First update of the Lebanese guidelines for osteoporosis assessment and treatment.

With the ageing of the population worldwide, the human, social and economic costs of osteoporosis will continue to rise. It is estimated that the magnitude of the problem is larger in developing countries, including those in the Middle East. In April 2002, a multidisciplinary panel of experts met and discussed practice guidelines for osteoporosis assessment and treatment in Lebanon: "Who to test, what measures to use, and when to treat ?" They were subsequently endorsed by the Lebanese scientific societies of Endocrinology, Rheumatology, Orthopedics, Obstetrics & Gynecology, Radiology and by the Eastern Mediterranean Regional Office (EMRO), branch of the World Health Organization (WHO). In April 2006, the Guidelines Committee and the Lebanese Society for Osteoporosis and Metabolic Bone Disorders (OSTEOS) led an initiative to update several recommendations detailed in the original guidelines document, based on relevant new local and international data. Revisited guidelines included recommendations regarding the normative database to be used, the specific skeletal sites to be evaluated, recommendations in men and recommendations in premenopausal women. The experts also sought an evaluation of the relevance of the specific risk factors, used in the WHO fracture risk assessment model, to fracture risk assessment in the Lebanese. The purpose of the update of the guidelines was to reevaluate the rationale for the recommendations using further evidence when available and to position the Lebanese Osteoporosis Guidelines in relation to the WHO initiative for global fracture risk assessment.