Journal of Reproduction & Infertility
Year:2005 | Volume:6 | Issue:1 (21) (OSTEOPOROSIS SPECIAL ISSUE)|Papers Count:13

Osteoporosis, a disease, 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; it is caused when bone resorption proceeded bone formation. Peak bone mass and bone loss are major determinants for risk of fragility fractures in people .Dangerous complication of osteoporosis is pathologic fracture that can cause even death among patients. Now a days multiple treatments are available and more are being developed. From prevention to treatment of established disease, the goal is to intervene as early as possible to ensure saving of bone mass and to preserve structural integrity of the skeleton, thus preventing pathologic fractures Currently available drugs are anti-resorptive and focus on decreasing bone turnover. Newer therapies with the aim of increasing bone formation are being studied and are about to be released. This document outlines all aspects of osteoporosis including risk factors, diagnosis, treatment and prevention all over the world and Iran.

Introduction: 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. Materials and Methods: 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.Results: 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.Conclusion: 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.

Introduction: Osteoporosis is a major problem of health care delivery services, both in developed and developing countries. Osteoporosis has bean defined as a disease characterized by low bone mass, which leads to enhanced bone fragility and increased fracture risk. Osteoporotic Fractures are one of the most common causes of disability and a major contributor to medical care costs in many regions of the world. There is substantial variation in the incidence of hip fracture in different regions. It has been projected that by the year 2050, 50% of all hip Fracture in the world will occur in Asia. Unfortunately there is not any information about incidence of hip fracture in Iran. The results of Iranian Multicenters osteoporosis study (IMOS) have shown 70% women and 50% men older than 50 years and older have osteoporosis or osteopenia. Thus this study performed to determine the incidence of osteoporosis hip Fracture in 3 years follow up of IMOS in Tehran. Materials and Methods: All the patients in the IMOS study who were 50 yr and over were selected to fill the questionnaire. The questions were about the incidence of fracture in 3 year after the beginning of IMOS and some demographic factors. Data analysis was performed with SPSS (11.5). Student T- test was used to determine the differences in mean values, and for quantitative measures x2 was used. P- Values less than 0.05 were considered significant. Results: The results of this study suggest that hip fracture incidence rate increase exponentially with aging and about 90.9 percent of all hip fractures occur in women. There is lower incidence of hip fracture in Tehran population compared to the Western Europe and North American population. It is unclear whether genetic or environment factors contribute to such variation.Conclusion: Correlation between hip fracture and osteoporosis in hip region can help in prediction the future fracture due to osteoporosis base on the results of bone densitometry.

Introduction: Osteoporosis is a common worldwide health-related problem. About 50% of men and 70% of women aged 50 years and over suffer from osteoporosis or osteopenia in Iran. Vitamin D deficiency has a high prevalence in Tehran population. Materials and Methods: This study was carried out on 184, 20-69 year old residents of 14 blocks around(4 kilometers) of 5 air pollution stations in Tehran. These stations were divided into 2 areas (polluted and non polluted). For all paricipum in study BMD and serum marker include vitamin D, Ca, P, Alk-ph, PTH and bone mineral density in lumbar region (L2-L4) and hip were assessed. SPSS (II.5) was used for statistical Analysis. The difference between mean values was assessed with student T- test, x2 for quatitative measures and if necessary, Fisher Exact Test was used. Risk was evaluated with relative risk and Odds Ratio. P- value less than 0.05 was perceived as significant. Results: Vitamin D deficiency prevalence in the men in polluted areas was higher than the men in non polluted areas (p=0.029). Prevalence of osteoporosis in polluted areas in both sexes was higher in contrast to non-polluted. (0.6% and 0.0% respectively, p=0.034). The chance of vitamin D deficiency in men living in polluted areas was 1.675 greater than the other men (odds ratio: 3.869, relative risk: 1.675).Conclusion: living in air-polluted areas can be an important risk factor for osteoporosis. Since the change in residency place may not be so simple, attention should be paid to the other aspects to decrease vitamin D- deficiency. Food fortification with vitamin D would be a good choice.

Introduction: vitamin D deficiency is cause of in bone diseases such as rickets in children and osteomalasia in adults. It can result in bone pain and myalgia. Since vitamin D deficiency is prevalent in Iran population, it will be useful to determine the relation between vitamin D deficiency and musculoskeletal of pain. Materials and Methods: Subjects were 20 to 69 years-old men and women of Tehran. Persons who had diseases such as rheumatoid arthritis, hyper or hypothyroidism, Parathyroidism and adrenal, diabetes mellitus, renal failure, aggressive hepatic failure and every kind of cancers, were excluded. Study participants were selected with gathering the data of all first- labors in Tehran. Blood sample was taken from all participants to measure serum vitamin D, PTH, Ca, P and Alk- ph. Candidates were invited for evaluation of bone density in BMD ward of Endocrinology and Metabolism Research Center. Data was analyzed with SPSS (11.5). T- Test was used to measure the difference between mean values, whenever possible; data was analyzed with nonparametric statistics. X2- test was used to compare the frequency of variables. P-values less than 0.05 were considered as significant. Results: 1229 persons were invited to undergo bone densitometry. 124 persons were excluded because of having one of the excluding criteria.After 3 times calling and face to face following, 830 out of 1105 persons (75.1%) took part in this study. 50% of women with continuous bone pain had some degrees of vitamin D deficiency (p=0.015). severe vitamin D deficiency was more prevalent in women over 50 complaining of pain, than the others (p=0.034).Conclusion: several degrees of vitamin D deficiency are shown in people with complains of unknown origin skeletal pain. Vitamin D supplements and food fortification with vitamin D will be helpful in reliving these kinds of pains.

Introduction: Bone mass loss is one of the most common menopausal symptoms resulting from cessation of estrogen production. Compounds with estrogen- like biological activity similar to "Isoflavones" present in plants especially Soy, may reduce bone loss in postmenopausal women 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.Materials and Methods: In this "before and after" clinical trial,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 baseline of the study, and at the 6 and 12 weeks. The food consumption data were analyzed by "Food Processor" software. Repeated measurement analysis was done to determine the changes in biochemical indices, anthropometric and dietary data. P-values less than 0.05 were considered as significant.Results: Comparison of weights, BMIs, physical activity and dietary intake of subjects during the study did not show any significant differences. Soy protein consumption, showed significant reductions in urinary deoxypyridinoline (biochemical marker of bone resorption) and significant increase in serum 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 telopeptide. Conclusion: 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.

Introduction: Osteoporosis is a major health problem because of the large health care costs associated with its clinical consequences. It is therefore of great important to identify modifiable risk factors. We investigated associations between fruit and vegetable intake and bone mineral density in rural population surround Tehran. Materials and Methods: The study population was a subgroup of a large study on the prevalence and causes of vitamin D deficiency in rural population surround Tehran. 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 was measured by standard methods. BMD was measured by Dual X-Ray (DXL) (Calscan) method at the heels. Results: Osteopenia and osteoporosis rate in women older than 50 were 55.5% and 33.3% and in men 69.2% and 7.7% respectively. The chance of having osteoporosis in women was 4.33 of men (RR=4.33). Fruit intake was not correlated with BMD. Vegetable intake was positively associated with BMD just in women. According to interquartile range of vegetables intake women were grouped as those consuming less than 1.5 serving of vegetables per day and those consuming more. The women reporting 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 consuming more vegetables had high intake of some nutrients such as vitamin C, vitamin A, potassium, magnesium, zinc, float, iron, sodium, calcium and phosphorus but none of them except for vitamin A (r=0.03, P<0.05) was correlated with BMD. Conclusion: High consumption of vegetables positively affects bone mineral density in women and daily intake of at least 1.5 servings of vegetables is recommended to prevent osteoporosis.

Introduction: Graves disease (GD) is one of the autoimmune diseases in which the immune system over stimulates the thyroid gland, causing hyperthyroidism. 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 turnover 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. Materials and Methods the subjects of our study were 31 consecutive untreated GD patients and 37 normal volunteers which were matched on sex proportion and age range. GD was diagnosed by suppressed levels of TSH and elevated levels of free T3 (fT3) and free T4 (fT4) and positive thyroid receptor antibody (TR). 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. Student T- test was used to compare the mean values and if necessary non- parametric statistics were used. X2 were used to compare the frequency of variables and if possible Exact Fisher Test was used. P- Values less than 0.05 were considered significant.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. After treatment we found a significant improvement and returning to normal range in all serum lab tests. There weren't any difference 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 turnover. These findings indicated that early diagnosis and management of Graves' disease can be effective for osteoporosis prevention in these patients.

Introduction: Many patients using Levothyroxine, have osteopenia or even osteoporosis by the definition of the World Health Organization based on bone mineral density (BMD). Dual-energy X-ray absorptiometry (DXA) of femur and spine, the standard method for diagnosis of osteoporosis, needs nonportable devices that are not available everywhere. DXL (DXA of calcaneus) is a mobile and less expensive method for assessing the bone. There is little data about this methods correlation with DXA in patients using Levothyroxine. The present study assessed the value of DXL in detecting changes in bone structure in these patients compared with DXA. Materials and Methods: In a cross-sectional analysis, 62 patients (4 men) with a mean age of 53.32+-10.54 years, were studied. A GE-Lunar device (DPX-MD) used for DXA of the hip (neck and total) and spine. DXA of the calcaneus measured using a Demeteck device. SPSS (10) was used for statistical analysis. Sensitivity and specificity of DXL method were measured with ROC curve. P- Value less than 0.05 were considered significant. Results: The mean age of patients was 53.32±10.54 years. Osteoporosis found in 18% of patients in any of the total of femur or L2-L4 regions (6% in total region, 16% in L2-L4 regions). Using DXL, osteoporosis diagnosed in 18% of patients. Using ROC curve, sensitivities of T-score ≤-2.5 of calcaneus for diagnosing of osteoporosis in total of hip and L2-L4 regions were respectively 75% and 60% and specificities were respectively 88.2% and 90.2% .Area under curve of total and spine regions were 0.975 (P-value=0.002) ,0.866 (P-value=0.000), respectively. Conclusion: DXL (DXA of calcaneus) can be recommended for screening of osteoporosis among Levothyroxine user patients. Those suspected of osteoporosis, should be examined by additional DXA measurement for establishment of diagnosis before initiation of therapy.

Introduction: Many patients under hemodialysis, have osteopenia or even osteoporosis by the definition of the World Health Organization based on bone mineral density (BMD). Dual-energy X-ray absorptiometry (DXA), the standard method to assess BMD, is not always available. Quantitative ultrasound (QUS) of phalanx is an inexpensive, mobile, and radiation-free diagnostic alternative. There is few data about correlation of this method with DXA in patients undergoing hemodialysis. The present study assessed the value of QUS in detecting changes in bone structure in patients under hemodialysis compared with DXA. Materials and Methods: The patients had End Stage Renal Disease (ESRD) who was referred for Bone densitometry in BMD ward of EMRC. BMD of the hip (neck and total) and spine was measured using a GE-Lunar DXA device (DPX-MD). QUS of phalanx was done in all of them using a DBM-Sonic 1200 device. This device measures amplitude dependent speed of sound (Ad-SOS). SPSS (10) was used for statistical analysis. ROC curve was drawn to measure the sensitivity and specificity of QUS of phalanx. P- Value less than 0.05 were considered as significant. Results: In a cross-sectional analysis, 64 patients (37 men) with a mean age of 51.33+-15.20 years and mean dialysis time of 49.45+-45.62 months (2-180), were studied. DXA measurements established the diagnoses of osteoporosis in 31.3% in any of the total of femur or neck of femur or L2-L4 regions (25% in Neck , 18.8% in Total , 7.9% in L2-L4 regions).Using QUS of phalanx, osteoporosis diagnosed in 28.1% of patients . Using ROC curve, sensitivities of T-score ≤-2.5 of phalanx for diagnosing of osteoporosis in neck and total of hip and L2-L4 regions were respectively 37.5% and 50% and 80% and specificities were respectively 75% and 77% and 76%. Area under curve for neck, total and spine regions were 0.692 (P-value=0.022), 0.701 (P-value=0.031), 0.809 (P-value=0.023), respectively.Conclusions: QUS of phalanx can be recommended for screening osteoporosis among hemodialysed patients. Those suspected of osteoporosis, should be examined by additional DXA measurement for establishment of diagnosis.

Introduction: 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 in these countries. In this study we aimed to assess the association between demographic factors and Osteoporosis in urban Iranian postmenopausal womenMaterials and Methods: This study was a case-control, case record and interview based study, It was conducted in two bone mineral density centers from Tehran (Bone mineral densitometry center of Shariati hospital as public and Mehrad bone densitometry as private center) during the period Jun 2002 to July 2003. Case group includes 163 Osteoporotic postmenopausal women whose their spine and femoral bone mineral density was measured by DEXA using lunar machine in both centers. Controls were selected from same bone mineral density center and matched to the case patients according to age groups. SPSS (10) was used for statistical analysis. Odds Ratios were calculated to evaluate the relationship between osteoporosisi and its risk factors. Student T-test was used to compare mean values and X2 to compare frequency of variables. P-values less than 0.05 were considered significant. Results: The odds ratios with 95% confidence interval for demographic risk factors of Osteoporosis are as follow: illiteracy (no schooling) 3.4 (1.64,7) in both centers, 2.31 (1.06, 5.06) in public center, 12.18 (1.41, 105.57) in private center, illiteracy of husband 5.09 (1.43, 18.12) in both centers, 3.76 (1.04, 13.69) in public center, occupation (being a housewife) 1.56 (.97, 2.50) in both centers, 2.041 (1.19, 3.50) in public center, After adjustment for age, weight and height and other important factors like age of menopause, menarche and ... all of the above factors remained significant except the occupation. Other demographic factors that were assessed in this study include: patient occupation in private center, husbands occupation and marital status in both centers, none of these factors found to have significant association with osteoporosis.Conclusions: No schooling and schooling less than 6 years were the major demographic factors that were associated with Osteoporosis as risk factors in both private and public centers in Tehran. In this study we found that there was not a strong association between occupation and osteoporosis as a risk factor (especially in private center, among rather high socioeconomic group). High education level has been shown as a protective factor of osteoporosis in both centers.