A study conducted in Kuwait by Dougherty and Al-Marzouk (2001) on 623 healthy Kuwaiti women aged between 20 and 79 years using dual-energy X-ray absorptiometry (DXA) found that the Bone Mineral Density (BMD) reference range was similar to the US/European reference value and higher than Saudis value. There were no differences found in the BMD among Kuwaiti subjects and Caucasian normative values.

Al-Ali et al. (2006) carried out a study to examine the prevalence of osteoporosis and particular determinants of bone mineral density (BMD) amongst healthy community-dwelling Kuwaiti males at Al-Amiri Hospital in Kuwait. The study included 172 volunteer Kuwaiti men aged 50 years and above and Kuwaiti men with this age represented 8.3% of the total population. BMD was measured for subjects at the lumbar spine, femoral neck and total hip using dual-energy X-ray absorptiometry. The study revealed that osteoporosis was found to represent 1.2% in lumbar spine, 1.2% in femoral neck, and 0.6% in total hip, while osteopenia represented 14.5% in the spine, 33.1% in femoral neck and 9.3% in total hip. Upon these findings Al-Ali et al. (2006) concluded that osteoporosis had low prevalence among healthy Kuwaiti men (aged 50 years and above) while osteopenia was found to be more common in the femoral neck area. [Al-Ali N, Al-Faraj J, Mahseen S, Al-Jarki F, Al-Khaldy J, Sharma P. Prevalence of osteoporosis and determinants of bone mineral density in healthy community-dwelling Kuwaiti men aged 50 years or older. Kuwait Medical Journal. 2006; 38(1):14-20]

Maalouf et al. (2000) carried out a study on 858 women and 165 men in Lebanon and demonstrated that the BMD reference value for the population (at the spine, femoral neck and radius) was found to be lower than that for US/European reference data. These results demonstrate that the prevalence of osteoporosis (at the femoral neck) in the Lebanese population for patients aged 50-79 years was found to be 13% when applying US/European reference values and 2% when applying Lebanese reference population.

Gannage-Yared et al. (2000) conducted a study on 316 Lebanese people (99 men and 217 women) aged between 30 and 50 years which revealed that 72.8% of the population is affected with Vitamin D insufficiency (described as a 25 (OH)D value below 15 ng/ml) and that it is more common in women (83.9%) than in men (48.5%). Furthermore, the study demonstrated that in both women and men the inadequate vitamin D intake and urban dwelling were found to be independent predictors of hypovitaminosis D.

El-Hajj et al. (2002) performed a population-based study in Beirut which included 213 young healthy Lebanese subjects aged between 25 and 35 revealed that young Lebanese subjects had a higher prevalence of osteoporosis and osteopenia and a lower peak bone mass when compared to the USA.

Wehbe et al. (2003) performed a study where Quantitative Ultrasonometry (QUS) was employed on 4,320 randomly selected women aged between 20 and 79 years to determine the prevalence of osteoporosis and osteopenia. The study measured broadband ultrasound attenuation (BUA), speed of sound (SOS) and stiffness index (SI) and displayed a general decline for BUA (19.2%), SOS (3.1%), and SI (30.3%) between late adolescence and old age. In the Lebanese young adult reference, the SI value was 8% lower compared to North American and European women. Furthermore, the SI value in Lebanese women aged 42 years was found to be 10.4% lower when compared to North American women and 7.5% lower when compared to European women. Due to the difference in the age-related female Lebanese reference data, the former studies propose using Lebanese standardized reference values rather than US/European values to reduce the risk of overestimating osteoporosis in the Lebanese population.

Hammoudeh et al. (2005) calculated Bone Mineral Density (BMD) values at the spine and femur in 574 Qatari women aged between 20 to 69 years using dual-energy X-rays absorptiometry (DXA). Values were found to be lower than Caucasians and Kuwaitis at the spine (subjects aged 60-69years) and higher at the total femur (subjects aged 40-59 years).

El-Desouki (2003) conducted a pilot study on 830 postmenopausal Saudi women aged 50-80 years old using dual X-ray absorptiometry (DXA) at the King Khalid University Hospital in Riyadh in Saudi Arabia to determine the prevalence of osteopenia and osteoporosis. The study concluded that osteopenia and osteoporosis are more common amongst postmenopausal Saudi women and that bone densitometry should be employed in measuring the severity of bone loss.

Ardawi et al. (2005) conducted a study on a randomly selected group of 1980 Saudi males and females aged between 20 and 79 years to determine the prevalence of osteoporosis in Saudi Arabia. The prevalence was found to be 44.5% in Saudi women when employing the manufacturer’s reference and 28.2% when employing the Saudi reference values, while for Saudi men the prevalence using the manufacturer’s reference showed a less percentage of osteoporosis compared to that when using Saudi reference values. Therefore, osteoporosis prevalence is overestimated in women and underestimated in men in the Saudi Arab population when the US/European reference is employed compared to employing the Saudi Arabian values.