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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 37 No Supple 2 (2008)
Articles
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Because of increase in elderly population, osteoporosis appears to become as a major public health issue in developing countries as in Iran. In order to obtain a clearer picture of osteoporosis in Iran, studies on different aspect of osteoporosis especially national projects about epidemiology and burden of disease, are required. Coordinating research programs is possible only by establishing a research network, so the national osteoporosis research network was suggested by Endocrinology and Metabolism Research of Tehran University of Medical Sciences. Iranian Osteoporosis Research Network (IORN) was established in 2002 by approval of Deputy for Research and the National Advisory Committee on Non-communicable Diseases of Ministry of Health and Medical Education of Iran. At first, five centers of Medical Sciences Universities and Research Centers in addition to the EMRC, participated in this project. Gradually more centers joined to the network and the numbers of IORN members are now 41 persons from 21 universities and research centers. IORN has had several activities: 1) Research projects, from among them are Iranian Multi-center Osteoporosis Study (IMOS) and Hip Fracture Registry Project (HFRP) in Iran 2) Educational activities with the aim of preventing osteoporosis and its related fractures 3) Establishment of osteoporosis clinic. In summery osteoporosis is an important public health issue especially in developing countries because of increasing in elderly population. Close relationship between academic and research centers through the IORN membership provided possibility of designing and applying national research projects on epidemiology and burden of osteoporosis.
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Background: The aim of this study was to investigate the relationship among circulating levels of OPG, RANKL, cytokine profiles, bone mineral density (BMD) and vertebral fractures in pre and postmenopausal women and comparing these finding in three groups including osteoporotic patients with and without fracture and healthy women.
Methods: In a cross-sectional study, 215 women who attended the BMD unit of Endocrinology & Metabolism Research Center (EMRC) of Tehran University of medical sciences were recruited. Serum Osteoporotegerin and sRANKL were measured. In addition, cytokines profile evaluated. Lumbar radiographs in the antero-posterior and left lateral projections were acquired following a standardized protocol and bone mineral densitometry was performed.
Results: In X-ray study, 65.2% of postmenopausal women and 34.8% of pre menopausal women had at least one vertebral fracture (P= 0.04). Serum OPG and TNFα concentration significantly correlated with age (OPG: P= 0.001, r= 0.22, TNFα: P=0.04, r= 0.15). In logistic regression model, RANKL/OPG ratio independent of age and BMD was predicted vertebral fractures.
Conclusion: Osteoimmunological insight in to vertebral fracture indicated that important role of proinflammatory cytokines and RANKL/OPG pathway in bone remodeling. -
Background: To evaluate bone turnover in coronary artery disease patients by using biochemical markers of bone formation and resorption.
Methods: As a cross-sectional study, bone mineral density and serum osteocalcin and crosslaps were measured in 44 angiographically documented coronary artery disease patients and 30 people with normal angiography invited to Endocrinology and Metabolism Research Center.
Results: Bone mineral density of femur was significantly lower in patient with coronary artery disease (P= 0.04). Prevalence of femur osteoporosis in patients with coronary artery disease was 43.2% whereas 14.8% of people with normal angiography had femur osteoporosis (P= 0.01, OR= 4.37; CI95%, 1.29-14, 77).Serum level of osteocalcin and crosslaps elevated significantly with increasing severity of coronary artery disease. A significantly positive correlation was found between coronary artery disease severity and serum level of osteocalcin (P= 0.008, r= 0.320). Crosslaps also showed similar correlation with number of diseased vessels (P= 0.02, r= 0.268). In multivariate analysis after adjustment of age, sex and BMI, severity of coronary artery disease was independently correlated with osteocalcin (P= 0.006) and crosslaps (P= 0.003).
Conclusion: It seems that coronary artery disease and severity of atherosclerosis may be as a bone turnover predictor. Thus recommendation of Bone density and turnover evaluation to patients with a coronary event may be valuable for earlier diagnosis and prevention of osteoporosis and fracture. -
Background: To determine the relationship between lipid profile and bone turnover in pre and postmenopausal women.
Methods: In a cross-sectional study, 279 women referred to Bone Mineral Densitometry (BMD) center of endocrinology and Metabolism research center for premenopausal evaluation were assessed for serum osteoporotegerin, receptor activator of nuclear factor kB (NF-kB) ligand (RANKL) and lipid profile in biochemistry and hormone laboratory.
Results: Serum Total cholesterol had significant inverse correlation with spine L2-L4 BMD (r=-0.152, P= 0.02) and L2-L4 t-score (r=-0.151, P= 0.02). Low density lipoprotein (LDL) cholesterol also related negatively to spine L2-L4 BMD (r=-0.184, P= 0.007), L2-L4 T score (r=-0.184, P= 0.007) and L2-L4 Z score (r=-0.134, P= 0.04).However no relation was found between triglyceride and high density lipoprotein and lumbar spine BMD values. Whereas 35.5 % of women with LDL >130 had serum RANKL upper than percentile 75, this value was 18.7% among women with LDL< 130(P=0.01, Odds Ratio= 2.39, CI: 1.24-4.6). Osteoprotegerin had no such a relation with LDL. In univariate analysis LDL had a significant relationship with RANKL independent of age (P= 0.02).
Conclusion: As RANKL is a bone marker that show bone loss, our finding may contribute to demonstrate a negative effect of LDL on bone metabolism. -
Background: Bone turnover is reported to increase in favor of resorption in overt hyperthyroidism and the rate of resorption is associated with the levels of thyroid hormones. As persistent increase in bone turn over is responsible for accelerated bone loss, patients with Graves' disease may have increased risk for osteoporosis. The aim of this study was to determine relationship between Graves' disease and bone markers.
Methods: The subjects of our study were 31 consecutive untreated GD patients and 37 normal volunteers who were matched on sex proportion and age ranging was diagnosed by suppressed levels of TSH and elevated level of free T3 and free T4 and positive thyroid receptor antibody. Through a clinical trial study executed in endocrinology and metabolism research center, we investigated the relationship between serum osteocalcin & cross-laps with Graves' disease and then kinds of treatment with PTU and methimazole after 8 weeks follow up.
Results: No significant differences in age and sex between patients and controls were found. Significant differences in serum bone markers and thyroid hormones were detected between patients and controls before therapy (p< 0.001). After treatment we found a significant improvement and returning to normal range in all serum lab tests. There were not any differences in the effect of treatment on thyroid hormones and bone markers between two groups.
Conclusion: We found close relationship between Graves' disease and bone markers. So that treatment of Graves' disease can improve bone turn over. These findings indicated that early diagnosis and management of Graves' disease can be effective for osteoporosis prevention in these patients. -
Background: A relation between adiponectin and bone homeostasis has been illustrated through studying adiponectin secretion and its receptor presentation in bone forming cells. The aim of our study was to investigate the relationship between fetal bone turnover and adipokines.
Methods: In a cross-sectional study performed in Tehran University of medical sciences related hospitals, 77 samples (39 males, 38 females) of umbilical cord blood immediately after delivery were gathered. Clinical characteristics such as gender, weight, length, weight to length ratio were recorded. Measurements of leptin, adiponectin, osteocalcin and crosslaps were done by ELISA methods in biochemistry and hormone laboratory of endocrinology and metabolism research center. The amounts of crosslaps and osteocalcin were expressed as t-scores, and then t-scores of crosslaps was subtracted from osteocalcin t-scores to establish estimation for bone formation, which we named Bone Formation Index.
Results: In Univariate Analysis, after entrance sex, birth weight and birth length as fixed factors, leptin and adiponectin displayed an independent effect on Bone Formation Index.
Conclusion: Our data suggest that both leptin and adiponectin have a remarkable impact on bone turnover in fetus. -
Background: Sunlight exposure is one of the ways for vitamin D synthesis. However, its effect on vitamin D status via experimental studies is poorly understood. This study was undertaken to address the possibility that sunlight exposure may increase the levels of serum vitamin D, and alter bone turnover in healthy young girls.
Methods: In a controlled clinical trial, young girls were assigned to the test group (n= 45) or control group (n= 80). An outdoor swimming pool was considered for this project and the test group was required to participate in these sessions at least for 8 sessions and to expose to direct sunlight at least for 20 minutes in each session. They were not allowed to use sunscreen during this time. Control group continued their usual manner of sun exposing. Serum levels of vitamin D, calcium, alkaline phosphatase, parathormone, osteocalcin and crossLaps were measured before and after duration of the study in both groups and compared between them.
Results: Subjects aged 27.46±8.78 years. Serum levels of vitamin D and bone markers were constant during the study in both groups. Changes of these variables were not significant between the groups after the study. Serum vitamin D in subjects with white skin color correlated with total time of direct sun exposing after the study (P= 0.002).
Conclusion: Sunlight exposure did not affect the serum vitamin D and bone turnover in healthy young girls. However, subjects with bright skin complexion benefit from sunlight exposing more than those with a dark skin color in the case of vitamin D improvement. -
Background: Vitamin D is an essential element for establishing bone and muscle structures. Unexplained musculoskeletal (MSK) pain is a common problem in elderly. The aim of this study is investigation of association between vitamin D deficiency and unexplained MSK pain.
Methods: In order to quantify serum levels of vitamin D and other biochemical parameters, serum samples were taken from 1105 subjects aged from 17 to 79 years old, selected based on randomized clustered sampling from 50 blocks in Tehran Unexplained MSK pain was assessed based on the verbal rating scale.
Results: Prevalence of MSK pain was 4.4% in the group with normal serum vitamin D, 4.9% in the group of mild vitamin D deficiency, 7.4% in the group of moderate vitamin D deficiency and 11.3% in the group of severe vitamin D deficiency. There was also a relative risk for unexplained MSK pain of severe vitamin D deficiency of 1.26 (95%CI: 1.01-1.72). Odds Ratio was 4.65 (CI95%:1.25-17.3) in this women. We found quite a high prevalence of unexplained MSK pain in people participated in our study. We also found a Conclusion: Positive relationship between BMI and unexplained MSK pain.
Conclusion: vitamin D deficiency may be a major cause of unexplained MSK pain especially in older women. -
Background: Bone quality is a relatively new concept that seems to be able to fill the gaps we encounter in the prediction of osteoporosis by bone mineral densitometry. The aim of this study was to investigate relationship between finger nail protein and bone turnover in postmenopausal women.
Methods: In a case-control study 123 postmenopausal women recruited from out patient clinic of Endocrinology and metabolism research center of Tehran University of Medical Sciences. In all participants DEXA scanning and spinal X-ray radiography were performed. Serum Osteocalcin and Cross laps concentrations were measured. Protein extraction from fingernail performed to evaluate protein content.
Results: Fingernail protein content significantly correlated with serum Cross laps concentration (P= 0.03, r= -0.27), lumbar spine BMD (P= 0.01, r=0.4), and total hip BMD (P= 0.01, r= 0.33). In logistic regression analysis, fingernail protein content predicted vertebral fracture (P= 0.002). This relationship was independent of age, BMI, lumbar spine BMD, and total hip BMD.
Conclusion: Common pathways may involve in structural protein synthesis. Thus evaluation of fingernail protein allows an estimation of bone quality, which would lead to a more complete evaluation of bone health. -
Background: The purpose of the present study was to determine mandible bone mineral density and evaluate its correlation with central BMD and bone turnover.
Methods: Two hundred and seven postmenopausal women were enrolled in this cross-sectional study. After receiving the testimonials, questionnaires were completed and physical exams were done. For all participants central BMD was measured through DXA method. In each women periapical radiography performed in two regions of mandible. The plain x-ray films were scanned using a standard film digitizer and standardized in size and intensity using a calibration step wedge phantom. The phantom was placed upper site in film cover. After the film digitized, the developed Matlab software was used to image processing.
Results: Mean age and body mass index of participants were 54.6±6.3 years and 28.57±4.9 kg/m2 respectively. Prevalence of osteoporosis and osteopenia in one of regions in central DXA were 17.4% and 48.2% respectively. There was strong correlation between mandible and total femur BMD (P= 0.001, r= 0.80).In osteoporotic patients bone loss in mandible BMD was more than central DXA (P= 0.02).
Conclusion: The main advantage of the proposed mandible BMD is to help clinicians make more accurate evaluation of Bone loss. Based on developed the suggested system a routine dental X-ray could be used to screen for bone loss. -
Background: Recent studies have reported different prevalence of vitamin D deficiency in different sex and age groups in developing countries. In the present survey, we elucidated the prevalence of vitamin D deficiency in a multi-center study among Iranian population.
Methods: In a random cluster sample of healthy men and women (ranged 20 to 69 years old), a number of 5232 subjects from five urban metropolitans' cities (Tehran, Tabriz, Mashhad, Shiraz and Booshehr) were recruited in 2001. Fasting blood sample was taken from participants and sent to the laboratory for measurement of 25-hydroxy vitamin D level. Meta-analysis was performed using fixed effect method for estimation of vitamin D deficiency prevalence in a national level.
Results: Moderate to severe vitamin D deficiency was estimated in urban areas (except for Booshehr because of its heterogeneity) equal to 47.2, 45.7 and 44.2% in age groups of <50, 50-60 and 60≤ years, respectively among men and 54.2, 41.2 and 37.5 percent among women in the same age groups. The highest prevalence of moderate to severe vitamin D deficiency in men was observed in Tehran. Mashhad and Booshehr had also the lowest prevalence of moderate to severe vitamin D deficiency among men and women.
Conclusion: Iran is a country with high prevalence of moderate to severe vitamin D deficiency and the prevalence of this deficiency is more evident in Tehran, capital of Iran. Therefore, consideration of main predictors for vitamin D deficiency in all age groups especially in Tehran is recommended.
