Post Menopausal

Osteopor osis in
Eg ypt
Current Status
Osteoporosis
Osteoporosis
Costs

Direct costs
 UK in 2001 $1.4 billion
 USA per annum $15 billion

Indirect costs
 Following hip fracture in women
 5–20% mortality within 1 year
 20% severely impaired mobility after 12 months,
requiring long-term nursing care
 50% do not regain previous mobility
Devastating Impact of
Osteoporosis
 1 out of 8 Europeans over the age of 50 will fracture their
spines

 3.5 billion euro/year in hospital healthcare alone

 Excludes outpatient and rehabilitation costs

 500,000 hospital bed nights/year

 Expected to double in the next 50 years with the ageing
population

 In 1999, the healthcare cost for treating fractures associated

with osteoporosis in both Europe and the United States was
$27,000 million
Menopausal
Osteoporosis

The Cost Of The Disease Is Great,

Both
From Humanitarian Approach
And The Financial Prospective.
Bone fracture with
minimal trauma
 Is the feared end point of
Osteoporosis
Problems of
Diagnosis
In 1995 The WHO stressed
the Importance of three
silent diseases that don’t
manifest any symptoms
except after major tissue
damage has occurred .
 Hypertension
 Hypercholesterolemia
 Osteoporosis

Silent Epidemics
Women’s Understanding of Their Own
Risk is Alarmingly Low
0 - 48% of women were aware of their risk prior to
their diagnosis with osteoporosis
Australia 15%
Brazil 27%
Canada 17%
France 48%
Germany 23%
Italy 19%
Jordan 0%
Lebanon
0%

Mexico 15%
Spain 42%
UK 8%

0 10 20 (%) 30
Percent 40 50
Doctors Are
Constrained By Lack of
Resources
 75% of physicians consider the access to
screening tools inadequate

 83% of physicians say level of health care

coverage is inadequate

 20% say lack of time limit their screening

capabilities
Lot of people suffer due
to the hesitancy with
which many physicians
currently approach the
silent epidemic of
Osteoporosis
Our Patients
18000
Egyptian
Postmenopausal ladies

11096 6904
Rural Urban
CAIRO
Meet Halfa
El Ahraz
Shebin El Kom
Kom Berra.
El bagour.
Mansoura
Talkha
Berken
Beni Swief
Seds
El Fashn
El Menya
Maghagha
Bayaho
Parameters
investigated
 Body: Height & weight
 Family income.
 Level of education.
 Physical exercise.
 Smoking.
 BMD.
 Fractures.
They were all
•Age 60-80 years

•Ambulatory

•Signed an informed Consent

•At least 5 years postmenopausal

Osteoporosis of the
Lumbar Spine

T-score -4
Osteoporosis of the
Femur Neck

T-score -2.7
Assessment of
Fractures

 Radiologically performed
Results
The mean age and age at
menopause and their
distribution

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%
 The percentage of level of education
80.00% 69.60%

60.00%

40.00%

17.25% 13.15%
20.00%

0.00%

Less than a preparatory school including Illiterates (%)

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

University Graduates (%)

Level of education No. (%)

Less than a preparatory school 12528 69.6
including Illiterates (%)

High-school (Preparatory- 3105 17.25

Secondary) graduate (%)

University Graduates (%) 2367 13.15

 The Incidence & Distribution Of Monthly Income
80.00%
62.30%

60.00%

40.00%
27.80%

20.00% 6.75%
3.15%

0.00%
Monthly Income

100-300 LE 300-500 LE 500-1000 LE >1000 LE

Monthly income Egyptian pound

Freq. %
100-300 LE 5004 27.8%
300-500 LE 11376 62.3%
500-1000 LE 1215 6.75%
>1000 LE 567 3.15%
 The mean height and weight
170

150

130 154.6 157.5

110

90

70

50 73.53

30

10 21.95

-10
Mean
Weight (Kg)
Height (Cm)
Average weight gain since age of 25 years
Average height at age of 25 (cm)

Mean ± SD

Weight (Kg) 73.53 ± 3.68

Height (Cm) 154.6 ± 5.8

Average weight gain since age of 21.95 ± 5.8

25 years
Average height at age of 25 (cm) 157.5 ± 1.14
 Repartition of the Participants (total 18000)
according to their BMD status
1400

1200

1000 1243

800 1073

600 793
765
636
618
400
442
200 309
121
0
Fem oral Neck Lum bar Spine Both Sites

Normal Osteopenia Osteoporosis

Normal Osteopenic Osteoporotic

% % %

Femoral Neck 2772 15.4% 9666 53.7% 5562 30.9%

Lumbar 7128 39.6% 6894 38.3% 3978 22.1%

Spine
Both Sites 1089 6.05% 11178 62.1% 5724 31.8%
 The prevalence of vertebral fractures at
baseline
160 154

140
126
120

100
75
80 70

60

40
28
20
10 5 11
1
0
1-3 fractures > 3 fractures

Normal Osteopenic Osteoporotic

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

Distribution of Smoking History in urban and rural
populations

Urban Rural Total χ2 p

Smoking

Current 198 234 432 0.01 0.996

Previous 360 441 801
Negative 7578 9198 16761
Total 8136 9864 18000
 Distribution of smoking status and
BMD among Urban and Rural
populations
Smoking Normal Osteopenia Osteoporosis χ2 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

 Distribution of monthly income in relation to BMD in urban
and rural populations

Income Normal Osteopenia Osteoporosis Total χ2 P

Urban 100-300 90 819 1359 2268 397.1 <0.001

300-500 54 3987 1026 5067

500-1000 270 162 117 549

>1000 81 90 81 252

Total 495 5058 2583 8163

Rural 100-300 108 990 1638 2736 476.8 <0.001

300-500 63 4833 1251 6147

500-1000 324 198 144 666

>1000 99 108 108 315

Total 594 6129 3141 9864

Distribution of monthly income in relation to
BMD in urban and rural populations
Distribution of Exercise in urban and rural
populations

Urban Rural Total χ2 p

Exercise

Positive 3411 4131 7542 0 0.957

Negative 4725 5733 10458
Total 8136 9864 18000
 0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
20%
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Access to Treatment

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Access to Treatment

El
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Access to Treatme
 0%
10%
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30%
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50%
60%
70%
80%
90%
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Women Understanding

ds
El
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About Osteoporosis

El
Ba
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Women Understanding

Women
Understanding
Number of Dexa
Machines
Number of DEXA

160

140

120

100

80

60

40

20

0
Cairo Shebin El Kom Mansoura Beny Sweif El Menya
Number of D