Household Coverage with Adequately Iodized Salt and Iodine Status of Nonpregnant and Pregnant Women in Uzbekistan.

Background: Globally, iodine deficiency has been drastically reduced since the introduction of salt iodization programs; nonetheless, many populations remain at-risk for iodine deficiency. This study aimed to assess the iodine status among women of reproductive age in Uzbekistan and to identify factors associated with iodine deficiency, including the availability of adequately iodized salt at the household level. Methods: A cross-sectional household survey was conducted to produce region-specific estimates of the household coverage with adequately iodized salt and iodine status among women for each of the 14 regions in Uzbekistan. Other information, such as socioeconomic status, lactation and pregnancy, residence, age, and consumption of iodine supplements, was also collected. Results: Overall, 36% of 3413 households had adequately iodized salt (iodine concentration >15 ppm [parts per million (mg I/kg salt)]), 20% had inadequately iodized salt (5-14 ppm), and 44% had salt without detectable iodine (<5 ppm). Adequate iodization was found in 33.2% of the 2626 salt samples taken from retail packages labeled as "iodized," 36.5% of the 96 samples taken from retail packages without mention of iodization, and 50.5% of the 674 samples without the original packaging (p < 0.001). The median urinary iodine concentration (UIC) of 140.9 µg/L (95% confidence interval [CI 132.4-150.7]) in nonpregnant nonlactating women indicated adequate iodine status, while for nonpregnant lactating and pregnant women, the median UIC of 112.9 µg/L [CI 99.3-128.4] and 117.3 µg/L [CI 101.8-139.9], respectively, indicated borderline adequacy. Significant differences in UIC (p < 0.001) were found between nonpregnant nonlactating women living in households with adequately iodized salt (UIC 208.9 µg/L), inadequately iodized salt (UIC 139.1 µg/L), and noniodized salt (UIC 89.9 µg/L). Conclusions: Coverage with adequately iodized salt is low in Uzbekistan, and women in households with poorly iodized salt have substantially worse iodine status; claims on packaging about salt iodization do not reflect salt iodine content. This highlights the importance and effectiveness of salt iodization and the need to strengthen this program in Uzbekistan.

Efficacy of strontium ranelate in combination with a D-hormone analog for the treatment of postmenopausal osteoporosis.

BACKGROUND: Vitamin D supplements are recommended in individuals with vitamin D insufficiency and established osteoporosis to reduce risk of fracture and falling. Active vitamin D metabolites have been found to be more effective for fall prevention than native vitamin D. OBJECTIVES: The aim of this study was to compare the efficacy of strontium ranelate in combination with alfacalcidol and strontium ranelate alone on bone mineral density (BMD) and fall risk in postmenopausal women with osteoporosis. METHODS: A total of 48 women (mean age 62.4 years) with postmenopausal osteoporosis were randomized to strontium ranelate monotherapy 2 g/day (n = 16), strontium ranelate 2 g/day plus alfacalcidol 1 µg (n = 16) or control (n = 16) and followed for 6 months. All women received calcium and vitamin D3 supplements. BMD was measured at the lumbar spine and proximal femora at the beginning and end of therapy. Patients performed functional tests such as the "up and go" and chair rising tests to estimate risk of fall status. Biochemical markers of bone turnover were also assessed. RESULTS: Statistically significant increases in BMD compared with baseline values and the control group were observed in both strontium ranelate treatment groups. Increases were also statistically significant in the strontium ranelate combination group compared with strontium ranelate alone. Strontium ranelate combination therapy for 6 months improved patients' ability to perform functional tests as well as increasing the number of women capable of performing the tests. No significant changes were observed in women receiving strontium ranelate monotherapy or in the control group. Serum levels of ß-CrossLaps, a marker of bone resorption, were significantly reduced compared with control in both strontium ranelate groups. A significantly greater reduction was observed in the strontium ranelate combination group compared with strontium ranelate alone (24.0%; P = 0.008). Increases in type 1 procollagen total N-terminal propeptide (TP1NP), a marker of bone formation, reached statistical significance in both strontium ranelate groups compared with baseline. CONCLUSION: Strontium ranelate and alfacalcidol combination therapy improves bone quality, fall risk and markers of bone turnover to a greater extent than strontium ranelate alone in patients with established osteoporosis.