2023 Impact Factor: 1.3
2023 CiteScore: 2.2
pISSN: 2251-6085
eISSN: 2251-6093
Chairman & Editor-in-Chief:
Dariush D. Farhud, MD, Ph.D., MG.
This journal is a member of, and subscribes to the principles of, the Committee on Publication Ethics (COPE). 
Vol 33 No Supple 1 (2004)
Articles
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Osteoporosis, characterized by low bone mass and microarchitectural deterioration of bone tissue leading to enlarged bone fragility and a consequent increase in fracture risk is a leading cause of morbidity and mortality in elderly people. The mortality rate in elderly persons with hip fracture approaches 20%. Half of them will be disabled in the remained life. Iranian Multicenter Osteoporosis Study (IMOS) developed by Endocrinology and Metabolism Research Center of Tehran University of Medical Sciences (EMRC-TUMS) and Ministry of Health and Medical Education in 2000. The aim of this study with more than 6000 participitants, was to determine normal range of BMD in Iranian population and assessing the current calcium and vitamin D status in Iran. The results were used for determining the normrmogram of BMD in Iranians and prevalence of Vit-D deficinecy among them. This document outlines all aspects of osteoporosis including risk factors, diagnosis, treatment and prevention of osteoporosis.
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Osteoporosis is the most common metabolic bone disease. In addition to morbidity, osteoporotic fractures also increase mortality risk in affected patients. Enough evidence is not available to indicate that, like western countries, osteoporosis is a public health problem in Iran. Therefore EMRC planned to estimate the burden of osteoporotic fractures in year 2001 based on existing sources of data. The EMRC study on bone density, the MOH study on unintentional injuries, and international literature on mortality risk following osteoporotic fractures were the main sources of information used for this study. To estimate burden of osteoporotic fractures, the prevalence of osteoporosis, the incidence of osteoporotic fractures, and the relative risk of mortality following these fractures were approximated. The mean duration of disability following major osteoporotic fractures was estimated through epidemiologic modeling. Assumptions on the disability weights of morbid conditions resulting from osteoporotic fractures were made through comparing these conditions with similar ones in Global Burden of Disease Study. Based on mortality and incidence rates, mean durations of disability, and disability weights; the DALYs indicator was calculated for Spine, Hip, and Forearm fractures. In women hip, spine, and forearm fractures were responsible for 15880, 1269, and 121 mortality- and morbidity-related lost years of life respectively. Similar figures in men were 16495, 2225, and 37 years. Collectively osteoporosis deprived Iranian population from 36026 healthy years of life (18757 in men and 17270 in women) in 2001. Higher burden of osteoporosis in men, mainly results from higher risk of mortality following fractures in male sex. The national study on unintentional injuries indicates that the incidence of osteoporotic hip fractures in Iranian population is much less than other populations. Higher bone mineral density and other probable differences between Iranians and other populations that affect fracture risk, like environmental conditions and life style, should be investigated as probable determinants of this difference. Limited available sources of information regarding osteoporotic fractures necessitate more comprehensive studies to clarify all aspects of this health problem.
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Hip fracture, the most dramatic complication of osteoporosis, constitutes a serious health problem of the elderly, with great socioeconomic consequences. Hip fracture epidemiology has been studied by many investigators. Until now, there are no reported studies in Iran regarding this issue. We studied hip fractures that occurred in Iran in 2003 and compared the findings with those of other countries. Data used were obtained from the Iranian Multicenter Study on Accidental Injuries, a large-scale population-based study conducted in 9 provinces across the country. The study was conducted by the Ministry of Health and Medical Education and continued for 135 days (4.5 months) in all centers, beginning in a date between 15 June 2003 and 15 July 2003 for each center. A total of 1482 new cases of hip fracture (1079 male, 403 female) were recorded during the study period. The crude annual incidence of hip fracture (per 100000 person-years) was 59.8 in men and 23.5 in women. The incidence rates increased exponentially after the age of 60 in both genders and nearly tripled after each decade. In comparison with hip fracture incidence rates of other countries, Iranian rates are considerably lower than other Asian, European, and American countries. The reasons for this low incidence rate remain uncertain. With increase in life span, rapid economic development and aging of the population, hip fracture will become a major health problem in Iran and studies are needed to increase awareness of osteoporosis and to monitor the epidemiology of hip fractures.
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Several demographic factors may be considered as barriers to osteoporosis prevention like high rate of illiteracy and low socioeconomic status in developing countries, there is lack of studies that assess the relationship between socioeconomic status and osteoporosis. This study was a case-control study and it was conducted in two bone mineral density centers in Tehran. Case group includes 163 osteoporotic menopaused women. Controls were selected from same bone mineral density center and matched to the case patients according to age groups. The odds ratios with 95% confidence interval for demographic risk factors of osteoporosis were as follow: illiteracy (no schooling) 2.31(1.06,5.06) in public center, 12.18(1.41,105.57) in private center, illiteracy of husband 3.76(1.04,13.69) in public center, occupation (being a housewife) 2.041(1.19,3.50) in public center. In this study we did not found a strong association between occupation and osteoporosis. High education level was shown as a protective factor of osteoporosis in both centers.
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Bone mass loss is one of the commonest menopause symptoms, resulting from cessation of estrogen production. Compounds which have estrogen – like biological activity similar to “Isoflavones” present in plants especially soy, may reduce bone loss in postmenopausal women, because as they are similar in structure to estrogens. This study, therefore, was undertaken to assess the effect of soy protein on bone metabolism biomarkers in postmenopausal women with osteopenia. This “before and after” clinical trial was carried out, on 15 postmenopausal women with osteopenia, between 45 to 64 years of age. The subjects were asked to consume 35 gram/day of soy protein for 12 weeks. Blood and urine samples, were taken at 0, 6 and 12 weeks of the study. Anthropometric measurements and a 2-day dietary recall were done at the beginning of the study, and at the 6 and 12 weeks. The food consumption data were analyzed by “Food Proccessor” software. Repeated measurement analysis was utilized to determine the changes in biochemical indices, anthropometric and dietary data. P-values less than 0.05 were considered as significant. Comparison of weight, BMI, physical activity and dietary intake of subjects during the study did not show any significant differences. Soy protein consumption, showed significant reductions in deoxypyridinoline (biochemical marker of bone resorption) and significant increase in total alkaline phosphatase ( biochemical marker of bone formation).There were no significant differences in serum osteocalcin, C- telopeptide, insulin- like growth factor binding protein 3 (IGFBP3), and type-I- collagen telopeptides. Considering the beneficial effects of soy protein consumption on bone metabolism biomarkers, inclusion of this inexpensive and available food item in postmenopausal women diet, may reduce bone loss and could be recommended for the prevention of osteoporosis.
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Osteoporosis is a major health problem because of the large health care costs associated with its clinical consequences. It is therefore of great importance to identify modifiable risk factors. We investigated association between fruit and vegetables intake and bone mineral density in rural population of Tehran surroundings. Subjects were a subgroup of a large study on prevalence and causes of vitamin D deficiency in rural population surrounding Tehran, capital of Iran. Fruit and vegetable intake of 82 subjects whose bone mineral density (BMD) was measured and had a 24 hour food recall, was assessed. Weight and height were measured by standard methods. BMD was measured by Dual X-Ray (DXL) (Calscan) method at the heels. Osteopenia and osteoporosis rate in women older than 50 years were 55.5% and 33.3% and in men were 69.2% and 7.7%, respectively. Fruit intake was not correlated with BMD. Vegetable intake was positively associated with BMD just in women. According to interquartile range of vegetable intake women were grouped as those consuming less than 1.5 servings of vegetables per day and those consuming more. The women reported consuming more than 1.5 serving of vegetables had significantly higher T-score (-1.1±0.8 compared with -1.9±1.0, P<0.01). Those consumed more vegetables had high intake of some nutrients such as vitamin C, vitamin A, potassium, magnesium, zinc, folate, iron, sodium, calcium and phosphorus but none of them except for vitamin A (r= 0.03, P<0.05) was correlated with BMD. High consumption of vegetables positively affected bone mineral density in rural women and daily intake of at least 1.5 servings of vegetables could positively affect osteoporosis prevention.
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Osteoporosis is a major public health problem in Iran. Bone densitometry is used to diagnose osteopenia and osteoporosis and if necessary, prevent bone fractures, especially that of femoral neck. Bone density is related to several factors including race, age, sex, environmental factors and nutrition. No comprehensive study has been performed in Iran, yet. Among the 10 to 75 year-old population living in Tehran, after excluding those who suffered from conditions affecting bone metabolism, 600 people were randomly selected from 50 clusters. All participants underwent a clinical examination and lumbar and spinal densitometry using DXA method. Prevalence of osteoporosis and osteopenia in women older than 50, was 28.1% and 53.3%, respectively. Prevalence of osteopenia and osteoporosis was higher in our study population. Peak bone density in the 25-35 -year-old population could be useful in policy-making for prevention and treatment of osteoporosis.
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PTH is the most important factor which control calcium homeostasis in the body in this study we tried to determine the normal range of PTH and Vitamin D with examining the relation between PTH and bone density and Vitamin D on the base of bones biological changes. Our subjects were, 20 to 69 years-old men and women of Tehran. Serum volume of PTH and vitamin D in different decades of life had significant difference. Range of serum PTH in osteporotic persons was 29.7-38 pgr/lit (95% SD). This range for non osteporotic persons was 24.33-30.2 pgr/lit. In this study ranges below 18 nmol/lit was considered as severe vitamin D deficiency and 23-36nmol/lit as mild deficiency. So the volume more than 36 nmol/lit volumes was normal range of vitamin D. it seems that biological changes of bones associate more with ranges of vitamin D which causes significant changes in PTH.
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Little is known about relation of transplantation and bone. We conducted a study to find out the frequency and predictors of osteoporosis in kidney transplanted patients in Iran. DEXA (DPX-MD, GE, Lunar corporation, USA) used for BMD of 61 kidney transplanted patients. Calcium, phosphate, alkaline phosphatase, BUN, creatinine and PTH, were also measured. Fourty four percent of patients were men (27). Mean±SD of age of men and women was 44.3±10.44 and 40/7± 13.77, respectively. Mean±SD of transplant duration was 33.9± 33. 2 months Mean±SD of dialysis time was 12±14 months. 29.5% of patients had osteoporosis. Osteoporosis was significantly higher in subjects with BMI less than 19 kg/m2 (P= 0.007). Alkaline phosphatase had a negative relation with osteoporosis in neck (P= 0.001). Other parameters had no significant relationship with osteoporosis. High prevalence of osteoporosis found in Iranian kidney graft recipients. Screening and therapeutic intervention in these patients is urgently needed.
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Quantitative Ultrasound (QUS) is a noninvasive, inexpensive and portable method for bone densitometry. It may measure some other parameters in addition to BMD, like elasticity and micro architecture. This study designed to determine the relation between reproductive factors and calcaneus QUS parameters in normal women of Tehran. BMD of heel in 151 normal women, 20-72Y/O (participator of Iranian Multi center Osteoporosis Study) was assessed using Achilles+ (GE, Lunar Corporation, USA). After assessment of normal values, Stiffness Index percentiles acquired. With consideration of correlation between variables, multiple regression analysis was used. Mean±SD values of Speed of Sound (SOS), Broad Band Ultrasound Attenuation (BUA) and Stiffness Index (SI), was 36/751527/25, 121/4215/1, 94/4617/92, respectively. Parameters decreased with age (P<0/01). Years of menopause significantly related with QUS parameters and age of menopause significant related with SOS and SI. Results show effectiveness of some reproductive factors on QUS parameters.
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This study planned for finding the agreement DXA and quantitative ultrasound (QUS) of phalanx in osteoporosis diagnosis and cut off point of QUS for osteoporosis diagnosis in postmenopausal women. In 180 postmenopausal women, BMD of axial regions with DXA (DPX-MD, GE, Lunar, USA) and phalanx with QUS (DBM-Sonic 1200) measured. Agreement of methods and cut off for QUS in defining osteoporosis obtained. Prevalence of osteoporosis with DXA was 28.8% (18.3% in L2-L4 and 3.9%-7.8% in femoral regions) and in 28.9% with QUS. Agreement of them (Kappa score) was 0.317 for spine and 0.036-0.068 for femoral regions. T-score= -2.0 was the cut off of QUS in spinal osteoporosis diagnosis (sensitivity=78.8% and specificity= 55.9%). We could not find cutoff point for osteoporosis in femoral regions. This means that QUS of phalanx is not a good replacement for DXA, but it can be used as a screening method for osteoporosis.
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DXL of calcaneus is a portable method for BMD. This study determined a cut off point for DXL in osteoporosis diagnosis. In 510 healthy postmenopausal women, BMD of axial regions with DXA (DPX-MD, GE,Lunar Corp, Madison, WI) and heel with DXL (Demeteck- Sweden), measured. The agreement of two methods and cut off point for DXL in defining osteoporosis, obtained. DXA found osteoporosis in 34.3% and in DXL in 26.1% of cases. Agreement (Kappa) was 0.407 for spine and 0.347 for femur. T-score = -1.8 for spine and T-score = -2.2 for femur were the cut off points of DXL in diagnosis of osteoporosis (sensitivity=84% specificity=60%) and (sensitivity=84% and specificity=70%), respectively. Area under curve for regions were 0.807 (P=0.000) and 0.859 (P=0.000), respectively. These results mean DXL can not be used as a replacement for DXA, but it may can be used as a screening method for osteoporosis.
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Osteoporosis is a common and asymptomatic disease. Fifty percent of men and 70% of women over 50 years are affected by osteoporosis or osteopenia. The disease and its complications can be prevented by raising society knowledge throughout education. The aim of this study was determining the effect of educational booklet on Knowledge & Practice of osteoporotic patients who were referred to Shariati Hospital. This was an experimental and self-control study in which the knowledge and practice was determined by standard questionnaire (face to face interview before education and telephone-route after education). Data were analyzed by Mann-Whitney U test. Three hundred and fourty patients coming to Shariati Hospital osteoporosis clinic were investigated. Educational booklet raised society knowledge and practice up to 24% and 16%, respectively. The results showed that educational booklets were not effective tools to increase knowledge and practice of the patients. We recommend other educational tools like meetings, posters, and Philip charts, to enable patients to take care of themselves optimally.
