Dubai Rheuminations

By Dr Irwin Lim, Rheumatologist

I've returned from 3 days in Dubai: 1.5 days spent at an Osteoporosis meeting and a very nice 1.5 days exploring Dubai.

Fascinating place. 80% of the population is expatriate and there is such a cultural mix. The oil money is obvious. Green space in a desert. Skyscrapers a plenty and massive development. Everything seems to be the "tallest" or the "biggest".

I'll admit to you that I enjoyed myself. I was feeling quite overworked and jaded, so was really looking forward to this short break.

As for the actual work part, I do have some insights to share with you:

• Delegates were from many parts of Asia, the Middle East & Australia. I often forget as I beaver away in clinic how well resourced we are in Australia. Access to Bone Densitometry and to anti-osteoporosis medications is taken for granted and the disparity is great around the world.
• 200 million women worldwide suffer with osteoporosis with that set to increase. A massive issue for what worldwide, is a very under-treated issue, causing pain and disability, and loss of independence.
• Two thirds of the world's population lives in Asia. As we see the incidence of hip fractures reduce in the West, the opposite is happening in the East. The Chinese doctor who spoke is bracing for a large medical and societal headache.
• While the Middle East is bathed in sunshine, the region has the world's highest rates of rickets. Vitamin D deficiency occurs in 50-90%.
• Treating osteoporosis in Anorexic females is terribly difficult and something I have close to no experience in. Take home message was that none of our medications work well if you can't actually get the patient to eat (calories & nutrients are needed for bone building).
• Extension studies for bisphosphonates were reviewed and the question of when to stop bisphosphonates after a period of treatment was discussed (this discussion deserves a separate post).
• Osteoporosis in Men is often neglected. Aspects of difference between the sexes were presented, as was data confirming that the bisphosphonate medications do work in males just like they do for females (I'll highlight this bony plight of men in a separate post).
• The worry about Atypical Femoral Shaft fractures occurring with prolonged use of bisphosphonates was highlighted. The take home message as summarised by the ASBMR Task Force - For every 1 Atypical femoral fracture that might occur, we avoid 100 cases of TYPICAL osteoporotic fractures of the hip.

All in all, a very pleasant 3 days (thanks to my wife for giving me the leave pass) spent expanding my knowledge on bone and on Dubai.