Iranian Journal of Public Health
Year:2007 | Volume:- | Issue:A SUPPLEMENTARY ISSUE ON OSTEOPOROSIS|Papers Count:11

Osteoporosis is the most common metabolic bone disease. It is characterized by low bone mass and micro-architectural deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risk. Osteoporosis is an asymptomatic disease and is an important public health issue because of its clinical expression in age-related fractures. In Iran it is estimated that the prevalence of osteoporosis among women who older than 50 years old is 6 percent which is less than other countries such as Canada and Japan. The estimated lifetime risk of hip fracture for white women at age 50 years is about 16 percent (versus five percent for men). The incidence of fall related hip fracture in Iran in 2003 in male and female was respectively 20.6 and 17.5 per 100,000 person-year which is increased significantly in old people. Nowadays, several treatments are available and more are being developed. Currently available drugs are anti-resorptive which focus on decreasing bone turnover. Newer therapies with the aim of increasing bone formation are being studied. This document outlines all aspects of osteoporosis "especially in Iran "including risk factors, diagnosis, prevention and treatment.

Background: The aim of this study was to investigate vertebral geometry changes and determine cutoff value of vertebral height to predict fractures.Methods: In a cross-sectional study, 280 postmenopausal women recruited In all subjects bone mineral density and radiography of the lumbar spine performed. Lateral radiographs were evaluated for identification of vertebral fractures, using a validated semiquantitative method. T-score of vertebral height was calculated based on data extracted from Iranian Multicenter Osteoporosis Study. ROC curve used to determine cut off value of vertebral height T-score to predict fractures. Results: The mean of age and BMI were 55.34±8.7 years and 27.73±5 kg/m2, respectively. Among osteoporotic women, 59.8% had one or more vertebral fractures and 23.8% had at least 2 fractures. In fracture group the T-score of spine and femur BMD was lower than the others. The mean of vertebral height in women without fractures was 12.94±0.6 cm, and in the patient with 4 or more fractures was 12.3, thus every fracture accompany with 1.2% decreases in the height of vertebrae.The prevalence of vertebral fracture in osteoporotic patients was 71.4% and in healthy cases 39.5%. Better estimation of vertebral height T score in ROC curve was less than -0.7.The sensitivity and specificity of the cut off value were 81.3% and 52.9%, respectively.Conclusion: Vertebral fractures are common fractures in postmenopausal women. There was a correlation between vertebral height and fractures. Vertebral geometric parameters especially height T score can be used for fracture screening.

Background: To determine the protective impact of efficient serum copper concentration on BMD in women and to asses its impression on bone.Methods: six hundred healthy women through a national project in Iran, IMOS, were selected via a cluster random sampling and enrolled the study. They were divided to pre menopausal (404/600, 67.7% of total) and post menopausal (190/600, 32%of total) groups. BMD was measured by biphotonic absorptimetry DEXA for hip and lumbar spine. Morning serum copper concentration was determined by atomic absorption spectrometry.Results: Mean age was 40.92±14.8yr .Mean serum copper concentration= 105.85±40.15 mg/dl and mean BMI= 27.13±4.81 kg/m2.Totaly 2.4% was smoking, 5% had regular physical activities three times a week and 17.5% was copper deficient. Prevalence of Osteoporosis in postmenopausal women was 12.9% in copper deficient persons vs.11.3% in normal serum copper ones. No significant difference found according to serum copper concentration associated with BMI, age and vitamin D. Spine BMD revealed a significant correlation with serum copper content. (P= 0.001). This correlation also existed for Total hip (P<0.05). Premenopausal women with serum copper level above 105 mg/dl revealed a significant difference in hip BMD compared to whom with less copper concentration.1.02± 0.13kg/m2 vs. 0.97± 0.13kg/m2 (P = 0.001). Copper had an independent role on determining hip BMD in pre menopaused women (P= 0.001).Conclusion: copper has an independent role on bone density in all healthy women. It could have an adjourning factor for bone loss as well as a protective agent for osteoporosis.

Background: A growing body of investigations demonstrated the essence role of zinc on growing and maintaining bone tissue. The idea that zinc could enhance bone content and adjourn or prevent osteoporosis in men, has been experimented as a hypothesis.Methods: Six hundred healthy men (age 20-69 yr) through Iranian Multicenter Osteoporosis Study (IMOS) which is a national project running in 5 provinces in Iran for prevention and treatment of osteoporosis was selected via a cluster random sampling and enrolled the study. Bone Mineral Density was measured by biphotonic absorptimetry DEXA for hip and lumbar spine. Zinc morning serum concentration was determined by atomic absorption spectrometry. SPSS 11.5 was used for data analysis. Body Mass Index (BMI) has been calculated by Weight (kg)/Height (meter)2 for each person.Results: The mean age was 40.83±15.06 yr .Mean BMI was 24.79±3.94 kg/m2, overlay 27.3% were smoking, 12.5% had regular physical activities three times a week and 12.2% had a history of renal stone. Among them 30.1% had zinc depletion, 56.8% normal range and 13.1% had serum zinc excess. 57.1% of individuals over 40 yr with hip osteoporosis were zinc deficient whereas 22.1% of them with normal BMD had this deficiency (P<0.001).Conclusion: It is concluded that zinc has a positive association with BMD in men over 40 yr and zinc deficiency is more common in osteoporotic individuals.

Background: In view of the current high prevalence of diabetes mellitus (DM) and osteoporosis, today there is great interest in studying the possible association between these two disorders. The aim of this study was to determine the association between type-2 DM, and Bone mineral density (BMD) in Iranian women.Methods: BMD was determined in the femoral neck and at the L2-L4 level (DEXA) 0f 518 women aged 40-80 years old, referred to bone densitometry unit of Endocrinology and Metabolism Research Center of Tehran University of Medical Sciences (146 patients with type 2 diabetes and 372 normal controls).Results: In diabetics patients, BMD values at the vertebral site were higher than non-diabetic patients but the difference was only significant in postmenopausal subgroup (P= 0.045). Besides, BMD values at the hip site were higher when compared with non-diabetes group, but the difference was not significant. Frequency of osteoporosis risk factors (tea consumption, sunlight exposure, late menarche, low physical activity, smoking habits, family history of osteoporosis and inadequate calcium intake) were not significantly different between diabetic and non-diabetic women , but prevalence of early menopause was higher in diabetic women (P= 0.046). Prevalence of osteoporosis in premenopausal and postmenopausal was 7% and 41.6% in diabetic and 15% and 36.8% in non-diabetic women, respectively. Prevalence of osteoporosis and osteopenia was not significantly different in diabetic and non-diabetic groups.Conclusion: The present results demonstrate that there is not clear association between BMD and type 2 diabetes mellitus.

Background: To investigate the relationship between renal stone formation and osteoporosis. Methods: Eight hundred thirty healthy subjects aged between 20 and 76 years were randomly selected from 50 clusters to take part in the study. Of these, 68 (8.2%) had a previous history of renal stone disease. All participants underwent clinical examination and bone mineral densitometry of the lumbar spine and femur using the dual-energy X-ray absorptiometry technique. Plasma levels of vitamin D3, calcium, phosphate, alkaline phosphatase, and parathyroid hormone were also measured.Results: Data showed that patients with a history of renal stones had a higher prevalence of osteoporosis (16.7%) and osteopenia (53.3%) than the subjects without a history of renal stone disease (11.2% and 35.7%, respectively). For both men and women the mean age of patients with a history of renal stone disease was significantly lower than patients with no disease history (men: with history 44.27+/-14.8, without history 50.28+/-12.3; P= 0.02) (women: with history 43.21+/-11.8, without history 49.06+/-9.6; P= 0.02). Female patients with a history of renal stone disease also had a significantly lower (8.74%) mean spinal bone density (P= 0.02), but there were no other significant differences in either the biochemical parameters that were measured or in the hip bone density.Conclusions: These data suggest that osteoporosis may be more prevalent in those patients that have had a history of renal stone formation.

Background: Recently, osteoporosis is an increasingly important public health problem in men. The aim of this study was to investigate relationship between life style and bone mineral density in men.Methods: Among the 20-76 year-old men of Tehran, 325 persons were selected randomly from 50 clusters. The persons suffering from rheumatoid arthritis, thyroid diseases, fractures or other conditions which effect bone metabolism were excluded. All participants underwent clinical examinations and lumbar and spinal densitometry using DXA method. Results: In lumbar spine, peak bone density was seen between ages 25 and 40 yr and in hip, between 20 and 30. In men older than 50 yr, prevalence of osteoporosis and osteopenia, were 3.9% and 50%, respectively. Bone mineral density was significantly correlated to calcium and vitamin D intake, physical activity and smoking.Conclusion: Nutritional intake and physical activity are important factors in maintaining bone mineral density. Peak bone density in 20-40 year-old population and its relation to life style could be useful in policy-making for the prevention of osteoporosis.

Background: Tea is the most commonly consumed beverage by Iranian adults after water, and while previous studies have examined the negative effects of coffee-based caffeine on Bone Mineral Density (BMD), the relationship between the consumption of tea and BMD has not been clearly explored. The aim of this study was to investigate the relationship between habitual tea drinking and BMD in the adult Iranian population.Methods: BMD was measured at the lumbar spine and hip, in 830 men and women living in Tehran, all aged between 20 and 76 yr old. The degree of tea consumption was assessed by questionnaire, and subjects were categorized as either tea drinkers (more than 5 cups of tea per day) or non–tea drinkers (equal or less than 5 cups of tea per day).Results: After adjusting for age and body mass index, it was found that female tea drinkers had a small (4.2%), but significantly higher BMD in the hip (P= 0.01).Conclusions: This may suggest a potentially positive effect for habitual tea drinking on the BMD of those women with an inadequate consumption of calcium and vitamin D.

Background: Osteoporosis is a disabling disease characterized by compromised bone strength, which predisposes a patient to increased risk of fracture. The aim of this study was evaluation the pattern of bone mass in Iranian healthy population.Methods: The study was performed between December 2000 and May 2001 on one thousand three healthy Iranian subjects who currently live in Tehran. They were selected randomly by cluster random sampling among men and women of 10-76 yr from 50 clusters. The volunteer people were referred to the Bone Mineral Density BMD unit of EMRC. The participants were recalled for three times and the response rate was 83%. BMD was measured by DXA using Lunar DPXMD device.Results: Females achieved maximum lumbar BMD up to 25-35. Femur BMD maximized in 30 to 35 and after 45 the intensity of bone loss increased. Female peak bone mass in lumbar region was 1.19±0.12 g/cm2 and in femur was 1.02±0.12 g/cm2. Male peak bone mass in lumbar region occurred between ages 25-40 yr, Male's femur BMD maximized in 20-30. In male peak lumbar bone mass was 1.22±0.16 g/cm2 and femur was 1.08±0.15 g/cm2. Osteopenia was recognized in 50% and 48.8% of women above 50 in spine and total femur, respectively, however these percentages were 37.1% and 34.8% among male subjects.Conclusion: Iranian BMD values sufficiently different from other countries to warrant a separate reference sample with which to compare individuals for the purpose of diagnosing osteoporosis and osteopenia according to the WHO criteria.

Background: The principal aim of this study was therefore to investigate association between family history of osteoporotic hip fracture, BMD and femur geometry in Bushehr city in South of Iran. Methods: In this cross-sectional study, data were obtained from Iranian Multi-center Osteoporosis Study (IMOS) in Bushehr. Healthy men and women aged 50 to 75 years were selected based on randomized clustered sampling of all regions of the corresponding city. BMD was measured once at the lumbar spine (L2-L4) and proximal femur with dual X-ray absorptiometry using Lunar DPX densitometers. From the DXA image the operator manually determines the hip axis length (HAL) and femoral neckshaft angle. The HAL was measured from the inner pelvic brim to the lateral side of the femur. The femoral neck–shaft angle was defined as the angle between the femoral neck axis and the femoral shaft axis.Results: There were no significant differences between the family fracture history groups with regard to the potential confounders of age and body mass index (BMI). HAL of women with history of hip fracture was greater but history of hip fracture showed no significant relation with other variables.Conclusion: These findings suggest that individuals with a positive family history may be at higher risk of osteoporotic hip fracture because they have greater HAL and more prone to buckle at the femur neck.

Background: Pregnancy and accelerated fetal growth always are related with major metabolic changes and body fat redistribution and adiponectin is one of principle adipocyte hormones, so studying adiponectin changes during pregnancy may reveal some hidden parts of fetal metabolism. The aim of this study was to assess adiponectin and leptin levels in umbilical cord and maternal serum, their relation with each other and with neonatal weight, birth length and other fetal growth markers.Methods: The study was carried out with 72 appropriate for age newborns (36 female, 36 male) and their mothers. The anthropometric variables of the newborns studied were birth weight, birth length, and birth weight/birth length and ponderal index. Maternal and umbilical cord adiponectin and leptin levels were measured by ELISA and compared.Results: The median of cord blood adiponectin concentration were 3 fold higher than those of maternal group. Umbilical cord blood leptin levels were significantly correlated with neonatal birth weight and birth weight/ birth length (r= 0.29, P= 0.01 and r= 0.24, P= 0.04, respectively). No statistical difference has been demonstrated between both groups of male and female neonates regarding birth weight, birth length, maternal and neonatal leptin levels, ponderal index and maternal and neonatal adiponectin levels.Conclusion: Neonatal leptin is related to birth weight. Adiponectin has no relation with birth weight. Neither leptin nor adiponectin correlated with gender difference.