==== Front
Ann Saudi MedAnn Saudi MedAnnals of Saudi Medicine0256-49470975-4466King Faisal Specialist Hospital and Research Centre 10.5144/0256-4947.2007.132asm-2-132LettersReply Sadat-Ali Mir Prof.Al Elq Abdulmohsen Dr.College of Medicine, King Fahd University Hospital, P.O. Box 40071, Al-Khobar 31952, Saudi Arabia, T: +966-50-584 8281, F: +966-3-897 1013, drsadat@hotmail.comMar-Apr 2007 27 2 132 133 Copyright © 2007, Annals of Saudi Medicine2007This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
==== Body
Dear Dr. Shaker: We thank Dr Shaker’s comments on our article “Osteoporosis among male Saudi Arabs: A pilot study. Annals Saudi Med 2006; 26(6):450–54.1 The concerns which are raised, we believe are unfounded.

The sample size was small. However, this is a pilot study which highlighted an important medical issue usually ignored by the medical community. In addition we would like to mention that our hospital-based prevalence of male osteoporosis does not differ much from the other two reports from Jeddah and Riyadh which found that the prevalence of osteoporosis among Saudi males over the age of 50 years was 28.2%2 and 23.5%3, respectively. As we stated in the conclusion of our study, more studies are needed to determine the national prevalence of male osteoporosis.

None of our patients in this study were suffering from sickle cell disease and we have emphasized in the methodology that patients with secondary causes of osteoporosis were excluded, keeping in mind that our patients are older than 50 years of age and were unlikely to be asymptomatic with sickle cell disease by this age.

Although this is a hospital-based study, the patients were taken from the ambulatory care unit and none of them were acutely ill or had prolonged immobilization.

We agree that 25-hydroxy-vitamin D and 24-hour urinary calcium are among the investigations needed to exclude secondary causes of osteoporosis. In fact, the vitamin D level is not available at our institution, but in the presence of normal calcium, phosphorus and alkaline phosphatase, it is unlikely that the patient will have significant vitamin D deficiency affecting the bone mass. Also we do not think that primary idiopathic hypercalciuria is an important cause of osteoporosis in this community, especially in the absence of a history of nephrolithiasis.4

Lastly, two DEXA scans of the upper femur are included here (Figure 1 and Figure 2).

Figure 1 DEXA scan of the upper femur showing low BMD with T-score <−2.5 indicating osteoporosis.

Figure 2 DEXA scan of the upper femur showing low BMD with T-score <−2.5 indicating osteoporosis.
==== Refs
REFERENCES
1 Sadat-Ali M  Al-Elq AM   Osteoporosis among male Saudi Arabs: A pilot study Annals Saudi Med 2006 26 6 450 54 
2 Ardawi MSM  Maimany AA  Bahksh TM  Nasrat HAN  Milaat WA  Al-Raddadi M   Bone Mineral Density of the spine and femur in healthy Saudis Osteoporosis Int 2005 16 43 55 
3 El Desouki MI  Sulimani RA   High prevalence of osteoporosis in Saudi women Grant from King Abdulaziz City for Science and Technology Project #LGP- 5–44 Data under publication 
4 Asplin JR  Bauer KA  Kinder J  Muller G  Coe BJ  Parks JH    Bone mineral density and urine