0.40 16 22
0.962 (0.05)
-2.00 35 74
0.771 (0.02)
-3.50 54
0.821 (0.12)
-1.57 51 96
BMD – Bone Mineral Density
SD-Standard Deviation

6. Femur BMD In Postmenopausal Saudis by Age
Category
No:
(%)
BMD SD
T-Score
Age 51-60
Normal
262 43
0.915 (0.07)
-0.50
Osteopenia
247 41
0.755 (0.04)
-1.87
Osteoporosis 97 16
0.606 (0.5)
-3.10
Total
606
100
0.800 (0.12)
-1.48
Low BMD
344 57
Age 61-70 38 15
0.905 (0.04)
-0.60
121 48
0.740 (0.04)
-1.99 91 36
0.587 (0.06)
-3.27
250 99
0.704 (0.11)
-2.27
212 84
Age 71-80 3 4
0.848 (0.01)
-0.90 30
0.743 (0.04)
-1.97 39 54
0.596 (0.06)
-3.19 72
0.668 (0.10)
-2.59 69 95
BMD – Bone Mineral Density
SD-Standard Deviation

7. Spine BMD In All Patients (50-80 Yrs)
Category
Number
(%)
BMD  SD
T-Score
Normal
243 26
1.12 (0.05)
-0.62
Osteopenia
284 31
0.962 (0.04)
-1.99
Osteoporosis
401 43
0.782 (0.07)
-3.480
Total
928
100
0.912 (0.15)
-2.40
Low BMD
685 74
BMD – Bone Mineral Density
SD-Standard Deviation
Femur BMD In All Patients (50-80 Yrs)
Category
Number
(%)
BMD SD
T-Score
Normal
303
32.7
0.908 (0.08)
-0.54
Osteopenia
397
42.8
0.750 (0.04)
-1.91
Osteoporosis
228
24.5
0.597 (0.06)
-3.19
Total
928
100
0.764 (0.13)
-1.78
Low BMD
625
67.3
BMD – Bone Mineral Density
SD-Standard Deviation

8. Prevalence of osteopenia and osteoporosis in Saudis (50 years), using US/European and Saudi reference data. Data are presented as percentages with osteopenia (> -2.5 SD to < -1 SD below young adult BMD) and osteoporosis (< -2.5 SD below young adult BMD), for spine (L2-L4) and femur (total).
(Ardawi MSM, et al. Osteoporosis Int 2005; 16: 43-55)
1980 PTS
20-79 AGE
M 915
F 1065

9. The proportion of Saudis aged 50 years with lower than -2
The proportion of Saudis aged 50 years with lower than -2.5 SD, stratified by body weight quartiles and sex.
(Ardawi MSM, et al. Osteoporosis Int 2005; 16: 43-55)

10. VITAMIN D LEVELS BELOW 20 NMOL/L EXCLUDED !

11. Optimal vitamin D status for the prevention and treatment of osteoporosis
Holick MF Drugs Aging 2007
Vitamin D deficiency is defined as serum 25 OH D level <50 nmol/l or 20 ng/ml

12. optimal 25 hydroxyvitamin D values
Normal hydroxyvitamin D values
20-56 ng/ml or nmol/l
optimal hydroxyvitamin D values
45-50 nglml or
nmol/l

13. Higher 25OHD levels prevent
Table: Threshold values for vitamin D insufficiency based on different outcomes and study types. A common threshold value of 50 nmol/l has been proposed for vitamin D insufficiency, whereas vitamin D deficiency is characterized by values < 25 nmol/l.
References
Study type
Threshold values
for 25-OHD (nmol/l)
Higher 25OHD levels prevent
Dawson-Hughes et al. 1991
Ooms 1994
Ooms et al. 1995
Chapuy et al. 1997
Guillemant et al. 1999
Jesudason et al. 2002
Vieth et al. 2003
Krall et al. 1989
Malabanan et al. 1998
Lips 2001
Cross-sectional
Crpss-sectional
intervention
30-80
Increases with age 30 60 90 50
Secondary
hyperparathyroidism
Decrease in BMD
Increase in bone turnover
Seasonal variation in PTH
Suppresible P-PTH
(Mosekilde L. Clin Endocrinol 2005; 62: )

14. (Sadat-Ali M & AlElq AM. Ann Saudi Med 2006; 26: 450-454)

15. (Sadat-Ali M & AlElq AM. Ann Saudi Med 2006; 26: 450-454)

16. (El-Desouki MI & Sulimani RA. Saudi Med J 2007; 28: 774-777)

17. (El-Desouki MI & Sulimani RA. Saudi Med J 2007; 28: 774-777)

18. Resurrection of vitamin D deficiency and rickets
M F HOLICK J. Clin.Inves 2006
Upward of % OF Children in Saudi Arabia and other sunny countries are vitamin D deficient !
Subclinical vitamin D deficiency in neonates (10 – 20 ng/ml) is associated with normal serum calcium and elvated PTH.

19. In conclusion Vitamin D deficiency is pandemic worldwide
Saudi Arabia and many other sunny countries are no exception
THE IMPACT OF THIS PROBLEM ON SKELETAL HEALTH AND MANY OTHER DISEASES SO PREVALENT ALREADY IN SAUDI ARABIA HAS TO BE ADRESSED URGENTLY