Experts in Saudi Arabia urge action as fragility fractures projected to rise

A new report 'Solutions for Fracture Prevention in Saudi Arabia' has been authored by the International Osteoporosis Foundation (IOF) Capture the Fracture program in collaboration with leading Saudi Arabian experts.

It reveals the osteoporosis burden and current health policy landscape in Saudi Arabia, and, most importantly, provides important recommendations to help tackle the projected rise in fragility fractures in the population.

Fragility fractures due to osteoporosis are a major public health concern in the Kingdom of Saudi Arabia. With the country facing a rapid increase in its older population, the number of fragility fractures is estimated to have increased by more than 25%—from 175,000 in 2019, to an estimated 222,000 in 2023.

The cost burden to the health care system was estimated at 635 million USD in 2019, of which 56% is attributed to hospitalization and surgery costs. These costs are expected to rise to 750 million USD in 2023.

Professor Riad Sulimani of King Saud University, College of Medicine and King Saud University Medical, President of the Saudi Osteoporosis Society and a co-author of the report, warns of the rising burden of osteoporosis-related fractures:

"Older people are most affected by osteoporosis which results in fragile bones which break easily, known as 'fragility fractures.' As the proportion of elderly individuals in Saudi Arabia is projected to more than double by 2050, the Kingdom will see a rapidly accelerating fracture rate. These fractures have serious consequences for sufferers and cost implications for the health care system."

"From a patient perspective, a broken hip for example can have devastating and life-threatening consequences. The mortality rate in Saudi Arabia is 27% in the year following a hip fracture. Among survivors, 52% are unable to return to their pre-fracture activity status, with approximately 32% needing walking assistance and 83% of those who require a wheelchair become bedridden."

"Important progress is being made to address the issue, notably through the 2018 National Plan for Osteoporosis Prevention and Management published by the Ministry of Health and the publication of the recently updated Saudi osteoporosis guidelines for the diagnosis and management of osteoporosis. Nevertheless, there are still significant gaps and missed opportunities which must be addressed urgently."

The experts pinpoint specific areas for improvement that would serve to increase the low rate of diagnosis and reduce the very high osteoporosis treatment gap.

Actions to be taken include the prioritization of low bone density and osteoporosis within the forthcoming Saudi Health Council plan; the improved training of health care professionals; addressing widespread vitamin D deficiency; improving the sub-optimal availability of bone mineral density scanners (DXA); addressing the under-reporting of vertebral fractures; initiating a national system to collect and monitor fracture-related data (e.g. fracture registries); and increasing community awareness of bone health, among other action points.

Another critical issue is the need for efficient Fracture Liaison Services (FLS) to be established in all hospitals that treat patients with fragility fractures. An FLS is a coordinated, multidisciplinary post-fracture care service within a hospital that increases post-fracture osteoporosis screening, diagnosis and treatment rates. Without appropriate diagnosis and treatment for osteoporosis, a patient who has sustained a fragility fracture is at double the risk of sustaining a second fracture, especially within two years.

To date, only eleven Saudi Arabian hospitals have FLS services. Exemplary services include the gold-level FLSs at the Alnoor Specialist Hospital Holly Makkah (Makkah), the Erfan and Bagedo General Hospital (Jeddah), King Fahad Hospital Jeddah (Jeddah), and the King Saud Medical City (Riyadh).

Professor Mona Fouda of King Saud University, College of Medicine and King Saud University Medical City and a co-author of the report, added, "In Saudi Arabia we are fortunate to have several important organizations that are dedicated to the cause of fragility fracture prevention and health care professional education. These include the Saudi Osteoporosis Society, the Saudi Orthopaedic Association, the Saudi Spine Society, the Saudi Society for Endocrinology and Metabolism, the Saudi Geriatric Society, and the Saudi Rheumatology Society. In addition, the Ministry of Health is working on establishing a national program for fall and fractures prevention in the elderly."

"As medical experts, the members of these institutes and societies understand the urgent need for osteoporosis prevention to protect our older population from devastating and life-changing fragility fractures."

"By putting into practice the comprehensive set of actions delineated in this report, we can significantly alleviate the impact of osteoporosis in our nation."

Dr. Philippe Halbout, CEO of the International Osteoporosis Foundation, added, "On behalf of IOF, I would like to extend my thanks to the many dedicated Saudi Arabian experts who have worked with the IOF Capture the Fracture Policy Group to publish this important report. There is no doubt that the blueprint of targeted, collaborative action that is set out in the report would result in better patient outcomes and reduced health care costs, allowing more older adults to enjoy healthy mobility as they age."