Saudi Osteoporosis Society Releases Updated National Guidelines
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. Despite the availability of safe and effective medications and improvements in treatment rates for osteoporosis in Saudi Arabia, treatment initiation remains suboptimal, with studies showing less than 10% of high-risk patients receiving effective secondary fracture prevention.
Updated National Guidelines
To combat these challenges the Saudi Osteoporosis Society has unveiled significant updates to its national osteoporosis guidelines, marking an important step forward in addressing the burden of osteoporosis in the Kingdom. Originally introduced in 2015, the guidelines were revised in 2023 to incorporate new strategies and evidence-based practices tailored to the unique needs of Saudi Arabia.
-> View Diagnosis and management of osteoporosis in Saudi Arabia: 2023 key updates from the Saudi Osteoporosis Society
“The updated guidelines have marked a significant step forward in osteoporosis care in Saudi Arabia,” said Dr. Mohammed Almohaya, an endocrinologist at King Fahad Medical City, Riyadh. “A key update is the use of the Saudi-specific FRAX model, which leverages local data to improve fracture risk assessment. This tool allows for more accurate risk estimation by considering local epidemiological data, enabling healthcare professionals to better identify individuals at high risk of fractures. Alongside this, the guidelines provide enhanced strategies for maintaining optimal levels of vitamin D and calcium, addressing a common public health concern in the region.”
Therapy monitoring has also seen advancements with the inclusion of bone turnover markers. These biomarkers offer valuable insights into treatment effectiveness and patient response. Furthermore, the guidelines now include romosozumab and sequential therapy as part of the pharmacological management options, expanding the therapeutic arsenal available to physicians.
Another pivotal update is the emphasis on establishing Fracture Liaison Services (FLS) across Saudi Arabia. These services aim to prevent secondary fractures by ensuring timely and comprehensive care for individuals who have already suffered a fracture. Recognising the critical gap in secondary fracture prevention, the National Plan for Osteoporosis Prevention and Management now prioritises the expansion of FLS and rehabilitation centres.
Impact and Feedback
The updated guidelines have already started to make an impact across various levels of the healthcare system. Healthcare professionals now have a structured, evidence-based framework for assessing fracture risk, initiating therapy, and preventing secondary fractures. This has also allowed for patients to benefit from a more personalised and comprehensive approach to osteoporosis care, paving the way for better outcomes and an improved quality of life.
On a policy level, the guidelines have been well-received by policymakers at the Ministry of Health, sparking hope for broader implementation and alignment with international best practices. By prioritising initiatives such as the establishment of FLS, the updated guidelines lay a strong foundation for reducing the burden of osteoporosis and improving bone health across Saudi Arabia.
Implementation Challenges
Despite the advancements, the implementation of the updated guidelines have faced challenges. Transitioning from DXA scans to the FRAX model as the initial screening tool has been met with resistance from some healthcare providers. Introducing a probability-based assessment of fracture risk with age-specific intervention thresholds has also proven challenging, as physicians are accustomed to the traditional thresholds of 20% for major osteoporotic fractures and 3% for hip fractures. Additionally, integrating both the traditional T-score and FRAX for therapy initiation has been difficult for many physicians to adopt. Simplifying fracture risk stratification for general practitioners remains another hurdle, particularly in ensuring widespread understanding and adoption.
To address these issues, the Saudi Osteoporosis Society has organized discussions with international experts and developed an updated booklet detailing fracture risk stratification. Released in October 2024, this booklet integrates both FRAX and T-score thresholds for initiating therapy, especially for individuals over the age of 65.
Promoting the Guidelines
The revised guidelines have been actively promoted through national conferences and events. They were highlighted during the 11th Saudi Endocrinology and Metabolism conference in October 2024, and presented at a dedicated course held on Osteoporosis Day. During this event, the updated booklet was officially launched by Dr. Salwa Aidarous, King Saud bin Abdulaziz University & FLS mentor from the Capture the Fracture® programme.
"The promotion of these updated guidelines underscores the collaborative efforts to advance osteoporosis care in Saudi Arabia. We are fortunate that societies like the Saudi Osteoporosis Society have played an active role pivotal role, actively sharing these updates at major events like the Saudi Endocrinology and Diabetes Annual Conference and the Osteoporosis Day scientific event. Initiatives like these ensure that healthcare professionals across the country are equipped with the latest tools and knowledge to improve patient outcomes."
Prof. Mona Fouda of King Saud University, College of Medicine and King Saud University Medical City, added:
“Advancing osteoporosis care requires not only updating our national guidelines, but also a commitment to education and collaboration with all stakeholders. Osteoporosis should be recognised as a dedicated medical subspecialty, with greater emphasis on training residents and fellows through specialised fellowship programs. Building strong partnerships between general practitioners and secondary care is equally vital to ensure comprehensive, multidisciplinary management and improved patient outcomes."
Prof. Fouda was also invited as a guest speaker in the 3rd forum for the home health care and geriatric medicine administration (Ministry of Health), in which she discussed fall and fractures prevention and how this can be part of the FLS as proposed by the European Union Geriatric Medicine Society.
Looking Ahead: Future Initiatives
In collaboration with the Ministry of Health and the Chair of Chronic Diseases, the Saudi Osteoporosis Society plans to host the 7th International Osteoporosis Conference in April 2025 . This event will serve as a platform to further discuss the updated guidelines and spotlight FLS. Key sessions will include FLS modelling in Saudi Arabia and updates on the fragility fractures registry, presented by leading experts such as Prof. Mona Fouda.