Second IOF Middle East Training Course on Osteoporosis held in Lebanon

The 2nd METCOP, held in Lebanon from November 16-18, 2006, attracted more participants than ever before. The problem of vitamin D deficiency and the need for fracture databases in the region were two of the issues highlighted.

‘I thought all was lost when war erupted in July… and then your messages of
support flooded in and brought tears to my eyes’, were the words of an emotional
Prof. Ghassan Maalouf at the start of the 2nd IOF METCOP (Middle East Training Course on Osteoporosis). At one moment, events appeared make the chances of this course ever taking place in Lebanon very slim indeed. However, not only did the course take place, but numbers attending from all over the Middle East and North Africa were even greater than last year.

This was justification, indeed, for the months of hard work invested in particular by
Prof. Jean-Philippe Bonjour, Course Leader, Prof. Pierre Delmas, IOF President and Prof. Ghassan Maalouf, Regional Coordinator, along with Profs. Claus Christiansen and Serge Ferrari who made up the team of internationally-renowned speakers forming the teaching faculty for this course.

A program of speeches covering the full spectrum of osteoporosis-related subjects was presented, this year’s course being especially tailored for the MENA countries, with much of the scientific material of particular relevance to the lifestyles and characteristics of the peoples of the region.


Prof. Jean-Philippe Bonjour lectured on ‘Bone biology relevant to osteoporosis’, ‘Pathophysiology’ and an update on the use of ‘Strontium Ranelate’ in treatment. He also spoke of the ‘Mechanical influence on bone mass and architecture’ and explained that bone architecture also appears to play a part in fragility fractures as well as bone density. This would explain the occasional occurrence of fragility fractures in patients with normal bone density.

His last presentation concerned the ‘Role of vitamin D, calcium and protein intakes’. The role of vitamin D in the prevention of osteoporosis has gained much attention in recent years, as latest studies show just how vital this vitamin is. It is now recommended that even breast-feeding babies would do better for vitamin D supplements.

Most populations worldwide lack vitamin D, but recent studies reveal that the peoples of the Middle East and North Africa appear to suffer from the greatest deficiencies. How to explain a lack of sun in such sunny countries and the fact that these deficiencies are greatest in females?

Dr. Marie-Helene Ghannage (Lebanon) provided some statistics from a study carried out in Lebanon, ‘Hypovitaminosis D in a Sunny Country’. She noted that average vitamin D intake was higher in men compared with women, in urban subjects compared with rural ones and in non-veiled women compared with veiled ones. Severe hypovitaminosis was observed in 30.7% of those studied and was more prevalent in women (41.5%) and in those veiled (61.8%). Veiled women living in rural areas had the lowest levels and rural men had the highest levels despite very low vitamin D intake.

Question time prompted a member of the audience to note that in much of the Middle East, lack of sun exposure has more to do with the simple fact that it is too hot to go outside than to veiling. The natural preference of the majority of people is to escape the sun and remain in air conditioning, unlike the populations of more temperate climates who actively seek the sun.

Prof. Pierre Delmas gave two presentations on diagnosis - ‘Biochemistry’ and ‘Assessment of vertebral fracture’. He followed up on the subject of HRT and SERMS, assessing the pro’s and con’s of these treatments. His final presentation, ‘Whom, How, When and How Long to Treat’ provided much-needed guidelines for patient care as, indeed, did his update on HRT.

Prof. Ghassan Maalouf addressed the audience on the subject of ‘Epidemiology, risk factors, socio-economic aspects’. A study completed in 2000 revealed the bone density norm of the Lebanese population to be lower than those of western populations and subsequent studies of MENA populations have confirmed a generally lower BMD prevalent in most of the countries of the region. However, it is yet to be determined whether there exists, consequently, a greater incidence of fragility fracture.

Prof. Maalouf, once again, called upon all countries of the region to give urgent priority to the setting up of fracture data bases. He stressed that this information is vital for the better understanding of the bone health of the regions populations.

Prof. Claus Christiansen provided a complete explanation of BMD testing in two lectures on the subject: ‘Diagnosis: Technology of Osteodensitometry’ and ‘Diagnosis: Clinical Use of Osteodensitometry’. Prof. Serge Ferrari gave presentations on two well-known treatments: ‘Bisphosphonates’ and ‘Parathyroid hormone’, and an interesting update on the latest findings concerning optimum length of treatment. His final presentation explored the genetics of osteoporosis: ‘Familial and hereditary osteoporosis’.