Payesh
Year:2004 | Volume:3 | Issue:1|Papers Count:13

Objective(s): To develop and validate a clinical tool to help physicians to identify which women are at increased risk for osteoporosis and should therefore undergo further testing with bone densitometry. Methods: Using the Endocrine and Metabolism Research Center (EMRC) database and postmenopausal women in Iranian Multicenter Osteoporosis Study (IMOS) who had undergone testing with dual-energy x-ray absorptiometry (DEXA) at femur and lumbar spine (L1-L4). The main outcome measure was low bone mineral density (T score of 2.5 or more standard deviations below the mean for young adult women) at femur, Lumbar spine or both sites. Logistic regression analysis was used to identify the simplest algorithm that would identify women at increased risk of low bone mineral density.Results: The study population comprised 4229 individual of whom 2148 women with menopause were selected; and 185 postmenopausal women from (IMOS) were also included. A simple algorithm based on age, weight, duration of menopause was developed. Validation of this 3 - item Iranian Osteoporosis Scoring System (IOSS) showed that the tool had a sensitivity of 61.7% and specificity of 72.4% for women with osteoporosis.Conclusion: IOSS can identify the majority of women likely to have low bone mineral density and is effective in substantially decreasing the need for all women to undergo DEXA testing.

Objective(s): To compare bone mineral density of different skeletal sites and to assess the possibility of using one skeletal site for diagnosing osteoporosis as opposed to the two sites required in the WHO criteria.Methods: A cross sectional study was carried out on 4229 patients referring to the BMD center of Shariati hospital from 1379-1382. Demographic data was collected. Dual- energy X-ray absorptiometry was performed on all cases. BMD results were defined according to the WHO diagnostic criteria.Results: Data was collected from 4229 individuals (91.8% female and 8.2% male) with a mean age of 53.44±11 years. Prevalence of osteoporosis using the lumbar site was 24.8%, using the femoral site was 12.4% and 27.8% according to the WHO criteria. Sensitivity of DXA at the lumbar spine was 88.9% and at the femoral site was 46.6%.Conclusion: The sensitivity of the lumbar spine for the diagnosis of osteoporosis shown in this study is highly acceptable yet in order to establish an osteoporosis diagnostic guideline for the Iranian population prospective studies are required.

Objective(s): To quantify the relationship between serum PTH, vitamin D and bone mineral density to determine normal range of vitamin D in normal population.Methods: A total of 830 healthy individuals aged 30 to 76 years old (60.8% women, 39.2% men) living in Tehran were randomly selected, following exclusion of people suffering from endocrine, rheumatologic or chronic diseases, fractures, other conditions or using drugs that affecting bone metabolism. Vitamin D and Ca intakes were assessed with a food frequency questionnaire. Self-reported daily time of sun exposure was used to categorize exposure to sunshine. All participants underwent clinical examination and lumbar spine and proximal of femur BMD by using dual-energy X-ray absorptiometry technique. Plasma level of 25(OH) D, Ca, Phosphate (P), Alkaline phosphates (ALK P), parathyroid hormone (PTH) measured during winter. The correlation between these results was investigated.Results: PTH correlated inversely with 25(OH)D .In multivariate analysis PTH correlated inversely with whole body BMD (mostly lumbar spine) but not with the hip BMD. No association was found between 25(OH) D levels and BMD at any site in univariate or multivariate analysis. Based on this relationship between PTH, vitamin D and BMD we obtained normal range of vitamin D. Cut -off point for sever vitamin D deficiency was lower than 18 nmol/l and range of moderate & mild were 18-23 & 23-36 nmol/l, respectively.Conclusion: Normal range determination of vitamin D based on relationship between PTH, vitamin D and BMD can be shown biological bone variation and is useful in prevention strategy.

Objective(s): Deficiencies in calcium and vitamin D intakes are involved in the etiology of osteoporosis, and health authorities recommend that the population consume a diet providing sufficient calcium and vitamin D. We studied the safety and efficacy of milk fortified with vitamin D3. Methods: We conducted a double-blind, placebo-controlled trial of fortified milk (600 IU/l vitamin D3) compared to unfortified milk in 216 subjects (aged 2-98 years). Serum 25-hydroxyvitamin D [25(OH)D], calcium, creatinine, PTH were measured at baseline and after intervention. 109 subjects ingested 400 mL fortified milk with 240 IU vitamin D, and 107 subjects ingested a control milk daily for 8 wk.Results: After subjects consumed fortified milk for 8 wk, serum 25(OH) D3 concentrations increased by 33%, and serum parathyroid hormone concentrations decreased by 40% compared with baseline; control subjects had a decrease of 7% in 25(OH)D and no significant change in serum parathyroid hormone. In the fortified group, serum 25(OH)D increased by 13 nmol/l from 39.94 nmol/l to 53.37 nmol/l . In the control group, serum 25(OH)D felt by 3 nmol/l from 43.11 nmol/l to 39.9 nmol/l. Conclusion: Vitamin D-fortified milk may assist in maintaining vitamin D status in the general population.

Objective(s): Osteoporosis and osteoporosis related fractures are usually considered conditions of post-menopausal or elderly women, but these problems also occur in men. In fact, nearly 30 percent of hip fractures occur in men. Because osteoporosis is clinically silent until fractures occur, men at risk for osteoporosis and those who have the disease need to be identified. The purpose of this study was to investigate BMD variation and prevalence of osteoporosis in men. Methods: Among a sample of male aged 10 to 76 years old, 403 individuals from 50 clusters were randomly selected, following exclusion of people suffering from rheumatoid arthritis, thyroid disease, menstrual problem, fractures or other conditions affecting bone metabolism. All participants underwent clinical examination and lumbar and spinal densitometry using DXA method. Results: In lumbar spine, the duration of peak bone density was between 25 and 40years old and bone loss started at 40 and after 50-bone loss was quickly. In hip, the duration of peak bone mass was from 20 to 30 years old. Bone loss after 50 years old was increased. Prevalence of osteoporosis and osteopenia in men older than 50 years old were 3.9% and 50%, respectively. Osteoporosis in men significantly was related with increase in age and decrease in body mass index. Conclusion: Osteoporosis in men is now recognized as an increasingly important public health issue. Adequate intake of Ca and vitamin D can be improved bone loss. Peak bone density in 20 to 39 years old male population could be useful indicator for prevention and treatment of osteoporosis.

Objective(s): To assess the effects of gynecological risk factors on bone mineral density (BMD) in Iranian perimenopausal women. Methods: The study population was referred women to the bone densitometry unit of Shariati hospital during 2000-2003 periods. After exclusion of 531 women reporting past or present corticosteroid use, 3209 women formed the final study population. Present HRT users (217 women) had significantly higher lumbar and femoral BMD than non-hormone users and this population excluded from further analyses. Postmenopausal status, late menarche, and late menopause were risk factors for low BMD. Protective factors against low BMD were increased body weight and increased number of pregnancies. In opposition to similar studies, hysterectomy and bilateral oopheroctomy had no significant relationship with decreased BMD. Results: A significant reverse correlation was found between length of breast-feeding and BMD. In the Multiple regression analysis, gynecological variables could account for only 23.5% of the variance in lumbar BMD and 38% of variance of femoral BMD. Conclusion: We conclude that reproductive history gives rise to some special risk groups, to whom BMD measurements and osteoporosis prevention efforts should be directed. However, it is impossible to predict BMD by gynecological characteristics.

Objective(s): To study of the effects of women reproductive factors on heel QUS parameters and comparison of it with BMD of femoral neck in normal women of Tehran.Methods: In 151 normal women, 20 - 72Y/O (participant of IMOS (Iranian Multicenter Osteoporosis Study), BMD (DXA) of femoral neck and QUS of heel (using Achilles+) was assessed. After assessment of normal values, Stiffness Index (SI) percentiles (2.5, 50, 97.5) in them established. Results: Mean values of BMD, SOS, BUA and SI, was 0.908±13.7, 36/75±1527/25, 121/42±15/1, 94/46±17/92, respectively. BMD and QUS parameters showed a significant decrease with age (P<0.01) and their relation with years since menopause was significant. Relation of gravity and parity and lactation with QUS parameters was significant but there was no such relation among BMD of femoral neck and gravity and parity. Its relation with lactation was weak.Conclusion: Results of this study shows more stronger effect of main reproductive factors on QUS parameters of heel than BMD of femoral neck measured with DXA method.

Objective(s): Osteoporosis remains a major problem following kidney transplantation. Radiographic measures of bone mass are of limited predictive value after transplantation and are complicated by preexisting renal osteopathy. Quantitative ultrasound (QUS) is a new and noninvasive method to assess skeletal status; however, limited data exist on ultrasonic bone parameters of phalanx after renal transplantation. We evaluated the potential of this method in osteoporsis diagnosis in renal allograft recipients in comparison to DXA and for better study of QUS results in these patients, we compared them to results of normal matched controls.Methods: Forty-two patients (age 40.17±11.9 years) were studied 2.8±2.9 years after transplantation. We used 49 healthy persons matched for age and sex as controls. A Lunar device (DPM-MD) was used for DXA scanning and QUS of phalanx was done in all of them using a DBM-Sonic 1200 device.Results: Osteoporosis found in 19% of all patients (9.5% in femoral neck, 9.5% in total region of femur and 9.5% in spinal region). Sensitivity of Ad-SOS( parameter measured with DBM-Sonic 1200) for osteoporosis diagnosis in above regions was respectively 100%, 75% and 25% and its specificity for that diagnosis in above regions was respectively 45%, 43% and 37% (there was not significant relation between them). Mean of Ad-SOS (amplitude dependent speed of sound, the parameter measured in QUS of phalanx) was 2036±79 in transplanted patients and 2060±86, in controls. There was no significant difference between them. Age, height and BMI were significantly related to Ad-SOS. Age and BMI had negative relation with Ad-SOS ( P-values 0.027 and 0.001).Ad-SOS had a positive relation with height (P-value = 0.013).There was no correlation between Ad-SOS and weight, dialysis time, time after transplantation, cumulative steroid dose and cumulative cyclosporine in transplanted patients.Conclusion: Our data suggests that QUS of phalanx is not a good way for assessing the changes of bone in renal transplanted patients in comparison to healthy persons, but may be used as a screening technique for osteoporisis in them. For establishment of diagnosis patient must be examined with DXA.

Objective(s): Osteoporosis is a common health related problem worldwide. About 50% of men and 70% of women aged 50 years and over suffer from osteoporosis or osteopenia in Iran. Patient education is of major value in prevention and management of osteoporosis complications. The aim of this study was to evaluate the efficacy of educational pamphlets for improving knowledge and practice of patients with osteoporosis.Methods: Of 370 patients with osteoporosis referred to an osteoporosis clinic during a 5- months period (Feb to Jun 2003), a total of 339 entered into the study. For each patient a standardized questionnaire was completed at baseline to evaluate her or his knowledge and practice about osteoporosis. Then patients received an educational pamphlet containing osteoporosis related materials. Patients received no other educational interventions during the study period. After 4 weeks a posttest were carried out using the same questionnaire. Results of pre and posttests were compared.Results: The mean age of respondents was 46.05 ±12.8 years, mostly female (95.6%), and 71.7% were in middle educational level. Comparing pre and posttests revealed 24% increase in knowledge score (from 5.01±3.05 to 7.96±2.12) and 16% improvement in practice skills of patients (P<0.001 for both comparisons).Conclusion: Educational pamphlets are of limited efficacy for improvement in knowledge and practice of patients with osteoporosis and combination of different educational methods is required to obtain satisfactory results.

Objective(s): To evaluate bone mineral density (BMD) in children and young adults with thalassemia and its potential risk factors. Methods: Two hundreds and twelve thalassemic patients aged 10-20 were enrolled in the study. In all patients height, weight, body mass index, growth indices, pubertal development, calcium intake and serum ferritin were assessed. BMD was determined by dual-energy X-ray absorptiometry (Lunar). BMD z scores between -1 and -2.5 were identified as low bone mass and z scores less than -2.5 were considered severely low bone mass. Results: Prevalence of severely low bone mass was 50.7% in lumbar spine, 10.8% in femur and 7.9% in both areas. There was no statistically significant between males and females. Low bone mass was observed in 39.5% and 37.5% of patients in lumbar and femoral areas. Patients with severely low bone mass in lumbar spine were older than the others (P<0.001). Conclusion: The data confirm significant reductions in BMD in Iranian thalassemic patients. Further research is needed to identify risk factors and preventive methods recommend.