Peak bone mass of Iranian population: the Iranian Multicenter Osteoporosis Study

Prevalence of osteoporosis in the Iranian population: a systematic review and meta-analysis

Purpose

The prevalence of osteoporosis increases as the population ages. The aim of this study was to conduct a systematic review and meta-analysis to estimate the prevalence of osteoporosis among the general population ≥ 50 years old in Iran.

Methods

Multiple databases including Scopus, WOS, Medline, Embase, and Persian databases (SID and Magiran) were systematically searched to identify relevant research papers. All population-based studies estimating the prevalence of osteoporosis in the Iranian population were included and imported into Endnote software. Two authors independently reviewed the articles. The Newcastle-Ottawa Scale was used to assess the risk of bias. Statistical analysis was performed using Stata software, and a significance level of 0.05 was applied to the analyses.

Results

Totally 2117 documents were retrieved from the databases up until October 11, 2022. After reading the full texts, 10 documents were included in the study. Our results indicated that the pooled prevalence of osteoporosis in the femoral neck region was 0.19 (95%CI: 0.12-0.26) and 0.19 (95%CI: 0.13-0.25) for women and men, respectively. Pooled prevalence of spinal osteoporosis was 0.29 (95%CI: 0.21-0.38) among women and 0.16 (95%CI: 0.12-0.19) among men. The total pooled prevalence of osteoporosis was 0.38 (95%CI: 0.29-0.48) for women and 0.25 (95%CI: 0.22-0.29) for men.

Conclusion

Our study highlights the elevated prevalence of osteoporosis among individuals aged 50 years and older, with females exhibiting higher rates. Notably, osteoporosis in the femoral neck region demonstrated the lowest prevalence in both sexes. The implementation of comprehensive strategies is imperative to address osteoporosis problems effectively.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-023-01352-9.

Osteoporosis guideline awareness among Iranian nurses: results of a knowledge and attitudes survey

Introduction

Osteoporosis is a chronic and progressive disease associated with gradual bone loss and elevated risk of fracture. Role of health care professional especially nurses in lowering burden of osteoporosis via patients and public education is critical. Current study conducted to evaluate knowledge and attitude regarding osteoporosis among the nurses in orthopedic wards and their experience with national clinical osteoporosis guideline.

Methods

A cross-sectional study was conducted from August to December 2016 among all nurses in orthopedic ward of hospitals affiliated to Shiraz University of Medical Sciences. The 23- item self-administered scale consisted of knowledge and attitude questions were used. Moreover, data regarding participation in osteoporosis training courses and awareness of the national osteoporosis clinical guideline were collected as a measure of nurses’ experience with guideline. The gathered data were analyzed using SPSS (V. 16), student t-test was used to compare total knowledge and attitude scores between categorical demographic and professional data. Pearson test was used to calculate the correlation between total knowledge and attitude scores and years of practice. A p-value < 0.05 was considered statistically significant.

Results

From total of 160 nurses, 143 of them completed the questionnaire (response rate: 89.3%). The total mean ± SD knowledge and attitude scores were 11.60 ± 3.10 and 3.47 ± 0.92 respectively. Six nurses (4.2%) had participated in osteoporosis training courses after graduation, and 39 (27.3%) had been aware of the national osteoporosis clinical guideline. Knowledge and attitude scores among nurses who practice in private hospitals was higher than those practices in the teaching hospitals. These differences were statistically significant based on student t-test. According to Pearson correlation coefficient, there was positive and significant correlation between nurses’ knowledge and attitude score (Correlation coefficient: 0.199, p-value = 0.037).

Conclusion

Our findings reveal that nurses’ knowledge and attitude regarding osteoporosis was not satisfactory. Most of them were not aware of national osteoporosis clinical guideline and had not participated in osteoporosis training courses after their graduation. We need more empowered nurses to lowering burden of osteoporosis and its consequences in the future.

Economic burden of osteoporosis in the world: A systematic review

Background: Osteoporosis is a skeletal disease that is associated with a reduction in bone mass and microstructures and deterioration of bone tissue. It is also associated with an increased risk of fracture that is the most important complication of osteoporosis. The knowledge about costs and economic aspects of osteoporosis plays an important role in making policies and planning measures for the prevention and management of this disease; hence, this study systematically investigated the available evidence on the costs associated with osteoporosis worldwide. Methods: In this systematic review, electronic searches were performed on various online databases, including PubMed, Embase, Scopus, web of science, ProQuest, and Cochrane. The timeframe selected for searching articles was from 1980 to 2018. Results: Of a total of 1989 papers, 28 papers were included in the study on the basis of inclusion criteria. Based on the data extracted from the mentioned studies, the mean age of people with osteoporotic fractures was 50 years, with the highest costs associated with hip fractures. Conclusion: Our review indicated that the cost of osteoporosis carries a significant economic burden on countries in the world. The main cost drivers in this study were Fracture-related costs. The direct annual cost of treating osteoporotic fractures of people on average is reported to be between 5000 and 6500 billion USD in Canada, Europe and the USA alone, not taking into account indirect costs such as disability and loss of productivity. Prevention of this disease can significantly reduce the costs incurred by the health system.

Bone mineral density in transfusion-dependent thalassemia patients and its associated factors in Southern Iran

Despite the significant improvements in the management of thalassemia, there are growing concerns regarding their long-term complications. We showed that low bone mass is one of the most prevalent complications among these patients. Insufficient physical activity and hypogonadism are the main possible associated factors followed by DM and insufficient sun exposure.

PURPOSE

Despite the significant improvements in the management of transfusion-dependent thalassemia (TDT), there are growing concerns regarding their long-term complications.

METHODS

This cross-sectional study included 615 TDT patients who were registered and followed in a comprehensive thalassemia clinic in Southern Iran. We measured serum biochemical tests and bone mineral density in all patients. We recorded physical activity and sun exposure subjectively, and an endocrinologist visited and examined all the patients. A group of age- and gender-matched healthy volunteers participated in the study as the control group.

RESULTS

The mean age of the studied population was 28.4 ± 7.7 years, and 55.8% were female. The prevalence of vitamin D deficiency was 45.6% and 54.4% in TDT patients and the control group. A portion of TDT patients suffered from different endocrinopathies, which included hypogonadism (49.8%), diabetes mellitus (17.2%), hypoparathyroidism (14.6%), and hypothyroidism (6.3%). The prevalence of low bone mass in patients with TDT was 48.3 and 74.6% in the femoral and lumbar bones, respectively. Low physical activity, insufficient sun exposure, diabetes mellitus, and hypogonadism were associated with low bone mass.

CONCLUSION

Low bone mass is highly prevalent among TDT patients in Southern Iran. Insufficient physical activity and hypogonadism are the main possible associated factors, followed by DM and insufficient sun exposure.

The role of using different reference population in the prevalence of low BMD in the thalassemia patients

Purpose

Prevalence of osteoporosis reported as high as 50% in thalassemia major patients. We compared bone density (BMD) of our patients with results of bone densitometry of participants of a national study, to find if BMD diagnosis is ethnicity sensitive or not.

Methods

In 177 adult beta thalassemia major patients and 490 normal subjects of 20-39 y/o range, dual-energy X-ray absorptiometry of the spine and femur performed. Normal subjects participated in Iranian Multi-center Osteoporosis Study (IMOS). Mean and standard deviation of normal ones achieved and Z-score of patients re-calculated based on normal Iranians. As BMD of normal participants and patients performed by devices of different brands, analyses done based on calculated standard BMD of all participants.

Results

BMD of patients was significantly lower than normal participants (P value <0.001). Frequency of Z-score ≤-2 found in 52% and 56% of patients in femur and spine regions, respectively. New Z-score of patients according to Iranian normal populations calculated. Frequency of this new Z-score ≤-2 found in 16% and 72% of patients in femur and spine regions, respectively.

Conclusions

We think in secondary osteoporosis, may be other cut-off points, especially according to BMD of normal population of that geographical region are needed.

The association between vitamin D status and metabolic syndrome and its components among female teachers residing in Yazd city

BACKGROUND

Studies trying to find the association between vitamin D status and metabolic syndrome (MetS) have led to inconsistent results, and community-based data for individuals living in the Middle East are limited.

OBJECTIVES

To find out if MetS and its components are associated with vitamin D status among female teachers residing in Yazd city during winter 2015.

MATERIALS AND METHODS

A total of 276 female teachers (case group, n=124 and control group, n=152) aged 20-60 years were included. Weight, height, waist circumference, blood pressure, daily energy intake, physical activity, serum 25 hydroxy vitamin D (25(OH)D₃), fasting blood glucose, triglycerides and high-density lipoprotein cholesterol (HDL-C) levels were assessed. Logistic regression was used to examine the odds ratio of MetS according to vitamin D status.

RESULTS

Mean serum 25(OH)D₃ was 32.79±18.62ng/ml and 33.73±20.20, in females with and without MetS, respectively (P>0.142). Compared to those with 25(OH)D₃of <20ng/ml, the odds ratio for MetS was 1.01 (95% CI: 0.48-2.13) and 0.95 (95% CI: 0.56-1.60) for those with serum 25(OH)D₃ levels of 20-29ng/ml and ≥30ng/ml, respectively (P trend=0.84). The association remained insignificant after adjusting for potential confounders. Furthermore, vitamin D status was not associated with MetS components (P>0.05).

CONCLUSION

Although several studies have claimed the association between vitamin D status and MetS, we could not find a similar connection in a sample of Iranian female teachers. Prospective studies are needed to determine the possible effect of vitamin D in the development of MetS, particularly in the Yazd province.

Comparison of the effect of vitamin D on osteoporosis and osteoporotic patients with healthy individuals referred to the Bone Density Measurement Center

Objective Osteoporosis is the most common metabolic disease of the bones. Osteoporosis reduces bone density, predisposes a person to fractures, and imposes high costs on societies. Osteoporosis develops from a variety of causes, one of the most significant is vitamin D deficiency. This study investigates the impact of vitamin D on osteoporosis. Materials and Methods In this clinical trial, 400 patients referred to the Bone Density Clinic of Kowsar Hospital in Semnan were selected by convenience sampling method. Bone densitometry tests were carried out using DEXA (x-ray absorptiometry) and serum vitamin D levels were measured by the ELISA method. Subjects with vitamin D deficiency were treated for 8 weeks with (50,000 Vitamin D units per week. At the end of the treatment period, all subjects were evaluated for bone density and the results of both groups were compared. Results 13% of subjects had osteoporosis and 14.2% had osteopenia. 19% of subjects had vitamin D deficiency, 38.8% had insufficient levels of vitamin D, and 42.3% had sufficient vitamin D levels. The level of vitamin D in patients with osteoporosis (5.50 ± 5.5 ng/ml) was less than those with osteopenia (7.83 ± 4.8 ng/ml) and those with normal bone mineral density (23.88 ± 18.42 ng/ml) (P <0.001). The prevalence of osteoporosis in the intervention group after intervention with vitamin D was significantly lower than the control group (32.3 versus 67.7 and P <0.001). Conclusion The prevalence of serum vitamin D deficiency in osteopenic and osteoporotic individuals was higher than in normal subjects, with a significant relationship between age and sex. Thus, treatment with vitamin D improves bone density indices.

Efficacy and Safety of the Biosimilar Recombinant Human Parathyroid Hormone Cinnopar® in Postmenopausal Osteoporotic Women: A Randomized Double-blind Clinical Trial

Background:

Due to high cost and burden of osteoporosis, it is reasonable to focus on the reduction of fractures as the main goal of treatment. We compared the efficacy and safety of a new biosimilar recombinant human parathyroid hormone (CinnoPar®, CinnaGen, Iran) to the reference product (Forteo®, Eli Lilly, USA) in a randomized double-blind clinical trial (RCT).

Methods:

Overall, 104 osteoporotic postmenopausal women aged 45–75 yr were randomized to receive 20 μg daily subcutaneous injections of either Forteo® or CinnoPar® for 6-months from 2011–2012. Bone biomarkers were measured at baseline, and during first, third, and sixth month’s follow-up along with lumbar spine, total hip, and femoral neck bone mineral density (BMD) assessment at the baseline and six months after that. The study was registered in Iranian registry of clinical trials under the registration number of IRCT138810121414N5. The endpoints were to compare bone biomarkers, BMD and drug safety between groups. Data analysis was performed using SPSS 11.

Results:

Age range of ninety-four patients who completed the study was 42–81 yr. Participants were divided into Forteo (45 subjects) and CinnoPar (49 subjects) groups. No significant difference in terms of bone biomarkers or BMD scores was shown between groups (P≥0.05). The most prevalent side effects were hypercalcemia and hypercalciuria without any significant statistical differences between groups.

Conclusion:

CinnoPar® can be considered as a good alternative therapy for Forteo® in postmenopausal osteoporotic women due to its comparable efficacy and safety properties.

Prevalence of vertebral fracture and densitometric osteoporosis in Spanish adult men: The Camargo Cohort Study

The aim of this study was to assess the prevalence of densitometric osteoporosis and vertebral fractures in Spanish men aged ≥50 years, and to study how the relationship between them may change depending on how osteoporosis is diagnosed. A community-based population of 1003 men aged ≥50 years was studied. Bone mineral density (BMD) was measured by DXA at the lumbar spine, femoral neck and total hip. Vertebral fractures were assessed by lateral thoracic and lumbar spine radiographs. The prevalence of osteoporosis was estimated with both the World Health Organization (WHO) (T-score of <-2.5 at the femoral neck, calculated using the young white female normal reference database) and the National Osteoporosis Foundation (NOF) criteria (T-score of <-2.5 at the femoral neck, total hip or lumbar spine, calculated using the young white male normal reference database). The prevalence of osteoporosis using the WHO criterion was 1.1% and using the NOF criterion was 13%, while that of vertebral fractures was 21.3%. The area under the curve (AUC) for the relationship between BMD and vertebral fracture prevalence was 0.64. The odds ratio for osteoporosis using the WHO definition was 2.57 (p = 0.13), and 1.78 (p = 0.007) using the NOF definition. Vertebral fracture prevalence rose with age. The prevalence of osteoporosis increased only moderately in men aged >70 years with the WHO criterion, and showed no change using the NOF definition. The prevalence of osteoporosis in Spanish men using the WHO definition is too small to have any meaningful clinical use. Although the figure is higher using the NOF definition, it would seem that population-based studies of BMD in men are of questionable value.

New horizons in treatment of osteoporosis

BACKGROUND

Prevalence of osteoporosis is increasing both in developed and developing countries. Due to rapid growth in the burden and cost of osteoporosis, worldwide, it seems reasonable to focus on the reduction of fractures as the main goal of treatment. Although, efficient pharmacological agents are available for the treatment of osteoporosis, there still remains a need to more specific drugs with less adverse effects.

MAIN BODY

This review article provides a brief update on the pathogenesis, presenting current pharmacological products approved by the US Food and Drug Administration (FDA) or Europe, and also newer therapeutic agents to treat osteoporosis according to the clinical trial data available at PubMed, UpToDate, International Osteoporosis Foundation (IOF), and clinical practice guidelines. As well, the effect of combination therapy and recommendations for future research will be further discussed.

SHORT CONCLUSION

The use of current antiresorptive and anabolic agents alone or in combinations for the treatment of osteoporosis entails several limitations. Mainly, their efficacy on non-vertebral fracture reduction is lower than that observed on vertebral fracture. In addition, they have potential adverse events on long time usage. Development of newer agents such as cathepsin k inhibitor and strontium ranelate not only have increased the available options for treating osteoporosis, but also have opened doors of opportunity to improvements in the effective treatment. However, the high cost of new agents have restricted their usage in selective patients who are at high risk of fracture or whom failed response to first line treatment options. Thus, personalized medicine should be considered for future evaluation of genetic risk score and also for environmental exposure assessment. In addition to permanent attention to early diagnosis of osteoporosis and understanding of the pathophysiology of osteoporosis for novel approach in drug discovery, there seems a need to more well-designed clinical trials with larger sample sizes and longer duration on current as well as on newer agents. Also, continuous research on plant-derived components as the source of discovering new agents, and conducting more clinical trials with combination of two or more synthetic drugs, plants, or drug-plant for the treatment of osteoporosis are recommended. Summary of treatment modalities for osteoporosis.

A Candidate Gene Association Study of Bone Mineral Density in an Iranian Population

The genetic epidemiology of variation in bone mineral density (BMD) and osteoporosis is not well studied in Iranian populations and needs more research. We report a candidate gene association study of BMD variation in a healthy cross-sectional study of 501 males and females sampled from the Iranian Multi-Centre Osteoporosis Study, Shiraz, Iran. We selected to study the association with 21 single nucleotide polymorphisms (SNPs) located in the 7 candidate genes LRP5, RANK, RANKL, OPG, P2RX7, VDR, and ESR1. BMD was measured at the three sites L2-L4, neck of femur, and total hip. Association between BMD and each SNP was assessed using multiple linear regression assuming an allele dose (additive effect) on BMD (adjusted for age and sex). Statistically significant (at the unadjusted 5% level) associations were seen with seven SNPs in five of the candidate genes. Two SNPs showed statistically significant association with more than one BMD site. Significant association was seen between BMD at all the three sites with the VDR SNP rs731246 (L2-L4 p = 0.038; neck of femur p = 0.001; and total hip p < 0.001). The T allele was consistently associated with lower BMD than the C allele. Significant association was also seen for the P2RX7 SNP rs3751143, where the G allele was consistently associated with lower BMD than the T allele (L2-L4 p = 0.069; neck of femur p = 0.024; and total hip p = 0.045).

Sarcopenia and its determinants among Iranian elderly (SARIR): study protocol

BACKGROUND

The elderly populations increase in world because of improved health status in communities, so health and independency of seniors has become and will be one of the main priorities of public health systems.Ageing have been associated with changes in body composition, including loss of muscle mass, loss of bone mass and increase fat mass. Involuntary age related loss of muscle mass, sarcopenia,has been linked to functional impairment and physical disability. Several definitions for sarcopenia have been presented based on the method of measuring body composition, but an internationally accepted definition doesn't presently exist yet.In 2010, the European working group on sarcopenia developed a new definition for sarcopenia according to measure muscle mass and muscle function. Several studies have been done about sarcopenia in world, but to our knowledge this study is the first in Iran which is one of the largest countries of the Middle East that faces a fast growing elderly population. The aim of this study is to evaluate sarcopenia and related risk factors in Iran according new definition of sarcopenia.

METHODS

This study will be conducted in two phase among elderly men and women over 55 years in the 6th district of TehranThe first phase will be a population-based cross-sectional study to determine the frequency of sarcopenia in the study population, and to conduct case finding for the second phase. The second phase will be a case-control study to comparison the metabolic and inflammatory factors in sarcopenic and non sarcopenic groups.The association between sarcopenia and major dietary pattern will be evaluated using factor analysis.

CONCLUSION

This study is the first study that evaluates sarcopenia and its risk factor in Iranian elderlies.We discuss details of how we collect the data and appropriate instruments to measure muscle mass, muscle power and muscle strength, and suitable cut- off to define sarcopenia in Iranian elderlies. We believe the result of our study can be useful to health policy makers prepare the necessary infrastructure for elderly health improvements and increase the quality of life in geriatric.

Osteoporotic fractures, DXA, and fracture risk assessment: meeting future challenges in the Eastern Mediterranean Region

The purpose was to report on the burden of osteoporotic fractures in the Eastern Mediterranean Region (EMR) and the use of bone mineral density (BMD) dual-energy X-ray absorptiometry (DXA) databases for osteoporosis diagnosis. PubMed electronic database was reviewed using the following MeSH terms: "Hip fractures," "Fractures, Compression," "Radius Fractures," "Osteoporosis," "Bone density," and "Middle East" up to July 2009. Incidence of hip fractures varied across the EMR between 100 and 295 per 100,000 person-years in women and 71 and 200 per 100,000 person-years in men. No data were found on other nonvertebral osteoporotic fractures. Prevalence of radiographic vertebral fractures older than 65 yr ranged between 15% and 25% in women and 7.3% and 18% in men. By 2020, the number of hip fractures older than 50 yr would increase by 20%. DXA manufacturer's reference curves for the spine were higher than population-specific ones. At the hip, National Health and Nutrition Examination Survey (NHANES) and population-based curves were comparable. Estimates of the relative risk of vertebral fracture per SD decrease in BMD using NHANES and local data set were similar, that is, 1.61 (1.17-2.23) and 1.49 (1.14-1.95), respectively. The EMR is similar to southern Europe regarding incidence rates of hip fracture, suggesting the health burden to be significant. Using DXA at the hip, population-specific reference databases did not perform better than NHANES on which the FRAX model has been developed highlighting the need for reviewing fracture risk assessment strategies in the EMR.

Bone mineral density reference ranges for Australian men: Geelong Osteoporosis Study

SUMMARY

A large population-based random sample of Australian white men was used to provide normative bone mineral density (BMD) data at multiple anatomical sites. The femoral neck BMD data are very similar to those obtained in USA non-Hispanic white males participating in the National Health and Nutrition Examination Survey III (NHANES III). The reference ranges will be suitable for similar populations.

INTRODUCTION

To provide normative BMD data for Australian men derived from a large population-based random sample.

METHODS

An age-stratified random sample of men was recruited from the Australian electoral rolls (n = 1,467 aged 20-97 years). BMD was quantified at multiple sites using Lunar densitometers.

RESULTS

Age-related differences in BMD were best predicted by linear relationships at the spine and hip and by quadratic functions at the whole body and forearm. At the spine, a small age-related increase in mean BMD was observed. Although in the subset with no spinal abnormalities, there was a decrease of 0.003 g/cm(2) per year from age 20. At the hip sites, mean BMD decreased at 0.001-0.006 g/cm(2) per year from age 20. At the forearm and whole body, BMD peaked at 41-47 years. Apart from a small difference in men greater than or equal to 80 years, the Australian femoral neck BMD data are not different to those obtained in USA non-Hispanic white males participating in NHANES III and were generally similar to those of large studies from Canada (CaMos) and Spain.

CONCLUSIONS

These data supply BMD reference ranges at multiple anatomical sites that will be applicable to white Australian men and similar populations such as USA non-Hispanic white men.

The effect of n-3 fatty acids on bone biomarkers in Iranian postmenopausal osteoporotic women: a randomized clinical trial

Recently, n-3 fatty acids are in the center of attention for their potent anti-inflammatory effects. Osteoporosis as a chronic senile disease is associated with inflammation, and the role of inflammatory mediators has been demonstrated in recent years. The beneficial effects of n-3 fatty acids on bone were proven in many animal studies, while to date, no conclusive data is available in human. The aim of this study was to evaluate the impact of n-3 fatty acids on bone biomarkers in osteoporotic postmenopausal women. Twenty-five osteoporotic postmenopausal women were recruited in the study and randomized in treatment and control groups. The patients received 900 mg n-3 fatty acid capsules or placebo per day for 6 months. Serum levels of osteocalcin, bone alkaline phosphatase (BALP), calcium, vitamin D, and parathormone and urine concentration of pyridinoline (Pyd) were measured at baseline, second month, and sixth month in both groups. In the treatment group, compared with baseline, at the second month, osteocalcin increased slightly; thereafter, it showed decrement trend until the end of the study. In the control group, it decreased all over the study. None of these changes was significant. BALP showed nonsignificant decrease from baseline over the time in both groups. Urine level of Pyd decreased significantly (P < 0.05) in the treatment group, while no significant change was seen in the control group. Serum calcium and vitamin D increased in both groups; however, changes were not significant. No significant changes were seen in calcium clearance and parathormone. In conclusion, n-3 fatty acids can decrease bone resorption; however, it could not affect bone formation significantly after 6 months treatment. Further investigations are recommended.

Relationship among dietary estimates of net endogenous acid production, bone mineral density and biochemical markers of bone turnover in an Iranian general population

Chronic, low-grade metabolic acidosis due to Western diets may be a risk factor for osteoporosis. The severity can be determined in part by net endogenous acid production (NEAP). In a population-based study, a total of 1028 healthy men and women aged 20-72 years were evaluated for dietary intakes and NEAP estimates with a validated food frequency questionnaire. Dual-energy X-ray absorptiometry (DXA) was used to determine BMD of the lumbar spine (L2-L4), distal third of radius, and proximal femur. Serum CrossLaps, degradation products of the C-terminal telopeptides of type I collagen, and osteocalcin were measured by highly specific ELISA methods. Lower estimates of energy-adjusted rates of NEAP were associated with greater femoral neck BMD (p=0.01) in premenopausal women and with greater BMDs at the distal radius (p=0.001) and lumbar spine (p=0.04) in postmenopausal women. Compared with women in the highest quartile of the estimates of the energy-adjusted rates of NEAP, pre- and postmenopausal women in the lowest quartile had significantly greater means of osteocalcin [9.12 (SD+/-1.62) vs. 5.24 (SD+/-1.41) ng/ml, p=0.02 and 11.74 (SD+/-1.69) vs. 7.79 (SD+/-2.63) ng/ml, p=0.002, respectively]. Analysis by quartiles of the estimates of energy-adjusted rates of NEAP did not reveal a relationship between BMD and bone turnover markers in men. In conclusion, we found that a high energy-adjusted rate of NEAP was associated with a significantly lower BMD in women but not in men and the energy-adjusted rate of NEAP had a negative relationship with bone formation.

Relationship among insulinlike growth factor I concentrations, bone mineral density, and biochemical markers of bone turnover in postmenopausal women: a population-based study

OBJECTIVE

: To assess the association among serum insulinlike growth factor I (IGF-I) concentrations, bone mineral density (BMD), and biochemical markers of bone turnover in a large group of postmenopausal women from the general population.

DESIGN

: As an extension of a larger epidemiological study, the Iranian Multicentral Osteoporosis Study, a total of 406 healthy postmenopausal women (age, 59.0 +/- 7.6 years) were randomly selected from 13 clusters in Bushehr Port. IGF-I, serum CrossLaps, degradation products of C-terminal telopeptides of type I collagen, and osteocalcin were measured by highly specific enzyme-linked immunosorbent assay. BMD was determined for the lumbar spine (L2-4) and proximal femur using dual-energy x-ray absorptiometry.

RESULTS

: The mean (+/- SD) serum IGF-I concentration for all postmenopausal women was 183.35 +/- 65.60 ng/mL. In age-adjusted analyses, there was no correlation between IGF-I and BMD at the lumbar spine and femoral neck. Compared with women in the lowest quartile of IGF-I, women in the highest quartile had a significantly greater means of osteocalcin (P = 0.04) and alkaline phosphatase (P = 0.01). Analysis by quartiles of IGF-I did not reveal an association with serum CrossLaps.

CONCLUSIONS

: Circulating IGF-I is associated with biochemical markers of bone formation, but there is no relationship among IGF-I, degradation products of C-terminal telopeptides of type I collagen, and BMD in postmenopausal women. Clearly more work will be needed before serum IGF-I can be used in clinical practice as a risk predictor for postmenopause-associated loss of bone mass.

Peak bone density in Croatian women: variations at different skeletal sites

It is known that different skeletal sites have different peak bone mass at different times and lose bone at different rates. The purpose of the study was to assess bone mineral density (BMD) in healthy female student population (N=220), aged 18-25 yr and to analyze whether young women of that age have already started to lose the bone mass at the trabecular and cortical parts of skeleton. The influence of dietary intake and physical activity on their bone mass was also assessed. BMD was measured, using dual-energy X-ray absorptiometry technique, in spine, proximal femur, and distal third of the radius and in total body. Significant negative correlation between age and bone mass was found in all skeletal regions (p<0.05 spine; p<0.0001 total femur; and p<0.01 total body) except in cortical part of the radius. Peak bone mass in young Croatian women was achieved before the age of 20, but later in the long-bone cortical skeleton, where BMD continued to increase after mid-20s. The BMD values are comparable with those from National Health and Nutrition Examination Survey study, except for the cortical part of the radius, where it is significantly lower. Body weight and physical activity were the most significant positive predictors of bone density in all measured sites.

Alfacalcidol treatment increases bone mass from anticatabolic and anabolic effects on cancellous and cortical bone in intact female rats

It has been reported that alfacalcidol had an anticatabolic and anabolic effect on bone in ovariectomized and aged male rat models, but this has not been tested on intact female rats. The current study was to determine the effects of alfacalcidol on cancellous and cortical bone in intact female rats with or without exercise. Seventy-four, 8.5-month-old, intact female rats were orally treated with 0, 0.005, 0.025, 0.05, or 0.1 microg/kg alfacalcidol alone or in combination with raised cage (RC) exercise for 3 months. In vivo peripheral quantitative computerized tomography (pQCT) of the proximal tibial metaphyses (PTM) and ex vivo histomorphometric analyses of the PTM and tibial shaft (TX) were performed. Only the 0.1 microg alfacalcidol/kg dose proved to be anabolic. pQCT analysis showed that this dose increased total and cortical bone mineral content and density and trabecular bone mineral density. Histomorphometrically, it induced an anabolic response by increased trabecular mass and microarchitecture from stimulated cancellous bone and bone bouton formations, and suppressed bone resorption more than bone formation on the trabecular and endocortical surfaces, to produce a positive bone balance. A positive correlation between trabecular connectivity and bone bouton numbers occurred. These findings suggest alfacalcidol treatment augments bone mass by increased cancellous bone mass and improved trabecular architecture through its anticatabolic and anabolic properties in the intact adult female rat. Last, raised cage exercise alone or the combination of raised cage and alfacalcidol was no more effective than alfacalcidol alone.