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بار بیماری استئوپروز درایران در سال 1380 Burden of osteoporosis in Iran 2 1 مقدمه: استئوپروز شایع‌ترین بیماری متابولیک استخوان است و علاوه بر ناتوانی و از کارافتادگی باعث افزایش نسبی خطر مرگ در مبتلایان به شکستگی‌های ناشی از آن می‌شود. در ايران شواهد كافي در مورد اين‌ كه استئوپروز، نظير كشورهاي غربي، يك مسألۀ سلامت عمومي است موجود نبود و لذا انجام اين مطالعه در دستور كار مركز تحقيقات غدد درون‌ريز و متابوليسم قرار گرفت. این مطالعه با هدف برآورد بار استئوپروز در سال 1380 در ایران انجام شد. مواد و روشها: از داده‌هاي مطالعۀ مركز تحقيقات غدد در مورد تراكم استخوان، داده‌هاي حاصل از ثبت حوادث توسط وزارت بهداشت در 9 استان كشور و مطالعات انجام شده در ساير جوامع در مورد خطر مرگ بيماران پس از وقوع شكستگي‌هاي قابل انتساب به استئوپروز استفاده شد. برای محاسبه بار بیماری، ابتدا شیوع استئوپروز، بروز شکستگی‌های قابل انتساب به استئوپروز و خطر نسبی مرگ ناشی از آنها برآورد شد. با استفاده از مدل‌های اپیدمیولوژی، دورۀ ابتلا به هر شکستگی برآورد و با استفاده از وزن ناتوانی اختصاص یافته به ناتوانی‌های مشابه در مطالعۀ بار جهانی بیماری‌ها، شاخص DALYs برای شکستگی‌های قابل انتساب به استئوپروز (مهره، هیپ وساعد) محاسبه شد. نتایج: سال‌های از دست رفته ناشی از شکستگی لگن در زنان 15880 سال، شکستگی مهره 1269 سال و شکستگی ساعد 121 سال به دست آمد. در مردان، سال‌های از دست رفته ناشی از شکستگی لگن 16495 سال، شکستگی مهره 2225 سال و شکستگی ساعد 37 سال به دست آمد. مجموع سال‌های از دست رفتۀ ناشی از استئوپروز 36026 سال در جمعیت ایران در سال 1380 محاسبه گردید که 18757 سال متعلق به مردان و 17270 سال متعلق به زنان بود. بیشترین علت بالا بودن بار استئوپروز در مردان افزایش خطر نسبی مرگ بعد از شکستگی‌هاي لگن و مهره در مردان است. در هر دو جنس شکستگی لگن بیشترین تعداد را به خود اختصاص داده بود. در منبع دادۀ مورد استفاده، شکستگی مهره در مردان بيش از زنان و در هر دو جنس کمتر از شکستگی‌هاي لگن و ساعد ثبت شده بود. نتيجه‌گيري: داده‌هاي به كار گرفته شده در این مطالعه حاكي از بروز كمتر شکستگی هيپ در ایران نسبت به ساير جوامع است. بايد به منظور توجيه بروز پايين‌تر اين شكستگي، بالاتر بودن نسبي تراكم معدني استخوان (BMD) در جمعیت ایران و تفاوت‌هاي احتمالي جامعۀ ايراني با جوامع ديگر را از نظر ساير عوامل مؤثر بر شكستگي هيپ، نظير محيط و سبك زندگي، مورد بررسي قرار داد. با توجه به محدوديت داده‌های موجود در خصوص شکستگی‌های قابل انتساب به استئوپروز در ایران، مي‌بايست مطالعات کامل‌تري در اين زمينه به منظور دست‌يابي به تصويري شفاف‌تر از ابعاد اين مشكل سلامتي انجام شود. 2 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 osteopor-otic 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. 25 37 Farid F Abolhasani فرید ابوالحسنی Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Iran abolhassanif@sina.tums.ac.ir Mojgan M Mohammadi مژگان محمدی Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Iran Akbar A Soltani اکبر سلطانی Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Iran OsteoporosisBurden of osteoporosisBone fracture 171.pdf World Health Organization. How Is the Public Interest Protected, in World Health Report 2000; Health Systems: Improving Performance.2000; P:117.##World Health Organization. Health Services: Well Chosen, Well Organized?, in World Health Report 2000; Health Systems: Improving Perfor-mance. 2000;P:47.##National Osteoporosis Foundation, Osteoporo-sis: Review of the Evidence for Prevention, Diagnosis, Treatment and Cost-effectiveness Analysis- 1998, Osteoporos Int.1998;(Suppl4):S7-S8.##Johnell O., Kanis J.A., Oden A., Sernbo I., Redlund- Johnel I., Petterson C., De Laet C., Jon-sson B. Mortality after osteoporotic fractures. Osteoporos Int.2004;15:38-42.##Forsen L., Sogaard A. J., Meyer H.E., Edna T. H., Kopjar B. Survival after Hip Fracture: Short- and Long-term Excess Mortality According to Age and Gender. Osteoporos Int.1999;10:73-78.##Hasserius R., Karlsson M.K., Nilsson B.E., Redlund-Johnell I., Johnell O. Prevalent vertebral deformities predict increased mortality and increa-sed fracture rate in both men and women: A 10 year Population-based Study of 528 Individuals from Swedish Cohort in European Vertebral Osteoporosis Study. Osteoporos Int.2003;14:61-8.##Kanis J. A. et al, The burden of osteoporotic fracture: A method for setting intervention thresh-olds. Osteoporos Int.2001;12:417-27.##Trombeti A., Herrmann F., Hoffmeyer P., Schurch M.A., Bonjour J.P., Rizzoli R. Survival and Potential years of life lost after hip fracture in men and age-matched women. Osteoporos Int. 2002;13:731-37.##Krappweis J., Rentsch A., Schwarz U.I., Kro-bot K.J., Kirch W. Outpatient Costs of osteo-porosis in a National Health Insurance Population. Clin Therap.1999;21:2001-14.##مطالع? بار ملی بیماری‌ها، وزارت بهداشت، درمان و آموزش پزشکی.##Murray C.J.L., Acharya A.K., Understanding DALYs. J Health Economics.1997;16:703-30.##Mathers C.D., Vos T., Lopez A.D., Salomon J., Ezzati M. (Edition), Disease Modeling Using DisMod, in National Burden of Disease Studies: A Practical Guide. Edition 2.0 Chapter 8 P: 64. Global Program on Evidence for Health Policy. Geneva: World Health Organization Oct.2001.##لاریجانی باقر، سلطانی اکبر، پژوهی محمد، باستان حق محمد حسن. تغییرات تراکم معدنی استخوان در افراد 20-69 ساله‌ای ساکن تهران. طب جنوب. سال پنجم، شماره 1،صفحات 41-49.##نقوی محسن، جعفری ناهید، علاء الدینی فرشید، دلاوری علیرضا. اپیدمیولوژی حوادث غیر عمدی در ایران در سال 1382. وزارت بهداشت درمان و آموزش پزشکی، معاونت سلامت، دبیرخان? تحقیقات کاربردی. (منتشر نشده است)##Cummings S. R., Melton L.J. Epidemiology and Outcomes of Osteoporotic Fractures. Lancet. 2002;359: 1761-7.##Salomon J.L. Health State Valuation in Summary Measures of Population Health, in Murray C. J. L. and Evans D. (ed.), Health System Performance Assessment, World Health Orga-nization, 2003.##GBD 90 Disability Weights and DALYs Calculation Template. These can be found in WHO website:http://www3.who.int/whosis/menu. cfm? path= evidence, burden, burden_ manual_ other & language= english##نقوی محسن، جمشیدی حمید رضا، بهره‌مندی از خدمات بهداشتی درمانی در جمهوری اسلامی ایران در سال 1381، وزارت بهداشت درمان و آموزش پزشکی 1383 (در دست انتشار).##Sanders K. M. Age- and Gender-Specific rate of fractures in Australia: A population-based study. Osteoporosis Int.1999;10:240-47.##Kanis J.A., Johnell O., Oden A., Sernbo I., Redlund-Johnell I., Dawson A., De Laet C., Jon-sson B. Long-term risk of osteoporotic fracture in Malmo. Osteoporosis Int.2000;11:669-74.##Memon A. Incidence of hip fracture in Kuwait. Int J Epidemiol.1998;27:860-65.##Lau E.M.C., Lee J. K., Suriwongpaisal P., Saw S. M., Das De S., Khir A., Sambrook P. Inci-dence of hip fracture in four asian countries: The Asian osteoporosis study (AOS). Osteoporosis Int.2000;12:239-43.##Memon A., Pospula W.W., Tantawy A.Y., Abdul-Ghafar S., Suresh A., Al-Rowaih A. Incid-ence of Hip fracture in Kuwait. Int J Epidemiol. 1998;27:860-65.##Koh L.K. H., Saw S. M., Lee J.J.M., Leong K., Lee J. Hip fracture rates in Singapore.1991-1998, Osteoporos Int.2000;12:311-18.##Iki M., Kagamimori S., Kagawa Y., Matsu-zaki T., Yoneshima H., Marumo F. Bone Mineral Density of the Spine, Hip and Distal Forearm in Representative Sample of Japanese Female Pop-ulation: Japanese Population –Based Osteoporosis (JPOS) Study. Osteoporos Int.2001;12:529-37.##Woo J., Li M., Lau E. Population Bone Mineral Density Measurement for Chinese Wom-en and Men in Hong Kong. Osteoporos Int.2001; 12:289-95.##Tenenhouse A., Joseph L., Kreiger N., Poli-quin S., Murray T. M., Blondeau L., Berger C., Hanley D.A., Prior J.C. Estimation of the Pre-valence of Low Bone Density in Canadian Women and Men Using a Population- Specific DXA Reference Standard: The Canadian Multice-nter Osteoporosis Study (CaMos). Osteoporos Int. 2000;11:897-904.##

بروز شکستگي استئوپروتيک لگن در پيگيري سه ساله افراد شرکت کننده در طرح جامع پيشگيري، تشخيص و درمان استئوپروز كشور The incidence of osteoporotic hip fracture in 3 years fallow up of Iranian Multicenters Osteoporosis Study (IMOS) 2 1 مقدمه: استئوپروزمشكل جدي سلامت در ساختارهاي ارائه مراقبت بهداشتي هم در كشورهاي پيشرفته و هم در كشورهاي در حال توسعه است. اين بيماري با کاهش توده استخواني و افزايش خطر شکستگي استخوان همراه است. شکستگي به دليل استئوپروز يکي از علل شايع ناتواني و از علل عمده تحميل هزينه‌هاي بيمارستاني در بسياري از مناطق دنيا محسوب مي‌شود که شيوع آن در جوامع مختلف متفاوت است. پيش بيني شده است که تا سال ۲۰۵۰ حدود ۵۰ % از تمام موارد شکستگي لگن در کشورهاي آسيايي اتفاق افتد. متأسفانه در ارتباط با ميزان بروز شکستگي لگن در ايران هيچ اطلاعي در دست نمي‌باشد. با توجه به اينکه نتايج طرح جامع پيشگيري، تشخيص و درمان استئوپروز در کشور که در مرکز تحقيقات غدد و متابوليسم دانشگاه علوم پزشکي تهران با همکاري معاونت سلامت وزارت بهداشت، درمان و آموزشي پزشکي در سال ۱۳۷۹ انجام شده نشان مي‌دهد که حدود ۷۰ % زنان و ۵۰ % مردان بالاي ۵۰ سال مبتلا به استئوپروز و يا استئوپني هستند، اين تحقيق با هدف تعيين ميزان بروز شکستگي به دليل استئوپروز لگن در تهران و با همکاري همان مرکز انجام گرفت. مواد و روشها: با مراجعه به پرونده کليه بيماران بالاي ۵۰ سال که در طرح جامع استئوپروز به عنوان نمونه طرح شناخته شده بودند و تماس تلفني و در صورت لزوم مراجعه حضوري به درب منازل اين نمونه‌ها، اقدام به تکميل پرسشنامه‌اي که بدين منظور تهيه شده بود نمودند و سوالاتي در ارتباط با بروز شکستگي در طي سه سال اخير (۸۳ - ۱۳۷۹ ) و نيز برخي اطلاعات دموگرافيک و عوامل خطرساز مرتبط با شکستگي استئوپروتيک پرسيده شد و با استفاده از نرم‌افزار (11.5) SPSS، آزمون 2 و T مورد تجزيه و تحليل قرار گرفت. سطح معني‌داري كمتر از 05/0 در نظر گرفته شد. نتايج: يافته‌هاي حاصل از اين پژوهش نشان داد که بروز شکستگي لگن با افزايش سن افزايش مي‌يابد و در زنان شايعتر از مردان است. ميزان بروز شکستگي استئوپروتيک لگن در مجموع 8/3% در طي سه سال اخير مي‌باشد که اين ميزان در مقايسه با کشورهاي آسيايي به مراتب کمتر است. احتمالاً عوامل ژنتيکي و فاکتورهاي محيطي در اين امر دخالت دارند. همچنين براساس نتايج اين بررسي ارتباط معني داري بين شکستگي لگن و استئوپروز در ناحيه لگن (016/0P=) و نيز بين ميزان تراکم استخوان در ناحيه لگن و شکستگي آن وجود دارد (001/0P=). نتيجه‌گيري: ارتباط معني‌دار بين شيوع شكستگي و تراكم معدني استخوان مي‌تواند تا حدي نشان‌دهنده توانايي پيشگويي شكستگي براساس نتيجه سنجش تراكم استخوان باشد. 2 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) has 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 2 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 popula-tion. 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 predict-tion the future fracture due to osteoporosis base on the results of bone densitometry. 37 43 Mitra M Zolfaghari میترا ذوالفقاری Faculty of Nursing and Midwifery, Tehran University of Medical Sciences Faculty of Nursing and Midwifery, Tehran University of Medical Sciences Iran Ziba Z Taghizadeh زیبا تقی‌زاده Faculty of Nursing and Midwifery, Tehran University of Medical Sciences Faculty of Nursing and Midwifery, Tehran University of Medical Sciences Iran Jila J Maghbouli ژیلا مقبولی Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Iran Abbas Ali AA Keshtkar عباس‌علی کشتکار Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Iran Anooshirvan A Kazemnejad انوشیروان کاظم‌نژاد Department of Biostatistics, School of Medical Sciences, Tarbiat Modares University Department of Biostatistics, School of Medical Sciences, Tarbiat Modares University Iran Bagher B Larijani باقر لاریجانی Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Iran IncidenceHip fractureOsteoporosisIMOS 172.pdf Cohen A.J., Roe J. Review of risk factors for osteoporosis with particular reference to a poss-ible etiological role of dietary salt. Food Chemic Toxicol.2000;237-53.##Consensus development conference prophyla-xis and treatment of osteoporosis. Am J Med. 1993;94:694-50.##Watts N.B. Focus on primary care postmeno-pausal osteoporosis, an update. Obstetric Gynecol Sur.2000;(suppl 3):49-55.##Cummings S.R., Melton L.J. Epidemiology and outcomes of osteoporosis fractures. Lancet.2002; 359:2018-26.##Cooper C., Epidemiology of osteoporosis. Osteoporos Int.1999;suppl 2:2-8.##جزوه مرکز تحقیقات غدد و متابولیسم دانشگاه علوم پزشکی تهران با همکاری دانشگاه شیراز، مشهد، بوشهر، اصفهان، تبریز. استئوپروز، تشخیص درمان، 1383- تهران.##Berarducci A. Osteoporosis Education: A Health-Promotion Mandate for Nurses. Orthopae-dic Nursing.2004;23:118-20.##Fugiwara N.K, Marti B., Gutzwiller F. Hip fracture mortality and morbidity in Switzerland and Japan. A cross-cultural comparison. SOZ pra-ventiv med.1996;38:8-14.##Lau E.M., Tee J.K. The incidence of hip fracture in four Asian countries: the Asian osteop-orosis study (Aos). Osteoporosis Int.2001;12:239-43.##Frassetto L.A., Todd K.M. Worldwide incidence of hip fracture in elderly women. Jou rnal of gerontology-series A. Biologic Med Sci. 2000;55:585-92.##Finsen V., Johnsen L.G., Trano G., Hansen B., Sneve K.S. Hip fracture incidence in central norway. A fallow up study. Clin Orthop Relat-Res. Issue.2004;419:173-78.##

بررسي ارتباط آلودگي هوا با ميزان تراكم وشاخص‌هاي بيوشيميايي استخوان در ساكنين مناطق مختلف تهران The influence of air pollution on the bone mineral density and serum markers in different areas of Tehran 2 1 مقدمه: استئوپروز يكي از بيماري‌هاي شايع و بدون علامت است. در ايران 50% مردان بالاي 50 سال و70% زنان بالاي 50 سال مبتلا به استئوپروز يا استئوپني هستند. به علاوه كمبود ويتامين D نيز در شهر تهران از شيوع بالايي برخوردار است. از آنجا كه وضعيت آلودگي هوا در شهر تهران بحراني است و آلودگي هوا مي‌تواند يكي از موارد تأثيرگذار بر ميزان ويتامين D سرمي باشد، اين مطالعه با هدف بررسي ارتباط آلودگي هوا در شهر تهران با ميزان شاخص‌هاي استخواني انجام شد. مواد و روشها: در اين مطالعه تعداد 184 فرد 69-20 ساله ساكن شهر تهران به صورت تصادفي از 14 بلوك در شعاع Km4 از 5 ايستگاه هواشناسي انتخاب شدند. مناطق به 2 منطقه پاك و آلوده تقسيم و سپس ويتامين D، كلسيم، فسفر، آلكالين فسفاتاز، پاراتورمون و تراكم استخواني در ناحيه لگن و كمر بررسي شد. براي تحليل داده‌ها نرم‌افزار آماري (11.5) SPSS، آزمون T براي مقايسه ميانگين مقادير به دست آمده، آزمون 2 براي متغيرهاي كيفي و Fisher Exact Test در موارد لزوم مورد استفاده قرار گرفت. براي مقايسه ميزان خطر و خطر نسبي از Odds Ratio يا Relative Risk و براي مقايسه چندين ميانگين از آناليز واريانس استفاده شد. سطح‌ معني‌داري كمتر از 05/0 در نظر گرفته شد. نتایج: بطور كلي 6/79% افراد مورد مطالعه مبتلا به كمبود ويتامين D بودند. كمبود ويتامينD سرم در مردان ساكن منطقه آلوده (2/86%) نسبت به مردان ساكن منطقه پاك (8/61%) بالاتر بود (029/0p=). شانس خطر كمبود ويتامينD در مرداني كه در منطقه آلوده زندگي مي‌كردند، 675/1 برابر ساير مردان مورد مطالعه بود (خطر نسبي=675/1 و نسبت شانس=869/3). استئوپروز نيز در مردان و زنان منطقه آلوده (6/0%) بيشتر از ساكنين منطقه پاك (0/0%) بود (034/0p=) و افرادي كه در منطقه آلوده زندگي مي‌كردند در مقايسه با ساكنين منطقه پاك 26/6 برابر بيشتر در معرض ابتلا به استئوپروز بودند. نتيجه‌گيري: بنابر نتايج اين مطالعه مواجهه با آلودگی هوا می‌تواند خطر ابتلا به استئوپروز را به نسبت بالایی افزایش دهد. از آنجا كه متغير محل سكونت ممكن است به سادگي امكان‌پذير نباشد، در نظر داشتن ساير راه‌هاي مقابله با كمبود ويتامين D مانند غني‌سازي مواد غذايي با ويتامين D مي‌تواند كمك كننده باشد. 2 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 assesed. SPSS (II.5) was used for stafistical Analysis. The difference between mean values was assessed with student T- test, 2 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 percived 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 sex 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. 43 53 Ziba Z Taghizadeh زیبا تقی‌زاده Faculty of Nursing and Midwifery, Tehran University of Medical Sciences Faculty of Nursing and Midwifery, Tehran University of Medical Sciences Iran Mitra M Zolfaghari میترا ذوالفقاری Faculty of Nursing and Midwifery, Tehran University of Medical Sciences Faculty of Nursing and Midwifery, Tehran University of Medical Sciences Iran Soroush S Mortaz Hejri سروش مرتاض هجری Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Iran Jila J Maghbouli ژیلا مقبولی Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Iran Anooshirvan A Kazemnejad انوشیروان کاظم‌نژاد Department of Biostatistics, School of Medical Sciences, Tarbiat Modares University Department of Biostatistics, School of Medical Sciences, Tarbiat Modares University Iran Mohammad M Pajouhi محمد پژوهی Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Iran emrc@sina.tums.ac.ir Air pollutionOsteoporosisVitamin DBMDLife styleCivilizationBiochemical marker 173.pdf Todd P., Selapharm D. Osteoporosis (up Date 2001). Available at: http:// www. americonger-iatrrcs. Org/education/forum/ oeteoporosis.shtml.##Media S. Osteoporosis prevention must begin early. Nut Fit News.2002,45:118-21.##لاریجانی باقر،سلطانی اکبر، پژوهی محمد، میرفیضی سیده زهرا. تغییرات تراکم معدنی استخوان در افراد 69-20 ساله ساکن تهران. مجله طب جنوب، سال 2(1381) شماره ،صفحات 45-49.##Craig S., Ultra violet index. Available at:file:// A:\uvindex.htm.##Wyburn R. Treatment and prevention of osteo-porosis. Arthritis Trust Am.1992;51:233-36.##leach J.F. Interrelation of atmospheric ozone and cholecalciferol (Vitamin D3) prodluction in man. Photochem photobiol Sci.2003;2:370-5.##Agarwal K. The impact of atmospheric pollu-tion on vitamin D status of infants aind toddlers in Delhi, India. Arch Dis child.2002;87:111-30.##Institute of Medicine, Food and Nutrition Board. Dietary Reference Intakes: Calcium, Phos-phorus, Magnesium, Vitamin D and Fluoride. National Academy Press, Washington, DC, 1999.##Calabrese E.J. The influence of ambient ozone on the incidence of bone fractures especially a mong the elderly. Med hypotheses.1979;5:201-7.##Holick M.F. Environmental factors that infl-uence the cutaneous production of vitamin D. Endocrinol Rev.2001;22:477-501.##متصدی زرندی سعید ، شریعت محمود. رابطه‌های توسعه پایدار کیفیت هوا در کشور جمهوری اسلامی ایران. 80-1379. پایان‌نامه دکترای تخصصی، مهندسی بهداشت محیط.##Mckenna M.J. Differencese in vitamin D status between countries in young adults and in the elderly. Am J Med.1992;93:69-77.##Keane E.M., Healy M., O’Moore R., Coakley D., Walsh J.B. Vitamin D-Fortified Liquid Milk: Benefits for the Elderly Community-Based Popu-lation. Calcif Tissue Int.1998;62:300-2.##kimlin M.G., Downs N.J, Parisi A.V. Compa-rison of human facial uvexposure at high and low latitudes and the potential impact on dermal vitamin D production. Med Hypotheses.1979; 5:201-7.##سلطانی اکبر، لاریجانی باقر، پژوهی محمد. بررسی عوامل خطرساز استئوپروز در زنان یائسه مراجعه کننده به واحد سنجش تراکم معدنی استخوان مرکز تحقیقات غدد دانشگاه علوم پزشکی تهران. فصلنامه طب جنوب، شهریور سال پنجم 1381شماره 1 صفحات 91-82.##شمس عباس ، غیاث‌الدینی منصور. رابطه آلودگی هوا با دفعات غیبت دانش‌آموزان دبستانی شهر تهران به دلیل بیماریهای تنفسی در سه منطقه آموزش و پرورش تهران 69-1368. پایان نامه مهندسی بهداشت محیط.##ملک افضلی محمد، .یونسیان مسعود.بررسی رابطه آلودگی هوا با ابتلا به مرگ در شهر تهران (بین سال‌های 1377 تا1378)1380 پایان نامه دکترای اپیدمیولوژی.##اسکویی فاطمه، محمودی باقرزاده افروز.بررسی ارتباط آلودگی هوا با وزن زمان تولد و نسبت تولد نوزاد کم وزن. پایان نامه فوق لیسانس مامایی 1382.##لاریجانی باقر،هاشمی‌پور سیما،گویا محمد مهدی. بررسی شیوع کمبود ویتامین D و عوامل مؤثر برآن در جمعیت 69-20 ساله شهر تهران، مجله علمی نظام‌پزشکی. (1382 ) دوره 21، شماره 4. صفحات 120-124##Omdahl J.L., Garry P.J., Hunsaker L.A. Nutri-tional status in a healthy elderly population : vitamin D. Am J Clin Nut.1982;36:1225-32.##Burnard B., Sloutskis D., Gianoli F. Serum 25-Hydroxy vitamin D: distribution and determin-ants in the Swiss population. Am J Clin Nut.1992; 56:537-42.##Chapuy M.C., Preziosi P., Maamer M. Preval-ence of vitamin D insufficiency in on adult nor-mal population osteoporos. Int.1997;7:439-43.##Vander R.P., Lowik M.R., Vanden Berg H. Serum vitamin D concentrations among elderly people in Eurpe. Lancet.1995;346:207-10.##Shaw C.K., Tezan K.Y., Chang TK. A prospe-ctive study of BMD chang in Taiwan. Calcif Tissue Int.1998;62:109-13.##Sedari S.H., Elidrissy A.W., Arabi K.M. Suni-lght and vitamin D status in normal Saudi subj-ects. Am J Clin Nurt.1983;38:129-32.##عزیزی فریدون، رئیس زاده فرید، میرسعید قاضی علی اصغر، کمبود ویتامین D در گروهی از ساکنان شهر تهران، پژوهش در پزشکی، (1379): سال چهارم، صفحات303-291. 28- قربانی شهنا، گلبابائی فرید. بررسی آلودگی هوا در کارگاه پرس یک صنعت تولید قطعات لاستیکی و ارائه طرح تهویه صنعتی 81-1380. پایان نامه MSPH مهندسی بهداشت حرفه‌ای.##نوری کبری، ضیائی سعیده. تآثیر آلودگی منواکسید کربن هوا بر میزان کربوکسی هموگلوبین، گلبولهای قرمز هسته‌دار، انتیمای شریان بند ناف در جنین و سرانجام حاملگی. 1381. پایان نامه فوق لیسانس مامایی.##Smith R. Asian rickets and osteomalacia. Q J Med.1990;76:899-901.##سال نامه آماری کشور,مرکز آمار ایران ,1380,شماره مسلسل نشریات مرکز آمار ایران :3589.##Lo C.W., Paris P.W., Holick M.F., Indian and Pakistani immigrants have the same capacity as caucasians to produce vitamin D in responses to ultra violet irradiation Am J Clin Nut.1986;44: 683-5.##Hunt S.P., O’Riodan J.L., Windo J., vitamin D status in different subgroups of British Asians. BMJ. 1976; 2:1351-4.##Aaron J.E. Gallagher J.C., Anderson J., Frequency of osteomalacia and osteoporosis in fracture of the proximal femur.Lancet.1974;1: 229-32.##Villareal D.T., Civitelli R., Chnes A., Aviolo L.V., Subclinical vitamin D deficiency in post-menopausal women with low vertebral bone mass. J Clin Endocrinol Metab.1991;72:628-31.##Bowes P. Church's food values of portions commonly used. 17th Edition. Philadelphia: Lipp-incot-Raven, 1998;PP:120-134.##قربانی شهنا، گلبابائی فرید. بررسی آلودگی هوا در کارگاه پرس یک صنعت تولید قطعات لاستیکی و ارائه طرح تهویه صنعتی 81-1380. پایان نامه MSPH مهندسی بهداشت حرفه‌ای##

استئوپروز، تشخيص، پيشگيري و درمان Osteoporosis, prevention, diagnosis and treatment 2 1 پوكي استخوان بيماري است كه با كاهش تراكم استخوان و از دست رفتن كيفيت ريزساختار استخوان شناخته مي‌شود كه خود منجر به افزايش خطر شكستگي مي‌شود. اين بيماري يكي از دلايل مهم ناتواني و مرگ در افراد مسن است. ميزان مرگ ومير ناشي از شكستگي لگن (سر استخوان ران) در سال اول بعد از شكستگي، در افراد مسن، به حدود 20% مي‌رسد و نيمي از اين افراد در باقيمانده عمر خويش دچار درجاتي از ناتواني خواهند بود. تراكم اوليه استخوان كه در سال‌هاي نوجواني و جواني به حداكثر مي‌رسد و سرعت كاهش تراكم استخوان در سال‌هاي بعدي عمر، دو عامل مهم در بروز پوكي استخوان هستند. عارضه مهم پوكي استخوان، شكستگي پاتولوژيك مي‌باشد كه در برخي موارد مي‌تواند كشنده باشد. امروزه روش‌هاي پيشگيري و درماني مختلفي در دسترس بوده يا در حال ارائه هستند. پيشگيري و درمان پوكي استخوان شامل روش‌هاي دارويي و غيردارويي است. در هر دو مرحله پيشگيري و درمان، هدف انجام هر چه زودتر اقداماتي است كه منجر به حفظ تراكم استخوان و مانع از دست رفتن يك‌دستي و صحت ساختار استخواني شود، تا به اين ترتيب از بروز شكستگي‌هاي پاتولوژيك جلوگيري شود. داروهاي اصلي در حال حاضر داروهاي ضد جذب هستند و عملكرد اصلي آنها كاهش سرعت واگردش استخواني است. درمان‌هاي جديدتري كه موجب افزايش توليد استخوان مي‌شوند نيز در حال بررسي هستند و ممكن است به زودي مورد استفاده گسترده قرار گيرند. اين مقاله مروري به بررسي جوانب مختلف بيماري پوكي استخوان اوليه در بالغين از جمله عوامل خطر، تشخيص، پيشگيري و درمان آن در جهان و ايران مي‌پردازد. 2 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 caus-ed 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 disea-se, 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 dru-gs are anti-resorptive and focus on decreasing bone turnover. Newer therapies with the aim of increaseing 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. 5 25 Bagher B Larijani باقر لاریجانی Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Iran emrc@sina.tums.ac.ir Mohammad Reza MR Mohageri Tehrani محمدرضا مهاجری تهرانی Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Iran Zohreh Z Hamidi زهره حمیدی Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Iran Akbar A Soltani اکبر سلطانی Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Iran Mohammad M Pajouhi محمد پژوهی Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Iran OsteoporosisPathologyic fractureDXAQUSBisphosphonatesCalcitoninPTHSERMsHRT 170.pdf Eastell R. Treatment of postmenopausal osteo-porosis. N Engl J Med.1998;338:736-746.##WHO study group. Assessment of fracture risk and its application to screening for postmeno-pausal osteoporosis. Technical report series 843. Geneva: WHO, 1994.##Shepherd A. J., An overview of osteoporosis Altern ther Health Med.2004;10:26-34.##Cooper C., Walker-Bone K., Arden N. Novel insights into the pathogenesis of the role of intrau-terine programming. Rheumatology.2000;39:1312 -15.##Cooper C., Eriksson J.G., Forson T. Maternal height, childhood growth and risk of hip fracture in later life: a longitudinal study. Osteoporos Int. 2001;12:623-9.##Anderson F.H., Francis R.M., Selby P.L. Sex hormones and osteoporosis in men. Calcif Tissue Int 1998;62:185-8.##Amin S., Yuquing Z., Clark T. Association of hypogonadism and oestradiol levels with bone mineral density in elderly men from the Fram-ingham Study. Ann Intern Med.2000;133:951-63.##Barrett-Conner E., Mueller J.E., Von Muhlen D.G. Low levels of oestradiol are associated with vertebral fractures in older men, but not women: the Rancho Bernardo Study. J Clin Endocrinol Metab.2000;85:219-23.##Larijani B., Soltani A., Pajouhi M. Bone mine-ral density variation in 20-69 y/o population of Tehran/Iran. Iranian South Med J.2002;5:41-49.##Larijani B. An overview of osteoporosis in Iran. 1th international osteoporosis seminar in Iran. Tehran, Iran.2004.##Royal College of Physicians of London. Fractured neck of femur: prevention and manage-ment. London: Royal College of Physicians, 1989.##Looker A.C., Orwoll E.S., Johnston C.C., Lin-dsay R.L., Wahner H.W., Dunn W.L., Calvo M.S., Narris T.B., Neyse S.P. Prevalence of low femoral bone density in older US adults from NHANES III. J Bone Miner Res.1997;12:1761-1768.##Abdollah Shamshirsaz A., Bekheirnia M.R., Kamgar M., Pourzahedgilani N., Habibzadeh M. R., Hashemi S.R., Abdollah Shamshirsaz A.H., Aghkhani S., Homayoun H., Larijani B. Meta-bolic and Endocrinological complication in Beta-thalassemia major: A multicenter study in Tehran. BMC Endocr Disord.2003;3:4.##Chapuy M.C., Arlot M.E., Duboeuf F.vitamine D3 and calcium to prevent hip fracture s in elderly women. N Engl J Med.1992;327:1637-1642.##Dawson-Hughes B., Harris S.S., Krall EA., Dallal G.E. Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med. 1997; 337:670-676.##Hashemipour S., Larijani B., Adibi H., Javadi E., Sedaghat M., Pajouhi M., Soltani A., Shafaei A.R. Hamidi Z., Fard A.R., Hossein-Nezhad A., Booya F. Vitamin D deficiency and causative fac-tors in the population of Tehran. BMC Public Health.2004;4:38.##Mc Kenna M.J. Differences in vitamin D stat-us between countries in young adults and the elderly. Am J Med.1992;93:69-77.##Larijani B., Bekheirnia M.R., Soltani A., Khalili-Far A.R., Adibi H., Jalili R.B. Bone mine-ral density is related to blood pressure in men. Am J Hum Biol.2004;16:168-71.##Hossein-nezhad A., Soltani A., Rahimi I., Shafaie A., Maghbooli Z., Larijani B. Relation between tea drinking and bone mineral density. Tabib-Shargh.2003;2:29-38.##حقیقیان رودسری آرزو، طاهباز فریده، ارجمندی بهرام، لاریجانی باقر، کیمیاگر مسعود. تأثیر پروتئین سویا بر شاخص‌های متابولیسم استخوان در زنان یائسه متبلا به استئوپروز، فصلنامه پزشکی باروری و ناباروری. سال ششم، شماره اول، زمستان 1383، صفحات 68-62.##Bekheiia M.R., Abllah Shahirsaz A., Kamgar M., Bouzari N., Erfanzadeh G., Pourzahedgilani N., Tataie S.M., Abllah Shahirsaz A., Kimiagar M., Ezzati F., Larijani B., Serum zinc and its relation to bone mineral density in beta-thalasse-mic adolescents. Biol Trace Elem Res.2004;97: 215-24.##Brown J.P. 2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. Canadian Med Assoc J.2002;167:sl-s34.##Marshall D., Johnell O., Wedel H. Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractu-res. BMA.1996;312:1254-9.##Cummings S.R., Nevitt M.C., Browner W.S., Stone K., Fox K.M., Ensrud K.E. Risk factors for hip fracture in white women. Study of Osteoporo-tic Fractures Research Group. N Engl J Med 1995;332:767-73.##Wasnich R.D., Davis J.W., Ross P.D. Spine fracture risk is predicted by nonspine fractures. Osteoporos Int.1994;4:1-5.##Davis J.W., Grove J.S., Wasnich R.D., Ross P.D. Spatial relationships between prevalent and incident spine fractures. Bone.1999;24:261-4.##Ismail A.A., Cockerill W., Cooper C., Finn J.D., Abendroth K., Parisi G. Prevalent vertebral deformity predicts incident hip though not distal forearm fracture: results from the European prosp-ective osteoporosis.Osteoporos Int.2001;12:85-90.##Klotzbuecher C.M., Ross P.D., Landsman P., Abbott T.A.I., Berger M. Patients with prior fractures have an increased risk of future frac-tures: a summary of the literature and statistical synthesis. J Bone Miner Res.2000;15:721-39.##Ross P.D., Davis J.W., Epstein R.S., Wasnich R.D. Pre-existing fractures and bone mass predict vertebral fracture incidence in women. Ann Intern Med.1991;114:919-23.##Tromp A.M., Smit J.H., Deeg D.J.H., Bouter L.M., Lips P. Predictors for falls and fractures in the longitudinal aging study Amsterdam. J Bone Miner Res.1998;13:1932-9.##Black D.M., Palermo L., Nevitt M.C., Genant H.K., Christensen L., Cummings S.R. Defining incident vertebral deformity, a prospective com-pareison of several approaches. The Study of Ost-eoporotic Fractures Research Group. J Bone Miner Res.1999;14:90-101.##Fox K.M., Cummings S.R., Williams E., Stone K. Study of Osteoporotic Fractures. Femo-ral neck and intertrochanteric fractures have diff-erent risk factors, a prospective study. Osteoporos Int.2000;11:1018.##Ettinger B., Black D.M., Mitlak B.H., Knick-erbocker R.K., Nickelsen T., Genant H.K. Reduc-tion of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: Results from a 3-year randomized clinical trial. JAMA.1999;282:637-45.##Black D.M., Arden N.K., Palarmo L., Pearson J., Cummings S.R. Prevalent vertebral deformities predict hip fractures and new vertebral deformi-ties but not wrist fractures. J Bone Miner Res. 1999;14:821-8.##Lindsay R., Silverman S.L., Cooper C., Han-ley D.A., Barton I., Broy S.B. Risk of new verte-bral fracture in the year following a fracture. JAMA.2001;285:320-3.##McClung M.R., Geusens P., Miller P.D., Zip-pel H., Bensen W., Roux C. Effects of risedronate on the risk of hip fracture in elderly women. N Engl Med.2001;344:333-40.##Kanis J.A., Melton L.J. III, Christiansen C., Johnston C.C., Khaltaev N. The diagnosis of oste-oporosis. J Bone Miner Res.1994;9:1137-41.##Cadarette S.M., Jaglal S.B., Murray T.M., McIsaac W.J., Joseph L., Brown J.P. Evaluation of decision rules for referring women for bone densitometry by dual-energy X-ray absorption-metry. JAMA.2001;286:57-63.##Cummings S.R., Black D.M., Nevitt M.C., Browner W.S., Cauley J.A., Genant H.K. Appen-dicular bone density and age predict hip fracture in women. JAMA.1990;263:665-8.##Kanis J.A., Johnell O., Oden A., Dawson A., De Laet C., Jonsson B. Ten years probabilities of osteoporotic fractures according to BMD and diagnostic thresholds. Osteoporos Int.2001;12: 989-95.##Torgerson D.J., Campbell M.K., Thomas R.E., Reid D.M. Prediction of perimenopausal fractures by bone mineral density and other risk factors. J Bone Miner Res.1996;11:293 -7.##Dargent-Molina P., Favier F., Grandjean H., Baudoin C., Schott A.M., Hausherr E. Fall-related factors and risk of hip fracture: the EPIDOS prospective study. Erratum in: Lancet 1996;348: 4161.##Dargent-Molina P., Schott A.M., Hans D., Favier F., Grandjean H., Baudoin C. Separate and combined value of bone mass and gait speed measurements in screening for hip fracture risk: results from the EPIDOS study. Osteoporos Int. 1999;9:188-92.##Adachi J.D., Olszynski W.P., Hanley D.A., Hodsman A.B., Kendler D.L., Siminoski K.G. Management of corticosteroid-induced osteo-porosis. Semin Arthritis Rheum.2000;29:228-51.##Hodgson S.F., Watts N.B. American associa-tion of clinical endocrinologists medical guide-lines for clinical practice for the prevention and treatment of postmenopausal osteoporosis. Endo-crine Practice.2003;9:554-564.##Dabbaghmanesh M.H., Pajouhi M., Larijani B. How is the agreement of QUS of heel and DXA in diagnosis of osteoporosis. Iran South Med J.2002;5:50-55.##Yeap S.S., pearson D., cawte S.A. The relationship between bone mineral density and ultrasound in postmenopausal and osteoporotic women. Osteoporosis Int.1998;8:141-6.##Larijani B., Dabbaghmanesh M.H., Sedaghat M., Akrami M., Hamidi Z., Rahimi I. Defining cut-off values for diagnosis of osteoporosis in postmenopausal women by quantitative heel ultra-sonography (QUS). Iran J Endocrin Met.2004; 69:39-45.##Sedaghat M., Hamidi. Z., Soltani. A., Rahimi. E., Maghbooli. Z., Larijani. B. Defining cut-off values for diagnosis of osteoporosis in postmeno-pausal women by quantitative phalanx ultrasono-graphy (QUS). 1th international osteoporosis semi-nar in Iran.Tehran, Iran, (2004).##NIH Consensus Development Panel on Osteo-porosis Prevention,Diagnosis, and therapy JAMA. 2001;285:785-95.##Bonjour J.P., Carrie A.L., Ferrari S., Clavien H., Slosman D., Theintz G., Rizzoli R. Calcium-enriched foods and bone mass growth in prepu-bertal girls: a randomized, double-blind, placebo-controlled trial. J Clin Invest.1997;99:1287-94.##Lloyd T., Martel J.K., Rollings N., Andon M. B., Kulin H., Demers L.M. The effect of calcium Supplementation and tanner stage on bone den-sity, content and area in teenage women. Osteo-poros Int.1996;6:286-3.##Rico H., Revilla M., Villa L.F., Alvarez de Buergo M., Arribas I. Longitudinal study of the effect of calcium pidolate on bone mass in eugo-nadal women. Calcif Tissue Int.1994;54:477-80. 55- Holbrook T.L., Barrett-Connor E.L., Wingard D.L. Dietary calcium and risk of hip fracture:14-year prospective population study. Lancet.1988; 2:1046 -9.##Baeksgaard L., Andersen K.P., Hyldstrup L. Calcium and vitamin D Supplementation incre-ases spinal BMD in healthy, postmenopausal women. Osteoporos Int.1998;8:255-60.##Kalkwarf H.J., Specker B.L., Bianchi D.C., Ranz J., Ho M. The effect of calcium Supplemen-tation on bone density during lactation and after weaning. N Engl J Med.1997;337:523-8.##Reid I.R., Mason B., Horne A. Effects of calcium supplementation on serum lipid concen-trations in normal older women: a randomized controlled trial. Am J Med.2002;112:343-7.##Vieth R., Cole D.E., Hawker G.A., Trang H. M., Rubin L.A. Wintertime vitamin D insufficie-ncy is common in young Canadian women, and their vitamin D intake does not prevent it. Eur J Clin Nutr. 2001;55:1091-7.##Munger R.G., Cerhan J.R., Chiu B.C. Pros-pective study of dietary protein intake and risk of hip fracture in postmenopausal women. Am J Clin Nutr.1999;69:147-52.##Hernandez-Avila M., Colditz G.A., Stampfer M.J, Rosner B., Speizer F.E., Willett W.C. Coff-eine, moderate alcohol intake and risk of fractures of the hip and forearm in middle-aged women. Am J Clin Nutr.1999;54:157-63.##Devine A., Criddle R.A., Dick I.M., Kerr D. A., Prince R.L. A longitudinal study of the effect of sodium and calcium intakes on regional bone density in postmenopausal women. Am J Clin Nutr. 1995;62:740-5.##Byrjalsen I., Haarbo J., Christiansen C. Role of cigarette smoking on the postmenopausal endo-metrium during sequential estrogen and proges-togen therapy. Obstet Gynecol.1993;81:1016.##Greendale G.A., Wells B., Marcus R., Barrett-Connor E. How many women lose bone mineral density while taking hormone replacement ther-apy? Results from the postmenopausal Estrogen/ Progestin interventions trial. Arch Intern Med. 2000;160:3065.##Russell R.G., Rogers M.J. Bisphosphonates: from the laboratory to the clinic and back again. Bone.19999;25:97-106.##Liberman U.A., Weiss S.R., Broll J. Effect of oral alendronate on bone mineral density and the incidence of fractures in postmenopausal osteopo-rosis. N Engl J Med.1995;333:1437-43.##Bauer D.C., Black D., Ensrud K. Upper gast-rointestinal tract safety profile of alendronate: the fracture intervention trial. Arch Intern Med.2000; 160:517.##Levine J., Nelson D. Esophageal stricture associated with alendronate therapy. Am J Med. 1997;102:489.##Schussheim D.H., Jacobs T.P., Silverberg S.J. Hypocalcemia associated with alendronate[letter]. Ann Intern Med.1999;130:329.##Bone H.G., Greenspan S.L., McKeever C., Alendronate and estrogen effects in postmenopa-usal women with low bone mineral density. Alen-dronate/Estrogen Study Group. J Clin Endocrinol Metab.2000;85:720-6.##Heaney R.P. Bone mass, bone loss, and osteo-porosis prophylaxis.Ann Intern Med.1998;128: 313-4.##Fraunfelder F.W., Fraunfelder F.T. Bisphos-phonates and ocular inflammation. N Engl J Med. 2003;348:1187-8.##The Writing Group for the PEPI.Effects of hormone therapy on bone mineral density: results from the postmenopausal estrogen/progestin inter-venetions (PEPI) trial. JAMA.1996;276:1389-96.##Riggs B.L., Hartmann L.C. Selective estrogen-receptor modulators mechanisms of action and application to clinical practice. N Engl J Med. 2003;348:618.##Cauley J., Norton L., Lippman M., Eckert S., Krueger K., Purdie D. Continued breast cancer risk reduction in postmenopausal women treated with raloxifene: 4-years results form the MORE trial. Breast Cancer Res Treat.2001;65:125-34.##Cummings S.R., Eckert S., Krueger K.A., Grady D., Powles T.J., Cauley J.A. The effect of raloxifene on risk of breast cancer in postmeno-pausal women: Results from the MORE rando-mized trial. JAMA.1999;281:2189-97.##Mosselman S., Polman J., Dijkema R.ER beta: identification and characterization of a novel human estrogen receptor. FEBS Lett.1996;392: 49-35.##Dempster D.W., Cosman F., Parisien M. Ana-bolic actions of parathyroid hormone on bone. Endocr Rev.1993;14:690-709.##Neer R.M., Arnaud C.D., Zanchetta J.R. Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med.2001;344:1434-41.##Chesnut C.H. III, Silverman S., Andriano K., Genant H.K., Gimona A., Harris S.,A randomized trial of nasal spray salmon calcitonin in postmeno-pausal women with established osteoporosis: the Prevent Recurrence of Osteoporotic Fractures Study. Am J Med.2000; 109:267-76.##Meunier P.J., Sebert J.L., Reginster J.Y., Bria-ncon D., Appelboom T., Netter P. Fluoride salts are no better at preventing new vertebral fractures than calcium-vitamin D in postmenopausal osteo-porosis: the FAVO Study. Osteoporos Int.1998; 8:4-12.##Scheiber M.D., Rebar R.W. Isoflavones and postmenopausal bone health: a viable alternative to estrogen therapy?. Menopause.1999;6(3):233-41.##Alexandersen P., Toussaint A., Christiansen C., Devogelaer J.P., Roux C., Fechtenbaum J. Ipriflavone in the treatment of postmenopausal osteoporosis: a randomized controlled trail. JAMA. 2001;285:1482-8.##Feskanich D., Weber P., Willett W.C., Rock-ett H., Booth S.L., Colditz G.A. Vitamin K intake and hip fractures in women: a prospective study. Am J Clin Nutr.1999;69:74-9.##Modelska K., Cummings S. Tibolone for post-menopausal women: systematic review of rando-mized trials. J Clin Endocrinol Metab.2002;87:16.##Bjarnason N.H., Bjarnason K., Haarbo J. Tibolone: influence on markers of cardiovascular disease. J Clin Endocrinol Metab.1997;82:1752-6.##Erdtsieck R.J., Van Kujik C., Birkenhager-Frenkel D.H. Course of bone mass during and after hormonal replacement therapy with and without addition of nandrolone decanoate. J Bone Miner Res. 1994;9:277-83.##Canalis E.M., Hintz R.L., Dietrich J.W. Effect of somatomedin and growth hormone on bone collagen synthesis in vitro. Metabolism.1997;26: 1079.##Baum H.B.A., Biller B.M.K., Finkelstein J.S. Effects of physiologic growth hormone therapy on bone density and body composition in patients with adult-onset growth hormone deficiency- a randomized, placebo-controlled trial. Ann Intern Med.1996;125:883-90.##Meunier P.J., Slosman D.O., Delmas P.D. Strontium ranelate: dose-dependent effects in established postmenopausal vertebral osteopo-rosis-a 2-year randomized placebo controlled trial. J Clin Endocrinol Metab.2002;87 :2060-6.##Christodoulou C., Cooper C. What's osteo-porosis? Postgraduate Med J.2003;79:133-138.##Holbrook T.L., Barrett-Connor E.L., Wingard D.L. Dietary calcium and risk of hip fracture:14-year prospective population study. Lancet.1988; 2:1046 -9.##Hergenroeder A.C., O'Brian Smith E., Shy-pailo R. Bone mineral changes in young women with hypothalamic amenorrhea treated with oral contraceptives, medroxyprogesterone, or placebo over 12 months. Am J Obstet Gynecol.1997;176: 1017.##Writing Group for the Women's Health Initiative Investigators. Risks and benefits of estr-ogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative Randomized Controlled Trial. JAMA.2002;288:321-33.##

همراهي كمبود شديد ويتامين D با شيوع دردهاي عضلاني اسكلتي با منشأ نا مشخص Vitamin D deficiency in people with musculoskeletal pain of unknown origin 2 1 مقدمه: كمبود ويتامينD3 كه در نتيجه فقدان اين ماده در رژيم غذايي يا قرارنگرفتن در معرض اشعه UV به ميزان كافي اتفاق مي‌افتد مي‌تواند همراه با ابتلا به بيماري‌هاي استخواني به صورت ريكتز در بچه ها و استئومالاسي در بزرگسالان ديده شود كه همراه با درد استخواني و عضلاني توأم با ضعف عضلاني مي‌باشد. از طرفی، در بيماران مبتلا به دردهاي اسكلتي و عضلاني با منشأ غيرمشخص نیز شيوع بالايي از كمبود ويتامين D گزارش شده است. با توجه به شيوع بالاي كمبود ويتامينD در كشور به نظر مي‌رسد بررسي ارتباط دردهاي عضلاني و اسكلتي با ميزان ويتامين D مي‌تواند راهكاري در مواجهه با اين معضل ارائه دهد. مواد و روشها: جمعیت مورد مطالعه مردان و زنان 69-20 سال ساکن شهر تهران بودند که در طرح پيشگيري، تشخيص و درمان استئوپروز مورد مطالعه قرار گرفتند. معیارهای خروج از مطالعه ابتلا به بیماری‌های آرتریت روماتوئید، کم کاری یا پرکاری تیروئید، پاراتیروئید و آدرنال، دیابت قندی، نارسایی کلیه، نارسايي پیشرفته کبدی و هر نوع سرطان بود. براي انجام نمونه‌گيري به روش تصادفي، اطلاعات مربوط به تمام زايمان‌هاي اول در شهر تهران جمع‌آوري شد و از اين تعداد، 50 نقطه به صورت تصادفي براي شروع نمونه‌گيري انتخاب شد. از افراد شركت كننده نمونه‌ خون جهت بررسي ميزان ويتامين D سرمي و هورمون‌ پاراتيروئيد، كلسيم، فسفر و آلكالين فسفاتاز گرفته شد. از افراد داوطلب جهت حضور در بخش سنجش تراكم استخوان مركز تحقيقات غدد دانشگاه علوم پزشكي تهران دعوت به عمل آمد. اطلاعات به دست آمده با استفاده از نرم افزار (11.5) SPSS آناليز شد. براي مقايسه ميانگين مقادير به دست آمده از T- test و بر حسب مورد از آزمون‌هاي غيرپارامتري استفاده شد. جهت مقايسه فراواني متغيرهاي مورد سنجش از آموزن 2 استفاده شد. سطح‌معني‌داري كمتر از 05/0 درنظرگرفته شد. نتایج: درمجموع 1229 نفر جهت شركت در طرح دعوت شدند.از اين تعداد 124 نفر يكي از معيارهاي خروج از مطالعه را داشتند كه از مطالعه خارج شدند. در نهايت از 1105 نفر باقيمانده، 830 نفر با سه بار پيگيري حضوري و تلفني در اين طرح شركت كردند؛ به عبارتي 1/75% از افراد دعوت شده با اين طرح همكاري نمودند. در اين بررسي كمبود ويتامين D در زنان داراي دردهاي تيز و مداوم استخواني در سنين زير 50 سال شايعتر از افراد بدون دردهاي تيز و مداوم استخواني بود (009/0=P). همچنين درجات شديد كمبود ويتامين D هم در اين افراد شايعتر بود. 50% زنان زير 50 سال كه دردهاي تيز و مداوم استخواني داشتند دچار كمبود شديد ويتامين D بودند (015/0=P). همچنين كمبود شديد ويتامين D با دردهاي مداوم استخواني در زنان بالاي 50 سال (6/28% ) نسبت به افراد بدون درد (9/7%) شايع‌تر بود (034/0=P). نتيجه‌گيري: به نظر مي‌رسد كمبود ويتامين D به ويژه در درجات شديد و در زنان مي‌تواند با دردهاي عضلاني-اسكلتي بدون منشأ مشخص همراه باشد؛ لذا بررسي اين بيماران از نظر سطوح ويتامين D و درمان آنها با اين ويتامين توصيه مي‌گردد. در اين رابطه غني‌سازي مواد غذايي با ويتامين D مي‌تواند راهكار مناسبي جهت كاهش شيوع كمبود ويتامين D و احتمالاً بهبود مشكلات عضلاني-اسكلتي در جامعه باشد. 2 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. 2- 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. 53 62 Jila J Maghbouli ژیلا مقبولی Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Iran Soroush S Mortaz Hejri سروش مرتاض هجری Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Iran Poulia P Ebrahim-pour پولیا ابراهیم پور Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Iran Hossein H Adibi حسین ادیبی Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Iran Alireza A Shafaei علیرضا شفایی Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Iran Ebrahim E Djavadi ابراهیم جوادی Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Iran emrc@sina.tums.ac.ir Vitamin DCalciumMuscular painSkeletal pain 174.pdf Working Group of the Australian and New Zealand Bone and Mineral Society. Vitamin D and adult bone health in Australia and New Zealand: a position statement. Med J Aust. 2005;182:281-5.##Norman A.W. An Introduction to Vitamin D. Department of Biochemistry & Biomedical Scien-ces,University of California, Riverside CA 92521.##Holick M.F. Environmental factors that influen-ce the cutaneous production of vitamin D. Am. J. Clin. Nutr.1995;61: 638S-645S.##Gartner L.M., Greer F.R. Prevention of rickets and vitamin D deficiency: new guidelines for vit-amin D intake. Pediatrics. 2003;111:908-10.##Harris S.S., Dawson-Hughes B. Seasonal chan-ges in plasma 25- hydroxyvitamin D concentra-tions of young American black and white women. Am J Clin Nutr.1998;67:1232-6.##Food and Nutrition Board. Dietary reference intakes: A risk assessment model for establishing upper intake levels for nutrients. Washington, D.C. National Academy Press, Institute of Medicine.1998;pp:1-71.##De Schepper J. Endocrine disorders associated with cystic fibrosis. Academisch Ziekenhuis Kind-eren-V.U.B., Laarbeeklaan 101, 1090 Brussels, Belgium.##Holik M.F.Vitamin D the underappreciated D-Rightful hormone that is important for skeletal and cellular health.Curr Opin Endocrinol Diabetes 2002;9:87-98.##Karges K., Morgan J.B., Owens F.N., Gill D.R. Effects of feeding vitamin D on feed intake, carcass characteristics and meat of beef steers. Anim Sci Res Rep.1999;143-146.##Karges K., Morgan J.B., Owens F.N., Gill D.R. Effects of supplemental vitamin D on blood parameters, calpastatin activity and PH of steer crcasses. Anim Sci Res Rep.1999.##Hayer C.E., Cantorna M.T., Deluca H.F. Vitamin D and multiple sclerosis. Proc Soc Exp Biol Med. 1997; 216: 21-7.##Cantorna M.T. Vitamin D and autoimomunity: is vitamin D status an environmental factor affecting autoimmune disease prevalence?. Proc Soc Exp Biol Med.2000;223-3.##Hollis B.W. Assessment of vitamin D nutria-tional and hormonal that is important for skeletal and cellular health.Curr Opin Endocrinol Diabetes 2002;9:87-98.##Scientific Committee on Food of European Commission Health & Consumer Protection Dir-ectorate General.Opinion of the Scientific Comm-ittee on Food on an application from MultiBene for approval of plant sterol-enriched foods. SCF/ CS/NF/DOS/24 ADD 2 Final 15 April 2003. ttp://europa.eu.int/comm/food/fs/sc/scf/index_en.html##Raiten D.J., Picciano M.F. Vitamin D and health in the 21st century: bone and beyond. Executive summary. Am J Clin Nutr.2004;80: 1673-7.##Alagol F., Shihadeh Y., Boztepe H. Sunlight exposure and vitamin D in Turkish women. J Endocrinal Invest. 2000; 23: 173-7.##Fonseca V., Tongia R., El-Hasmi M., et al. Exposure to sunlight and vitamin D deficiency in Saudi Arabian women. Postgrad Med J.1984; 60:589-91.##Keane E.M., Healy M., ? Moore R., et al. Vitamin D Fortified liquid milk, Benefits for the Elderly Community-Based Population. Calcif Tissue Int.1998;62:300-2.##لاریجانی باقر، هاشمی‌پور سیما، گویا محمد مهدی، پژوهی محمد. بررسی شیوع کمبود ویتامین و عوامل مؤثر بر آن در جمعیت 69-20 ساله شهر تهران، مجله علمی سازمان نظام پزشکی جمهوری اسلامی ایران، (1382) .2،صفحات 131-125.##Mascarenhas R., Mobarhan S. Hypovitamin-osis D-induced pain. Nutrition Reviews. Washin-gton:2004;62:354-60.##Block S.R., Plotnikoff G.A. Vitamin D Defic-iency is not associated with nonspecific musculos-keletal pain syndromes including Fibromyalgia / in reply, Mayo clinic proceedings. Rochester. 2004;79:1585-8.##Torrente de La Jara G., Pecoud A., Favrat B. Musculoskeletal pain in female asylum seekers and hypovitaminosis D3, Bri Med J. 2004;329 (7458):156.##Myalgia working group. People with unde-termined muscle / bone pain may be severely vitamin D deficient, Atlanta. Drug Week, Pain medicine.2004:504.##Aldo B., Nicola D. A woman with bone pain, fracture, and malabsorption. Lancet.1999;347:300.##Russell J.A. Osteomalacic myopathy, Depar-tment of Neurology, Lahey Clinic Medical Center, Burlington, MA 0.1886##Plotnikoff G.A., Quigley J.M. Prevalence of severe Hypovitaminosis D in patient with persis-tent, nonspecific musculoskeletal pain, Mayo Clinic Proceedings.December.2003;78:1463-70.##

تأثير پروتئين سويا بر شاخص‌هاي متابوليسم استخوان در زنان يائسه مبتلا به استئوپني Effect of soy protein on bone markers in osteopenic menopause women 2 1 مقدمه: كاهش توده استخواني يكي از مهمترين عوارض دوران يائسگي است كه اغلب ناشي از افت سطح هورمون‌هاي تخمداني مي‌باشد. تركيبات شبه استروژني مثل ايزوفلاون‌ها كه در گياهان به ويژه سويا يافت مي‌شوند به دليل شباهت ساختماني با استروژن ممكن است سرعت كاهش توده استخوان را در زنان يائسه كم كنند. لذا اين تحقيق با هدف بررسي اثر پروتئين سويا بر شاخص‌هاي بيوشيميايي متابوليسم استخوان در زنان يائسه مبتلا به استئوپني انجام شد. مواد و روشها: اين مطالعه به روش كارآزمايي باليني و به صورت قبل و بعد، بر روي 15 زن يائسه مبتلا به استئوپني64-45 ساله انجام گرفت. به افراد شركت كننده، مصرف روزانه g35 پروتئين سويا به مدت 12 هفته توصيه شد. نمونه‌گيري خون و ادرار، اندازه‌گيري‌هاي تن سنجي و يادآمد غذايي 2 روزه در هفته‌هاي 0 ،6 و12 صورت گرفت. داده‌هاي بررسي مصرف غذايي با برنامه Food Proccessor تحليل و جهت بررسي تغييرات شاخص‌هاي متابوليسم استخوان و تغييرات داده‌هاي آنتروپومتري و رژيم غذايي از آناليز اندازه‌گيري‌هاي تكراري استفاده گرديد. سطح‌ معني‌داري كمتر از 05/0 در نظر گرفته شد. نتایج: مقايسه تغييرات وزن، BMI، فعاليت بدني و دريافت انرژي و ساير مواد مغذي مداخله‌گر در مراحل مختلف بررسي تفاوت معني‌داري را نشان نداد. مصرف پروتئين سويا، كاهش معني‌داري را در شاخص دزوكسي‌پيريدينولين ادرار و افزايش معني‌داري در شاخص آلكالن‌فسفاتاز تام نشان داد (05/0>P)؛ اما تغييرات ايجاد شده در شاخص‌هاي استئوكلسين، C – تلوپپتيد، پروتئين پيوندشونده با عامل رشد شبه انسوليني (IGFBP3) و تلوپپتيد كلاژن نوع I معني‌دار نبود. نتيجه‌گيري: با توجه به تاثير مفيد مصرف پروتئين سويا بر شاخص‌هاي متابوليسم استخوان، گنجاندن اين ماده غذايي ارزان ودر دسترس، در رژيم غذايي روزانه زنان يائسه، احتمالاً سرعت روند كاهش توده استخواني را در آنها كم مي‌نمايد و مي‌تواند گامي مثبت در جهت پيشگيري از پوكي استخوان باشد. 2 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 Proccessor” 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. 62 69 Arezo A Haghighian Roudsari آرزو حقیقیان رودسری Food industry and Nutrition Faculty, Shahid Beheshti University of Medical Sciences Food industry and Nutrition Faculty, Shahid Beheshti University of Medical Sciences Iran Farideh F Tahbaz فریده طاهباز Food industry and Nutrition Faculty, Shahid Beheshti University of Medical Sciences Food industry and Nutrition Faculty, Shahid Beheshti University of Medical Sciences Iran Bahram B Arjmandi بهرام ارجمندی Food industry and Nutrition Faculty, Shahid Beheshti University of Medical Sciences Food industry and Nutrition Faculty, Shahid Beheshti University of Medical Sciences Iran Bagher B Larijani باقر لاریجانی Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Iran emrc@sina.tums.ac.ir Masoud M Kimiagar مسعود کیمیاگر Food industry and Nutrition Faculty, Shahid Beheshti University of Medical Sciences Food industry and Nutrition Faculty, Shahid Beheshti University of Medical Sciences Iran Soy proteinIsoflavonespostmenopausal womenBone metabolism markersOsteopenia 175.pdf Barrett C.E. Epidemiology and the menopause: A global overview. Int J Fertil.1993;38:6-14.##Arjmandi B.H., Alekel L., Hollis B.W., Amin D. Dietary soybean protein prevents bone loss in an ovariectomized rat model of osteoporosis .J Nut.1996; 126:161-7.##Dempster D.W., Lindsay R.Pathogenesis of osteoporosis. Lancet.1996;341:797-801.##Position statement of the north american meno-pause society. Management of postmenopausal osteoporosis. Menopause.2002;9:84-101.##Scharbo D.M. Hormone replacement therapy. Nurse Pract.1996;21:1-13.##Groeneveld F.P., Bareman F.P., Barensen R. Determinants of first prescription of hormone rep-lacement therapy.A follow up study among 1689 women aged 45-60 years. Maturitas.1994;20:81-9.##Lignieres D.B. Hormone replacement therapy :clinical benefits and side-effects.Maturitas.1996; 23(suppl):S31-6.##Johannes C.B., Crawford S.L., Posner J.G., Mckinlay S.M. Longitudinal patterns and correla-tes of hormone replacement therapy use in middle aged women. Am J Epidemiol.1994;140:439-52.##Ross P.D., Norimatsu H., Davis J.W., Yano K., Wasnich R.D. A comparison of hip frcture incide-nce amonge native Japanese,Japanese Americans, and American Caucasians. Am J Epidemiol.1991; 133:801-9.##Adiercreutz H., Mazur W. Phytoestrogens and Western diseases. Ann Med. 1997;29:95-120.##Glazier M.G., Bowman M.A. A review of the evidence for the use of phytoestrogens as a replac-ement for traditional estrogen replacement thera-py. Arch Intern Med. 2001;161:1161-72.##Love R.R., Barden H.S., Mazess R.B., Epstein S., Chappel R.J. Effects of tamoxifen on lumbar spine bone mineral density in postmenopausal women after 5 years. Arch Intern Med.1994;22: 2585-8.##Messina M.J. Legumes and soybeans: Over-view of their nutritional profiles and health effects Am J Clin Nutr.1999;70(suppl):439s-50s.##Wangen K.E., Duncan A.M., Merz-Demlow B.E. Effects of soy isoflavones on markers of bone turnover in premenopausal and postmeno-pausal women. J Clin Endocrinol Metab.2000;85: 3043-48.##Kuiper G.G., Carisson B., Grandien K. Comp-arison of the ligand binding specifity and transc-ript tissue distribution of estrogen receptors alpha and beta. Endocrinology.1997;138:863-70.##Arjmandi B.H., Getlinger M.J., Goyal N.V., Alekel l., Hasler C.M. Role of soy protein with normal or reduced isoflaonecontent in reversing bone loss induced by ovarian hormone deficiency in rats. Am J Clin Nutr.1998;68(suppl):1358s-63s.##Arjmandi B.H., Birnbaum R., Goyal N.V., Getlinger M.J. Bone sparing effect of soy protein in ovarian hormone-deficient rats is related to its isoflavone content. Am J Clin Nutr.1998;68 (suppl):1364s-8s.##Register T.C., Jayo M.J., Anthony M.S. Soy phytoestrogens do not prevent bone loss in post-menopausal monkeys. J Clin Endocrinol Metab. 2003;88:4362-70.##Clarkson T.B., Anthony M.S., Morgan T.M. Inhibition of postmenopausal atherosclerosis. Pro-gression:a comparison of the effects of conjugated equine estrogens and soy phytoestrogens. J Clin Endocrinol Metab.2000; 86:41-47.##Setchell K.D., Brown N.M., Lydeking-Olsen E. The clinical importance of the metabolite equol-a clue to the effectiveness of soy and its isoflavones. J Nutr.2002;132:3577-84.##Arjmandi B., Khalil D.A., Smith B.J. Soy protein has a greater effect on bone in postmeno-pausalwomen not on hormon replacement therapy as evidenced by reducing bone resorption and urinary calcium excretion. J Clin Endocrinol Metab.2003;88:1048-54.##Yamori Y., Moriguchi E.H., Teramoto T., Miura A. Soybean isoflavones reduce postmeno-pausal bone resorbtion in female Japanese immig-rants in Brazil: A ten week study. J Am Coll Nutr. 2002;21:560-63.##Picherit C., Pelissero C.B., Chanteranne B., Lebecque P. Soybean isofavones dose-depend-ently reduce bone turnover but do not reverse established osteopenia in adult ovariectomized rats. J Nutr.2001;131:723-8.##Uesugi T., Fukui Y., Yamori Y. Beneficial effects of soybean isoflavone supplementation on bone metabolism and serum lipids in postmenopa-usal Japanese women: a four week study .J Am Coll Nutr.2002;21:97-102.##Watts N.B. Clinical utility of biochemical markers of bone remodeling. Clin.Chem.1999;45 (8 Pt 2):1359-68.##Fanti P., Monier-Faugere M.C., Geng Z. The phytoestrogen genistein reduces bone loss in short term ovariectomized rats. Osteoporosis Int.1998; 8:274-81.##Picherit C., Coxam V., Bennetau-Pelissero C., Kati-Coulibaly S. Daidzein is more efficient than genistein in preventing ovariectomy-induced bone loss in rats. J Nutr.2000;130:1675-81.##Agnusdei D., Crepaldi G., Isaia G. A double blind, placibo controlled trial of ipriflavone for prevention of postmenopausal spinal bone loss. Calcif Tissue Int.1997;61:142-7.##Gennari C., Agnusdei D., Crepaldi G. Effect of ipriflavone-a synthetic derivative of natural isoflavones-on bonemass loss in the early years after menopause. Menopause.1998;5:9-15.##Potter S.M., Baum J.A., Teng H., Stillman R.J. Soy protein and isoflavone:their effects on blood lipids and bone density in postmenopausal women.Am J Clin Nutr.1998;68(suppl 6):1375s-79s.##Alekel D.L., Germain A.S., Peterson C.T., Hanson K.B. Isoflavone-rich soy protein isolate attenuates bone loss in the lumbar spine of perimenopusal women. Am J Clin Nutr.2000;72: 844-52.##Barnes S., Phytoestrogens and osteoporosis-What is a safe dose?. Br J Nutr. 2003;39:S101-S108.##

بررسی رابطه مصرف ميوه‌ها و سبزيها با تراکم معدنی استخوان در جمعيت روستايي اطراف تهران Relationship between fruits and vegetables intake and bone mineral density in rural population surrounding Tehran 2 1 مقدمه: استئوپروز يکی از بيماري‌های غير واگير شايع در دوران سالمندی است که عوارض آن هزينه های زيادی را به جامعه تحميل می‌کند. اصلاح عوامل مؤثر بر تراکم معدنی استخوان می‌تواند در پيشگيری از اين بيماری نقش داشته باشد. در تحقيق حاضر رابطه مصرف ميوه و سبزيها با تراکم معدنی استخوان در جمعيت روستايي اطراف تهران بررسی شده است. مواد و روشها: از مجموع نمونه‌های مورد بررسي در طرح شيوع و علل کمبود ويتامين D در روستاهای اطراف شهر تهران، 82 زن و مرد 80-10 ساله که تراکم معدنی استخوان آنها اندازه‌گيری و يک پرسشنامه يادآمد 24 ساعته خوراک برای آنها تکميل شده بود، از نظر مصرف ميوه و سبزيها مورد بررسی قرار گرفتند. قد و وزن طبق روش‌های استاندارد و تراکم معدنی استخوان به روش Dual X-Ray (DXL) (Calscan) و در ناحيه پاشنه پا اندازه‌گيری شد. نتایج: درصد شيوع استئوپنی و استئوپروز در زنان بالای 50 سال به ترتيب 6/55% و 3/33% و در مردان 2/69% و 7/7% و خطر نسبی(RR) استئوپروز در زنان نسبت به مردان 33/4 بود. ميزان مصرف ميوه‌ها به تنهايي ارتباط معنی داری با تراکم معدنی استخوان نداشت. ارتباط مصرف سبزيها با تراکم معدنی استخوان تنها در زنان معنی‌دار بود. تفاوت بين بيشترين و کمترين چارک مصرف سبزيها در افراد استئوپروتيک و سالم 4/1 واحد غذايي بود. بر اساس همين تفاوت افراد به دو گروه مصرف کننده کمتر و بيشتر از 5/1 واحد غذايي از سبزي‌ها تقسيم شدند. سن، قد، وزن و BMI زنان در دو گروه مصرف سبزی تفاوت آماری معنی داری نداشت. T-scoreزنانی که سبزی بيشتری مصرف می‌کردند بطور معنی‌داری بالاتر بود (8/0±1/1- در مقابل 0/1±9/1- ، 01/0P<). در گروهی که سبزي بيشتر مصرف می کردند دريافت بعضی ريزمغذي‌ها مانند ويتامينA، ويتامينC، فولات، کلسيم، فسفر، مس، آهن، سديم، پتاسيم، منيزيم و روی بالاتر بود اما هيچ يک بغير از ويتامينA (3/0r= و 05/0P<) ارتباط معنی‌داری با T-score نداشتند. نتيجه‌گيري: مصرف زياد سبزيها تأثير مثبتی روی تراکم معدنی استخوان در زنان دارد و توصيه به مصرف حداقل 5/1 واحد غذايي از اين گروه غذايي در پيشگيری از استئوپروز مؤثر خواهد بود. 2 Introduction: Osteoporosis is a major health problem because of the large health care costs asso-ciated 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 gro- uped 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, folate, 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. 69 79 Hossein H Adibi حسین ادیبی Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Iran Samira S Ebrahimof سمیرا ابراهیمف Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Iran Soroush S Mortaz Hejri سروش مرتاض هجری Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Iran Negar N Salehomom نگار صالح عموم Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Iran Masoud M Arzaghi مسعود ارزاقی Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Iran Saeed S Hosseini سعید حسینی Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Iran emrc@sina.tums.ac.ir OsteoporosisBMDFruitsVegetablesRural populationDiet pattern 176.pdf World Health Organization. Reducing risk, promoting healthy life. World Health Report, 2002. Geneva: WHO.##Cooper C., Campion G., Melton L. Hip frac-tures in the elderly: a world-wide projection. Ost-eoporos Int.1992;2:285-289.##Bunker V. The role of nutrition in osteoporos. British J Biomedicine Science.1994;51:228-40.##World Health Report. Consumption Patterns Contribute to Mortality. Geneva.2002.##Tuker K.L., Hannan M.T., Chen H., Cupples L. A., Wilson PW.F., Kiel D.P. Potassium, magnes-ium, and fruit and vegetables intake are associa-ted with greater bone mineral density in elderly men and women. Am J Clin Nutr.1999;69:727-36.##New S.A., Robins S.P., Campell M.K., Martin J.C., Gerton M.J., Bolton-Smith C.., Grubb D.A., Lee S.J., Reid D.M. Dietary influences on bone mass and bone metabolism: further evidence of a positive link between fruit and vegetable consum-ption and bone health. Am J Clin Nutr.2000;71: 142-51.##Tuker K.L., Chen H., Hannan M.T., Cupples L. A., Wilson P.W.F., Felson D. Bone mineral dens-ity and dietary patterns in older adults. Am J Clin Nutr.2002;76:245-52.##Wattanapenpaiboon N., Lukito W., Wahlqvist M.L., Strauss B.J. Dietary carotenoid intake as predictore of bone mineral density. Asia Pac J Clin Nutr.2003; 12:467-73.##Tylavsky F.A., Holliday K., Danish R., Womack C., Norwood J., Carbone L. Fruit and vegetable intakes are an independent predictor of bone size in early pubertal children. Am J Clin Nutr.2004;79:311-7.##Tucker K., Hannan M.T., Kiel D.P. The acid-base hypothesis: Diet and bone in Framingham osteoporosis study. Eur J Nutr.2001;40:231-7.##Appel L.J., Moore T.J., Obarzanek E., Vollmer W.M., Svetkey L.P., Sacks F.M. A clini-cal trial of the effects of dietary patterns on blood pressure. N Eng J Med.1997;336:1117-24.##Buclin T., Cosma M., Appenzeller M., Jacq-uet A.F., Decosterd L.A., Biollaz J., Burckhardt P. Diet acids and alkalis influence calcium retention in bone. Osteoporos Int.2001;12:493-9.##Remer T., Manz F. Potential renal acid load of foods and its influence on urine pH. Am J Dietetic Assoc.1995;95:791-7.##Maurer M., Riesen W., Muser J., Hulter H.N., Krapf R. Neutralization of western diet inhibits bone resorption independently of K intake and reduces cortisol secretion in humans. Am J Phy-siol.2003;284:F32-F40.##Mühlbauer R.C. Effect of vegetableg on bone metabolism. Nature.1999;40:343-344.##Mühlbauer R.C., Lozano A., Reinli A. Onion and a mixture of vegetables, salads, and herbs affect bone resorption in rat by a mechanism independent of their base excess. J Bone Miner Res.2002;17:1230-6.##Mühlbauer R.C., Lozano A., Reinli A., Wetli H. Various selected vegetables, fruits, mushrooms and red wine residue inhibit bone resorption in rats. J Nutt.2003;133:3592-7.##Hammond K.A. Dietary and clinical assess-ment. In: Mahan LK & Escott-Stump S. Food, nutrition and diet therapy, 11th Edition. Philade-lphia. WB Saunders.2004;pp:407-435.##غفار پور محمد، هوشیار راد آرش، کیانفر هادی. راهنمای مقیاسهای خانگی، ضرایب تبدیل و درصد خوراکی مواد غذایی. تهران، انتشارات کشاورزی، 1378: صفحات 46-1.##Pongchaiyakul C., Nguyen T.V., Kosulwat V., Rojroongwasinkul N., Charoenkiatkul S., Rajata-navin R. Effect of urbanization on bone mineral density: A Thai epidemiologic study. BMC Mus-culoskeletal Disorder.2005;5:67-9.##Hashemipour S., Larijani B., Adibi H., Javadi E., Sedaghat M., Pajouhi M. Vitamin D deficien-cy and causative factors in the population of Tehran. BMC Public Health.2004;25:38.##Kaptoge S., Welch A., McTaggart A., Mull-igan A., Dalzell N. Effects of dietary nutrients and food groups on bone loss from the proximal femur in men and women in the 7th and 8th decades of age. Osteoporos Int.2003;14:418-28.##U.S. Department of Agriculture: The food guide pyramid. Home and Garden Bulletin No 252, Washington, DC,1992,U.S.Government Prin- ting Office.##McGartland C.P., Robson P.J., Murray L.J. Cran G.W., Savage M.J., Fruit and vegetable consumption and bone mineral density: the Nor-thern Ireland Young Hearts Project. Am J Clin Nutr.2004;80:1019-23.##Hirota T., Kusu T., Hirota K. Improvement of nutrition stimulates bone mineral gain in Japanese school children and adolescents. Osteoporos Int. 2005 [Epub ahead of print].##Feskanich D., Singh V., Willette W.C., Col-ditz G.A. Vitamin A intake and hip fractures among postmenopausal women.J Am Med Assoc. 2002;287:47-54.##Melhus H., Michaelsson K., Kindmark A., Bergstrom R., Holmberg L., Mallmin H. Excess-ive dietary intake of vitamin A is associated with reduced bone mineral density and increased risk for hip fracture. An Int Med.1998;129;770-778.##Remer T., Manz F. Potential renal acid load of foods and its influence on urine pH. Am J Diet Assoc. 1995;95:791-97.##Macdonald H.M., New S.A., Fraser W.D., Campbell M.K., Reid D.M. Low dietary potass-ium intakes and high dietary estimates of net endogenous acid production are associated with low bone mineral density in premenopausal wom-en and increased markers of bone resorption in postmenopausal women. Am J Clin Nutr.1995;81: 923-933.##Green J., Kleeman C. Role of bone in regu-lation of systemic acid-base balance. Kidney International.1991; 39:9-26.##Arnett T. Regulation of bone cell function by acid-base balance. Proceedings of the Nutrition Society. 2003;62;511-20.##Mueller K., Trias R. Bone density and compo-sition: age related and pathological changes in water and mineral content. J Bone Joint Sur. 1966;48A:140-8.##World Health Report nutrition in different cou-ntries, social aspects.2003.##

ارتباط بيماري گريوز و تأثير درماني آن با شاخص‌هاي استخواني Relationship between Grave's disease and effectiveness of its treatment with bone markers 2 1 مقدمه: بيماري گريوز نوعي بيماري خود ايمني است كه با افزايش تحريك پذيري غده تيروئيد و در نتيجه هيپرتيروئيدي همراه مي‌باشد. افزايش واگردش استخواني به علت افزايش جذب استخواني در هيپرتيروئيدي گزارش شده است و ميزان جذب استخواني بستگي به ميزان هورمون‌هاي تيروئيدي در خون دارد. اين گونه افزايش واگردش استخواني مسؤول كاهش توده استخواني بوده و در نتيجه بيماران گريوزي با افزايش خطر ابتلا به استئوپروز روبرو مي‌باشند. هدف اين مطالعه بررسي ارتباط بين بيماري گريوز و شاخص‌هاي استخواني است. مواد و روشها: افراد مورد بررسي در اين مطالعه شامل 31 بيمار مبتلا به گريوز بودند كه شروع به درمان نكرده بودند و 37 داوطلب سالم بود كه از نظر جنس و سن با گروه بيماران مطابقت داشتند. بيماري گريوز از طريق مختل شدن ميزان سرمي TSH و افزايش مقادير سرمي T3 آزاد و T4 آزاد و آنتي‌بادي گيرنده تيروئيد مثبت تشخيص داده شدند. در نهايت رابطه بين ميزان سرمي استئوكلسين و Cross laps با بيماري گريوز و سپس بعد از 8 هفته درمان و پيگيري با دو نوع داروي متي‌مازول و پروپيل تيواوراسيل بررسي شد. براي مقايسه ميانگين از T-test استفاده شد، در مواردي كه آزمون‌هاي پارامتريك قادر به نشان دادن اختلاف نبود از آزمون ناپارامتري Mann-Whitney استفاده شد. براي مقايسه مقادير فراواني توزيع متغيرها از آزمون 2و در مواردي كه شرايط انجام اين آزمون وجود نداشت از Fisher Exact test استفاده شد. سطع معني‌داري كمتر از 05/0 در نظر گرفته شد. نتايج: قبل از درمان مقادير سرمي شاخص‌هاي استخواني و هورمون‌هاي تيروئيدي بين بيماران و گروه شاهد تفاوت معني‌داري نداشت. بعد از درمان بهبودي و برگشت در حد طبيعي در تمام تست‌هاي آزمايشگاهي مشاهده شد. بين دو گروه درماني از نظر تأثير درمان بر هورمون‌هاي تيروئيدي و شاخص‌هاي استخواني تفاوتي وجود نداشت. نتيجه‌گيري: ارتباط بارزي ميان بيماري گريوز و شاخص‌هاي استخواني وجود دارد. بنابراين درمان بيماري گريوزي مي‌تواند واگردش استخواني را بهبود بخشد. اين يافته‌ها نشان مي‌دهد كه تشخيص و درمان زود هنگام بيماري گريوز مي‌تواند براي پيشگيري از پوكي استخوان مؤثر باشد. 2 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 diagno-sed 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 osteo-calcin & 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. 2 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. 79 87 Poulia P Ebrahim-pour پولیا ابراهیم پور Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Iran Peyman P Shoushtari-zadeh پیمان شوشتری‌زاده Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Iran Vahid V Hagh-panah وحید حق‌پناه Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Iran emrc@sina.tums.ac.ir Bita B Rajabi-pour بیتا رجبی‌پور Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Iran Sasan S Sharghi ساسان شرقی Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Iran Graves diseaseBone markersOsteoporosisBMDThyroidHyperthyroidism 177.pdf Leblond C.P., Fertman M.B., Puppel I.D., Cur-tis G.M. Radioiodine autography in studies of human goitrous thyroid glands. Arch Pathol Lab Med.1946;41:510.##Sethi R., Blackburn P., Graves Disease. Medi-cal Conditions. Published by NHS, London,2005.##اردلان محمدرضا. بیماری گریوز (Graves). مجله دانشگاه علوم پزشکی کردستان سال دوم، شماره هشتم، تابستان 77، صفحات: 38-29.##Uzzan B., Campos J., Cucherat M., Nony P., Boissel J.P., Perret G.Y. Effects on bone mass of long term treatment with thyroid hormones: A meta-analysis. J Clin Endocrinol Metab. 1996;81: 4278-4289.##Harvey R.D., McHardy K.C., Reid I.W., Paterson F., Bewsher P.D., Duncan A.,Robins P. Measurement of bone collagen degradation in hyperthyroidism and during thyroxine replace-ment therapy using pyridinium cross-links as specific urinary markers. J Clin Endocrinol Metab 1991;72:1189-1194.##Krane S.M., Brownell G.L., Stanbury J.B., Corrigan H. The effect of thyroid disease on calcium metabolism in man. J Clin Invest.1956; 35:874.##Follis R.H. Skeletal changes associated with hyperthyroidism. Bulletin of Johns Hopkins Hosp 1953;92:405.##Soudry G., Donohoe K.J. Graves disease. Joint Program in Nuclear Medicine.1994.##Moore E. Graves Disease. A Practical Guide, Published by McFarland, Colorado.2001.##Vamos A., Balazs C., Korhaz K.G. Bone metabolism markers in patients with Basedow-Graves disease. Orv Hetil.1997;138:2403-5.##Siddiqi A., Parsons M.P., Lewis J.L., Monson J.P., Williams G.R., Burrin J.M., TR expression and function in human bone marrow stromal and osteoblast-like cells. J Clin Endocrinol Metab. 2002;87:906-14.##Longo B.C. Harrison's principles of internal medicine. 16th Edition McGraw Hill.2005.##Mahaux J.E., Chamla-Soumenkoff J., Delcourt R., Levin S. Painful enlargement of left subtrape-zoid lymph nodes in Graves' disease. Br Med J. 1971;1:384.##Weetman A.P. Graves' disease. N Engl J Med. 2000;26:1236-47.##Siddiqi A., Burrin J.M., Noonan V., James V., Wood D. F., Price C. P., Monson J. P. A Longitudinal Study of Markers of Bone Turnover in Graves' disease and Their Value in Predicting Bone Mineral Density. J Clin Endocrinol Metab. 1997;82,753-759.##Sugita E., Nagakura H., Fjsum, Taniyama M., Morita Y., Kawauchi A., Sjsum S., Katagirii T., Bany M. Evaluation of Bone Mass of Os Cal cis in Graves' Disease by Ultrasound Bone Densitometry: Third Department of Internal Med-icine, Department of Surgery, Showa University School of Medicine, 1-5-8,Hatanodai,Shinagawa- ku, Japan.##

همخواني روش DXL با روش DXA در تشخيص پوكي استخوان در بيماران مصرف‌كننده لووتيروكسين Correlation between DXL and DXA in assessment of bone structure in patients using Levothyroxine 2 1 مقدمه: مصرف لووتيروكسين يك عامل خطر براي پوكي استخوان محسوب مي‌شود. روش DXA استاندارد طلايي تشخيص پوكي استخوان است. اطلاعات اندكي درباره همخواني نتايج DXL (سنجش تراكم استخوان به روش DXA در منطقه پاشنه) با روش DXAمحوري (كمر و لگن) در بيماران مصرف‌كننده لووتيروكسين وجود دارد. اين مطالعه براي بررسي همخواني اين دو روش در بيماران مصرف كنندة لووتيروكسين طراحي شده است. مواد و روشها: در اين مطالعه 62 بيمار مصرف كننده لووتيروكسين حضور داشتند. متوسط سني افراد 54/10 32/53 سال بود. 42 نفر از زنان يائسه بودند و متوسط سن يائسگي آنها 80/5 61/48 سال بود. تراكم معدني استخوان در نواحي كمر و لگن (منطقه عمومي ران) به روش DXA با يك دستگاه GE-Lunar (USA، DPX-MD ) و در ناحيه پاشنه با يك دستگاه Calscan (Demetek, Sewden) صورت گرفت. نرم افزار مورد استفاده (10) SPSS بود. حساسيت و ويژگي روش DXL براي تعيين پوكي استخوان در دو ناحيه كمر و لگن با استفاده از منحني ROC به دست آمد. سطح معني‌داري كمتر از 05/0 در نظر گرفته شد. نتایج: با استفاده از روش DXA، در18% بيماران استئوپروز يافت شد (6% در ناحيه عمومي ران و16% در ناحيه كمر). با استفاده از روش DXL در18% بيماران استئوپروز مشاهده گرديد. با استفاده از منحني ROCحساسيت 5/2T-Score≤ در ناحيه پاشنه براي تشخيص پوكي استخوان درناحيه عمومي ران وناحيه كمر به ترتيب 75% و60% و ويژگي آن براي اين تشخيص در نواحي فوق‌الذكر به ترتيب 2/88% و2/90% بود.سطح زير منحني براي نواحي عمومي ران و ناحيه كمر به ترتيب 975/0 (002/0= P-value) و 866/0 (000/0= P-value) بود. نتيجه‌گيري: به نظر مي‌رسد روش DXL، مي‌تواند در غربالگري بيماران مصرف كننده لووتيروكسين براي پوكي استخوان مفيد باشد. تأييد نهايي تشخيص با انجام سنجش تراكم استخوان به روش DXA در نواحي محوري الزامي است. 2 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 method's 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. 87 93 Rahmatollah R Hafezi رحمت‌اله حافظی Department of Physiotherapy, Faculty of Medicine, Baghiat-allah University of Medical Sciences Department of Physiotherapy, Faculty of Medicine, Baghiat-allah University of Medical Sciences Iran Zohreh Z Hamidi زهره حمیدی Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Iran Akbar A Soltani اکبر سلطانی Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Iran emrc@sina.tums.ac.ir Abbas Ali AA Keshtkar عباس‌علی کشتکار Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Iran OsteoporosisBMDDXADXLLevothyroxine 178.pdf Eastell R. Treatment of postmenopausal osteo-porosis. N Engl J Med.1998;338:736-46.##WHO study group. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Technical report series43.Geneva: WHO.1994.##Kanis J.A., Devogelaer J.P., Gennari C. Practical guide for the use of bone mineral measurements in the asessment of treatment of osteoporosis: a posi-tion paper of the European Foundation for Osteopo-rosis and Bone Disease. Osteoporos Int.1996;6: 256-61.##Bauer D.C., Nevitt M.C., Ettinger B., Stone K. Low thyrotropin levels are not associated with bone loss in older women: a prospective study. J Clin Endocrinol Metab.1997;82:2931-2936.##Uzzan B., Campos J., Cucherat M., Nony P., Boissel J.P., Perret G.Y. Effects on bone mass of long-term treatment with thyroid hormones: a meta-analysis.J Clin Endocrinol Metab.1996;81:4278-89.##Mosekilde L., Eriksen E.F., Charles P. Effects of thyroid hormones on bone and mineral metabolism. Endocrinol Metab Clin North Am.1990;19:35-63.##Mosekilde L., Melsen F., Bagger J.P., Myhere- Jensen O., Sorensen N.S. Bone changes in hyper-thyroidism. Interrelationship between bone morpho-metry, thyroid function and calcium-phosphorus metabolism. Acta Endocrinol.1977;85:515-525.##Wartofsky L. Osteoporosis:a growing concern for the thyroidologist. Thyroid Today.1988;11:1-11.##Auwerx J., Bouillon R. Mineral and bone meta-bolism in thyroid disease: a review. Q J Med.1986; 60:737-752.##Baran D.T., Braverman L.E. (Editorial). Thyro-id hormones and bone mass. J Clin Endocrinol Metab.1991;72:1182-1183.##Wu¨ster C., Schilddru¨ S. Osteoporose In Schil-ddru¨se 1993: Therapie der Hyperthyreose,pp380-392. Eds D Reinwein & B Weinheimer. Berlin, New York: DeGryter,1994.##Ross D.S., Neer R.M., Ridgway E.C., Daniels G.H. Subclinical hyperthyroidism and reduced bone density as a possible result of prolonged supper-ssion of the pituitary-thyroid axis with L-thyroxine. Am J Med.1987; 82:1167-70.##Paul T.L., Kerrigan J., Kelly A.M., Braverman L.E.,Baran D.T. Longterm L-thyroxine therapy is associated with decreased hip bone density in pre-menopausal women. JAMA.1988;259:3137-3141.##Taelman P., Kaufman J.M., Janssens X., Vand-ecauter H., Vermeulen A. Reduced forearm bone mineral content and biochemical evidence of incr-eased bone turnover in women with euthyroid goiter treated with thyroid hormone. Clin Endo-crinol.1990;33:107-17.##Diamond T., Nery L., Hales I. A therapeutic dilemma: suppressive doses of thyroxine signify-cantly reduce bone mineral measurements in both premenopausal and postmenopausal women with thyroid carcinoma. J Clin Endocrinol Metab.1990; 72:1184-88.##Guo C.Y., Weetman P., Eastell R. Longitudinal changes of bone mineral density and bone turnover in postmenopausal women on thyroxine. Clin End-ocrinol.1997;46:301-7.##Hawkins F., Rigopoulou D., Papapietro K., Lopez M.B. Spinal bone mass after long-term treat-ment with l-thyroxine in postmenopausal women with thyroid cancer and chronic lymphocytic thyro-iditis. Calcif Tissue Int.1994;54:16-9.##Nuzzo V., Lupoli G., Del Puente A., Rampone E., Carpinelli A. Esposito Del Puente A. Bone min-eral density in premenopausal women receiving levothyroxine suppressive therapy. Gynecol Endo-crinol.1998;12: 333-337.##Mu¨ller C.G., Bayley T.A., Harrison J.E., Tsang R. Possible limited bone loss with suppressive thy-roxine therapy is unlikely to have clinical releva-nce. Thyroid.1995;5:81-87.##Leese G.P., Jung R.T., Guthrie C., Waugh N., Browning M.C. Morbidity in patients on L-thyro-xine: a comparison of those with a normal to those with a suppressed TSH. Clin Endocrinol.1992;37: 500-3.##Salomon B.L., Wartofsky L., Burman K.D. Pre-valence of fractures in postmenopausal women with thyroid disease. Thyroid.1993;3:17-23.##Kung A.W.C., Pun K.K. Bone mineral density in premenopausal women receiving long-term phys-iological doses of thyroxine. JAMA.1991;265: 2688-91.##Grant D.J., McMurdo M.E.T., Mole P.A., Paterson C.R., Davies R.R. Suppressed TSH levels secondary to thyroxine replacement therapy is not associated with osteoporosis. Clin Endocrinol. 1993;39:529-533.##Schneider D.L., Barrett-Connor E.L., Morton D.J. Thyroid hormone use and bone mineral density in elderly women. Effects of estrogen. JAMA.1994; 271:1245-9.##Franklyn J.A., Betteridge J., Dykin J., Holder R., Oates G., Parle J.V. Long-term thyroxine treat-ment and bone mineral density. Lancet.1992;340:9-13.##Cummings S.R., Black D.M., Nevitt M.C., Browner W.S., Cauley J.A., Genant H.K., Mascioli S.R., Scott J.C., Seeley D.G., Steiger P. Append-icular bone density and age predict hip fracture in women. The Study of Osteoporotic Fractures Res-earch Group. JAMA.1990;263:665-8.##Wasnich R.D., Ross P.D., Heilbrun L.K., Vogel J.M. Selection of the optimal skeletal site for frac-ture risk prediction.Clin Orthop.1987;216:262-9.##Vogel J.M., Wasnich R.D. Ross P.D. The clinical relevance of calcaneus bone mineral measu-rements: a review. Bone Miner.1988;5:35-58.##Riario-Sforza G.G., Incorvaia C., Scazzoso A., Travisi T., Nitti F., Fumagalli M. Cut off values of bone mineral density defining postmenopausal wo-men with bone fractures. Ann Rheum Dis. 1995; 54:807-10.##Hui S.L., Slemenda C.W., Johnston C.C. Jr. Baseline measurement of bone mass predicts frac-ture in white women. Ann Intern Med.1989;111: 355-61.##Gardsell P., Johnell O., Nilsson B.E., Nilsson JA. The predictive value of fracture, disease, and falling tendency for fragility fractures in women. Calcif Tissue Int.1989;45:327-30.##Black D.M., Cummings S.R., Genant H.K, Ne-vitt M.C., Palermo L., Browner W. Axial and appe-ndicular bone density predict fractures in older women. J Bone Miner Res.1992;7:633-8.##Baran D.T., Faulkner K.G., Genant H.K., Miller P.D., Pacifici R. Diagnosis and management of ost-eoporosis: guidelines for the utilization of bone densitometry. Calcif Tissue Int.1997;61:433-40.##Pacheco E.M.B., Harrison E.J., Ward K.A., Lunt M., Adams J.E. Detection of osteoporosis by Dual Energy X-ray Absorptiometry (DXA) of the Calcaneus: Is the WHO Criterion applicable? Cal Tis Int.2002;70:475-482.##Kullenberg R., Falch J.A. Prevalence of osteoporosis using bone mineral easurements at the calcaneus by dual X-ray and laser (DXL). Osteoporos Int.14:823-7.##Wasnich R.D., Ross P.D. A comparison of single and multi-site BMC Measurements for asse-ssment of spine fracture probability. J Nucl Med. \1989;30:1166-177.##Melton L.J., Atkinson E.J., O'Fallon W.M., Wa-hner H.W., Riggs B.L. Long-term fracture predict-tion by bone mineral assessed at different skeletal sites. J Bone Miner Res.1993;8:1227-33.##

همخواني سونوگرافي انگشت و روش DXA در تشخيص تغييرات استخواني در بيماران دياليز خوني Correlation between QUS of phalanx and DXA in assessment of bone structure in patients under hemodialysis 2 1 مقدمه: استئوپروز در بيماران دياليزي شايع است و روش DXA كه استاندارد طلايي تشخيص آن است، همه جا در دسترس نيست. سونوگرافي كمي انگشتان، روشي غيرتهاجمي، ارزان و قابل حمل براي بررسي پوكي استخوان است كه در حال حاضر اطلاعات اندكي درباره همخواني نتايج آن با روش DXA در بيماران دياليز خوني وجود دارد. اين مطالعه براي بررسي همين مطلب در بيماران دياليز خوني طراحي شد. مواد و روشها: افراد مورد مطالعه، بيماران مبتلا به نارسايي كليه تحت دياليز خوني بودند كه در بخش سنجش تراكم استخوان مركز تحقيقات غدد درون‌ريز و متابوليسم دانشگاه علوم پزشكي تهران مورد بررسي قرار گرفتند. تراكم توده استخوان در نواحي كمر و لگن (گردن و منطقه عمومي ران) به روش DXA و با استفاده از دستگاه GE-Lunar (DPX-MD, USA) و در ناحيه انگشتان به روش سونوگرافي كمي با استفاده از يك دستگاه DBM-Sonic 1200 (Italy) صورت گرفت. متغير اندازه گيري شونده در سونوگرافي انگشتان Amplitude-dependent Speed of Sound (Ad-SOS) بود. نرم افزار مورد استفاده (10) SPSS بود و جهت سنجش حساسيت و ويژگي روش سونوگرافي انگشت، منحني ROC رسم شد. سطح معني‌داري كمتر از 05/0 در نظر گرفته شد. نتايج: ‌در اين مطالعه مقطعي، 64 بيمار دياليز خوني با متوسط سني 20/15 33/51 سال كه بطور متوسط 62/4545/49 ماه تحت دياليز خوني قرار داشتند مورد مطالعه قرار گرفتند. با استفاده از روش DXA ، در3/31% بيماران، استئوپروز يافت شد (25% در ناحيه گردن ران، 8/18% در ناحيه عمومي ران و 9/7% در ناحيه كمر). با استفاده از روش QUS انگشتان در 1/28% بيماران استئوپروز مشاهده گرديد. با استفاده از منحني ROC حساسيت5/2-T-Score ≤ در انگشتان براي تشخيص پوكي استخوان درناحيه گردن و عمومي ران وناحيه كمر به ترتيب 5/37%، 50% و 80% و ويژگي آن براي اين تشخيص در نواحي فوق‌الذكر به ترتيب 75% و77% و76% بود. سطح زير منحني براي نواحي گردن و عمومي ران و ناحيه كمر به ترتيب 692/0 (022/0= P-value)، 701/0 (031/0=P-value) و 809/0 (023/0= P-value) بود. نتيجه‌گيري: به نظر مي‌رسد سونوگرافي انگشتان، مي‌تواند در غربالگري بيماران دياليز خوني براي پوكي استخوان روش مناسبي باشد. افرادي كه با اين روش احتمال پوكي استخوان در آنها مطرح شود، براي تأييد نهايي تشخيص بايد مورد سنجش تراكم استخوان به روش DXA قرار گيرند. 2 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. Quantit-ative ultrasound (QUS) of phalanx is an inexpensive, mobile, and radiation-free diagnostic alterna-tive. There is few data about correlation of this method with DXA in patients undergoing hemo-dialysis. The present study assessed the value of QUS in detecting changes in bone structure in pat-ients 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 measu-red 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. 93 98 Zohreh Z Hamidi زهره حمیدی Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Iran Mitra M Mahdavi-mazdeh میترا مهدوی‌‌مزده Department of Internal Medicine, Faculty of Medicine, Tehran University of Medical Sciences Department of Internal Medicine, Faculty of Medicine, Tehran University of Medical Sciences Iran Sima S Maziar سیما مازیار Department of Internal Medicine, Faculty of Medicine, Tehran University of Medical Sciences Department of Internal Medicine, Faculty of Medicine, Tehran University of Medical Sciences Iran Abbas Ali AA Keshtkar عباس‌علی کشتکار Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Iran Mohammad M Pajouhi محمد پژوهی Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Iran emrc@sina.tums.ac.ir OsteoporosisBMDDXAQUSHemodialysis 179.pdf Lyhne N., Pedersen F.B. Changes in bone and mineral control during long- term CAPD. Indica-lion of a sex-dependent bone mineral loss.Nephral Dial Transplant.1995;10:395-8.##Hussain R., Ahmed A., Soonro A.S. Frequency of metabolic bone disease in haemodialysis pafi-ents. J Pak Med Assoc. 1996;46:83-6.##Taal M.W., Masud T., Green D., Cassidy M.J. Risk factors for reduced bone density in haemo-dialysis patients. Neph Dial Transplant.1999;14: 1922-8.##Fontaine M.A., Albert A., Dubois B. Fracfure and bone mineral density in hemodialysis patie-nts. Clin Nephrol.2000;54:218-26.##Nowak Z., Tlustochowicz W., Wankowicz Z., Bone mineral density in dialysis Patients: The optimal regior of interest depending on parathor-mone levels. Pol Merkceriusz Lek.2000;9:822-5.##Nowak Z., Tlustchowioz W., Wankowicz Z. Bone mineral density in patients with irreversible renal failur trated with peritoneal dialysis. Pol Arch Med Wewn.2001;106:1035-40.##Zayour D., Daouk M., Medawar W. Predictors of bone mineral density in patients on hemo-dialysis. Transplant Proc.2004;36:1297-301.##WHO study group. Assessment of fracture risk and its application to screening for postmeno-pausal osteoporosis. Technical report series 843. Geneva: WHO,1994.##Heaney R.P., Kanis J.A. The interpretation and utility of ultrasound measurement of bone. Bone. 1996; 18:491-2.##Gluer C.C. Quantitative ultrasound techniques for the assessment of osteoporosis. Expert agree-ment on current status. J Bone Mineral Res.1997; 12:1280-1288.##Mondry A., Rudiger Hetzel G., Willers R. Quantitative Heel Ultrasound in assessment of bone structure in renal transplant recipients. AmJ Kidney Dis.2001;37:932-937.##Kosch M., Hausberg M., Link T., Kemkes M., Barenbrock M., Dietl K.H., Matzkies F, Rahn K. H., Kisters K. Measurement of skeletal status after renal transplantation by quantitative ultrasound. Clin Nephrol.2000;54:15-21.##Pluskiewicz W., Adamczyk P., Drozdzowska B. Skeletal status in children, adolescents and young adults with end-stage renal failure treated with hemo-or peritoneal dialysis. Osteoporos Int.2002;13:353-7.##Przedlacki J., Pluskiewicz W., Wieliczko M. Quantitative ultrasound of phalanges and dual-energy X-ray absorptiometry of forearm and hand in patients with end-stage renal failure treated with dialysis. Osteoporos Int.1999;10:1-6.##Da Costa J.A., de Castro J.A., Foss M.C. The evaluation of renal osteodystrophy with cortical quantitative ultrasound at various bone sites. Ren Fail.2004;26:237-41.##Peretz A., Penaloza A., Mesquita M. Quan-titative ultrasound and dual X-ray absorptiometry measurements of the calcaneus in patients on maintenance hemodialysis. Bone.2000;27:287-92.##Pluskiewicz W., Adamczyk P. Drozdzowska B. Skeletal status in children and adolescents with chronic renal failure before onset of dialysis or on dialysis. Osteoporos Int.2003;14:283-8.##Montagnani A., Gonelli S., Cepallaro C. Quantitative ultrasound in the assessment of skel-etal status in uremic patients. J Clin Densitom. 1999;2:389-95.##Taal M.W., Cassidy M.J., Pearson D. Use-fulness of quantitative heel ultrasound compared with dual-energy X-ray absorptiometry in deter-mining bone mineral density in chronic haemo-dialysis patients. Neph Dial Transplant.1999; 14:1922-8.##

ارتباط بين فاكتورهای جمعيتي و استئوپروز در دوران پس از يائسگي در زنان شهري ايراني Association between demographic factors and osteoporosis in urban Iranian postmenopausal women 2 1 مقدمه: فاكتورهاي جمعيتي متعددي دركشورهاي در حال توسعه مانند بالابودن ميزان بيسوادي يا سطح اقتصادي- اجتماعي پايين به عنوان موانع پيشگيري از استئوپروز در نظر گرفته می‌شوند. ولي در زمينه ارتباط بين سطح اقتصادي- اجتماعي و استئوپروز در اين كشورها مطالعات محدودی انجام شده است. هدف از انجام اين مطالعه بررسي ارتباط بين فاكتورهاي انساني و استئوپورز در زنان شهري يائسه بوده است. مواد و روشها: روش مطالعه شاهد- مورد بوده و به صورت ثبت مورد و مصاحبه انجام پذیرفته است. اطلاعات در دو مركز اندازه گيري تراكم استخوان در تهران (مركز سنجش تراکم استخوان بيمارستان شريعتي به عنوان مركز دولتي و مركز سنجش تراكم استخوان مهراد به عنوان مركز خصوصي) طي دوره زمانی خرداد 1381 تا تیر 1382 مورد استفاده واقع شدند. گروه مورد شامل 163 زن يائسه دارای پوكي استخوان بودند كه دانسيته ستون فقرات و فمور آنها در هر دو مركز به شیوه DEXA و توسط دستگاه لونار اندازه گرفته شده بود. گروه شاهد نيز از همين مراكز انتخاب شدند و از نظر نسبي با گروه مورد هماهنگ شدند. تحليل داده‌ها بوسيله نرم افزار آماري (10)SPSS انجام شد. ارتباط بين عوامل خطر و استئوپروز به وسيله Odds Ratio مورد سنجش قرار گرفت. براي مقايسه ميانگين از - test T و براي مقايسه فراواني توزيع متغيرها از آزمون 2 استفاده شد. سطح معني‌داري كمتر از 05/0 در نظر گرفته شد. نتايج: تفاوت نسبت با حدود اطمينان 95% براي عوامل خطرساز انساني استئوپروز به این ترتيب است: بيسوادي (افرادي كه مدرسه نرفته‌اند) 4/3 (7 و 64/1) در هر دو مركز، 31/2 (06/5 ، 06/1) در مراكز دولتي، 18/12 (57/105، 41/1) در مراكز خصوصي، بيسوادي شوهر 09/5 (12/18، 43/1 ) در هر دو مركز، 76/3 (69/13، 04/1) در مراكز دولتي، شغل (خانه دار بودن) (50/2 ، 97/0 ) 56/1 در هر دو مركز، (50/3 ، 19/1) 041/2 در مراكز دولتي، پس از هماهنگ كردن سن، وزن، قد و ساير فاكتورهاي مهم مثل سن يائسگي، سن منارک و ... تمام فاكتورهاي بالا، همچنان با اهميت باقي ماندند. ساير فاكتورهاي جمعيتي كه در اين مطالعه مورد بررسي قرار گرفتند شامل شغل بيمار در مركز خصوصي، شغل همسر و وضعيت تاهل در هر دو مركز، ارتباط معني‌داري با استئوپروز نداشتند. نتيجه‌گيري: بی سوادی و پایین بودن سطح تحصیلات (كساني كه كمتر از 6 سال به مدرسه رفته‌اند) به عنوان عوامل خطرساز (ريسك فاكتور) در هر دو مركز خصوصي و دولتی تهران با استئوپروز مرتبط بود. در اين مطالعه مشخص شد كه ارتباط قوي بين شغل و استئوپروز به عنوان عوامل خطرساز وجود ندارد (به خصوص در مراكز خصوصي، كه در اين مراكز گروه هاي بالاتر اقتصادي اجتماعي بيشترند). تحصيلات بالا يك فاكتور محافظت كننده در مقابل استئوپروز درهر دو مركز شناخته شد. 2 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 osteoporo-sis in these countries. In this study we aimed to assess the association between demographic fac-tors and Osteoporosis in urban Iranian postmenopausal women Materials 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 mach-ine 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 2 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, husband's 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. 98 107 Afsaneh A Keramat افسانه کرامت School of the Health Sciences, Pune University School of the Health Sciences, Pune University India Alireza A Khalilifard علیرضا خلیلی فرد Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Iran Hossein H Adibi حسین ادیبی Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences Iran emrc@sina.tums.ac.ir Aronieh A Chopra آرونیه چوپرا Center of Rheumatic Diseases Center of Rheumatic Diseases India Vebnaya V Kunjir وینایا کونجیر Center of Rheumatic Diseases Center of Rheumatic Diseases India Boshan B Patwardhan بوشان پتواردهان Center of Rheumatic Diseases Center of Rheumatic Diseases India OsteoporosisRisk factorDemographic factorsMenopause 180.pdf Woolf A.D. Strong bones in later life. Bulliten of the World Health Organization the interna-tional Journal of Public health.1999;77:368-369.##Wark J.D. Osteoporosis: a global perspective. Bulliten of the World Health Organization the international journal of public Health.1999;77: 451-458.##Eastell R., Reid D.M., Compston J., Cooper C., Fogelman I., Francis R.M., Hay S.M., Hosking D. J., Purdie D.W., Ralston S.H., Reeve J., Russell R.G., Stevenson J.C. Secondary prevention of ost-eoporosis: when should a non-vertebral fracture be a trigger for action?. QJM.2001;94: 575-97.##DeCastro J.A.S. The view from Brazil: desi-rable but not yet feasible. Bulliten of the Word Health Organization The International Journal Of the Public Health.1999;77:424-426.##Delmas P.D., Fraser M. Strong bones In Later life: Luxury or necessity?. Bulletin of the Word Health Organization The International Journal Of Public Health.1899; 77:416-422.##Poor G. Osteoporosis care in Hungary. Bulletin of the World Health Organization The Interna-tional journal of Public Health. Bull World Health Organ.1999;77(5):429-30.##Ettinger B. Personal perspective on low-dosage estrogen therapy for postmenopausal women. Menopause.1999;6:273-6.##Berarducci A. Osteoporosis awareness.Fla nur-se.1998;46:1-2(Review).##Decastro J.A.S., Osteoporosis in brazil. Bull World Health Organ.2002;pp:80-89.##Ghosh U.K., Roy S., Sharma D., Gaur S.C., Ganguli G. Relationship of osteoporosis with socioeconomic status, physical activity and puerp- eral calcium supplementation. J Obstet Gynecol India.1996;46:224-8.##Schriger D.L. Analyzing the relationship of exercise and health: methods, assumptions, and limitations. Med Sci Sports Exer.2001;33(6 Suppl):S359-63.##Hardy R., Kuh D. Social and environmental conditions across the life course and age at meno-pause in a British birth cohort study. BJOG.2005; 112:346-54.##Greendale G.A., Huang M.H., Wang Y., Fink-elstein J.S., Danielson M.E. Sport and home phys-ical activity are independently associated with bone density.Med Sci Sports Exer.2003;35:506-12.##Varenna M., Binelli L., zucchi F., Ghiringhlli D., Gallazzi M., Sinigaglia S. Prevalence of Oste-oporosis by Education Level in a Cohort of Post-menopausal Women. Osteoporos Int.1999;9:236-241.##GnanLcL- Ersoz F.,Gokce- Kutsal Y., Oncel S., Eryavuz M., Peker O., Ok Z. A multicenter case control study of risk factors for low tibia speed of sound among residents of urban areas in Turkey.Rheumatol Int.2002;22:20-6.##Farahmand B. Y., Persson P.G., Michaelsson K., Baron J.A., Parker M.G., junghall S. Socio-economic Status, Marital Status and Hip Fracture Risk: a papulation-based case-control study. Ost-eoporos Int.2000;11: 803-808.##Delmas P.D., Fraser M. Strong bones in later life: luxury or necessity? Bull World Health Organ.1999;77:416-22.##Bonjour J.P. Peak bone mass. Osteoporosis International.1994;4:S7-13.##Rizzoli R. Protein intake during child hood and adolescence and attainment of peak bone mass. Published by Lippincott, Philadelphia.1999; pp:231-43.##Bonjour J.P., Rizzoli R. Bone acquisition in adolescence. Osteoporosis. Published by Academ-ic press, San Diego.1996:pp:465-75.##Armamento-Villareal R. Estrogen status and heredity are major determinants of premenstrual bone mass.J clin Inves.1992;90:2464-71.##Dhuper S. Effects of hormonal status on bone density in adolescent girls. J Clin Endocrinol Metab.1990;71:1083-8.##Ruiz J.C., Mandel C., Grabedian M. Influence of spontaneous calcium intake and physical exer-cise on the vertebral and femoral bone mineral density of children and adolescence. J Bone Miner Res.1995;10:675-82.##Bass S. Exercise before puberty may confer residual benefits in bone density in adulthood: stu-dies in active pre pubertal and retired female gymnasts. J Bone Miner Res.1998;13:500-7.##Matkovic V. Bone status and fracture rates in two regions of Yugoslavia. Am J Clin Nutr. 1979; 32:540-9.##Halioua L., Anderson J.J. Lifetime calcium intake and physical activity habits: independent and combined effects on the radial bone of healt-hy premenopausal Caucasian women. Am J Clin Nutr.1989;49:534-41.##Recker R.R. Bone giant in young adult women. J Am Med. Assoc.1992;268:2403-8.##Saadi H.F., Reed R.L., Carter A.O., Qazaq H. S., Al-Suhaili A.R. Bone density estimates and risk factors for osteoporosis in young women. East Mediterranean Health J.2001;4:730-737.##Finkestein J.S., T.Lee M., Sowers M.F., Hettinger B., Neer R.M., Kelsey J.L., Cauley J.A., Hung M., Greendale G.A. Ethnic Variation in Bone Density in Premenopausal Women: effects of Anthropometric and lifestyle Factor. J Clin Endocrinol Metab.2002;87:3057-3067.##World Health Report, Executive Summary, Conquering suffering, enriching humanity Life expectancy, health expectancy. Word Health Report, Archive.1997-2000.##Person D., Taylor R., Masud T. The relation-ship between social deprivation, osteoporosis, and falls. Osteoporos Int.2004;15:132-8.##Jones S., Johansen A., Brennan J., Butler J., Lyons R.A. The effect of socioeconomic depriva-tion on fracture incidence in the United Kingdom. Osteoporos Int.2004;15:520-524.##Drozdzowska B., Pluskiewica W., Skiba M. Knowledge about osteoporosis in a cohort of Polish females: the influence of age, level of edu-cation and personal experiences. Osteoporos Int. 2004;15:645-8.##Roberts S.E., Goldacre M.J. Time trends and demography of mortality after fractured neck of femur in an English population, 1968-98: database study. BMJ.2003;4:771-5.##