Bone mineral density. What normative data should we use to report Saudi female patients?

Despite the fact that the Kingdom of Saudi Arabia (KSA) was a pioneer in developing its bone mineral density (BMD) reference population (RP), BMD is still reported in most Saudi dual energy x-ray absorptiometry (DEXA) centers according to Lebanese RP. The aim of the current work was to assess the implication of using normal ranges other than Saudi female normal range in reporting BMD of Saudi female patients (SFP).

This study was conducted at the Security Forces Hospital, Riyadh, KSA. Three published Arabian female DEXA RPs were reviewed and statistically compared. The implication of using RPs other than Saudi female reference population (SFRP) in reporting SFP was assessed in 1653 patients who were reported according to SFRP, Lebanese female reference population (LFRP) and Kuwaiti female reference population (KFRP). All female patients' BMD data performed between June 1995 and July 2003 were included in the study.

The 2 published SFRPs were comparable along most age decades. On the other hand, significant differences between SFRP and LFRP, and between SFRP and KFRP were noted. While the LFRP was lower than SFRP along most age decades, the KFRP was higher than the SFRP. The use of LFRP in reporting BMD values of SFP resulted in an overall false negative rate of 20%. The use of KFRP in reporting BMD values of SFP resulted in an overall false positive rate of 15%.

The current use of LFRP in reporting SFP should be discontinued and instead SFRP should be used. Further national studies are needed to reassure the Saudi RP and to resolve the differences between the current 2 SFRP at the second and fifth age decades.