Protocol for preliminary, multicenteric validation of "PoCOsteo device": A point of care tool for proteomic and genomic study of osteoporosis.

One of the goals of the HORIZON 2020 project PoCOsteo was to develop a medical device, which would measure and/or quantify proteomic as well as genomic factors as present in whole blood samples collected through finger prick. After validating the tool in the clinical setting, the next step would be its clinical validation based on the existing guidelines. This article presents the protocol of a validation study to be carried out independently at two different centers (Division of Endocrinology and Diabetology at the Medical University of Graz as a clinic-based cohort, and the Endocrinology and Metabolism Research Institute at the Tehran University of Medical Sciences as a population-based cohort). It aims to assess the tool according to the Clinical & Laboratory Standards Institute guidelines, confirming if the proteomics and genomics measurements provided by the tool are accurate and reproducible compared with the existing state-of-the-art tests. This is the first time that such a detailed protocol for lab validation of a medical tool for proteomics and genomic measurement is designed based on the existing guidelines and thus could be used as a template for clinical validation of future point-of-care tools. Moreover, the multicentric cohort design will allow the study of a large number of diverse individuals, which will improve the validity and generalizability of the results for different settings.

The process of hip fracture management before and during the COVID-19 pandemic in Iran.

BACKGROUND: The COVID-19 pandemic affected the control of many chronic conditions, including hip fractures, worldwide. This study was to examine the impact of the COVID-19 pandemic on the management of hip fractures in a referral orthopedic hospital in Iran. By understanding how the pandemic has influenced the care of hip fracture patients, we can gain valuable insights into the challenges, adaptations, and potential improvements in orthopedic healthcare during such public health crises. METHODS: Data was collected on hip fracture patients aged 50 and above who were admitted to the hospital before and during the pandemic. The number of admissions and operations, length of hospital stay, and time from admission to surgery were recorded from the hospital information system (HIS) and compared between the two periods. RESULTS: The median number of admitted hip fracture patients per month increased slightly during the pandemic (11%), although this increase was not statistically significant (p = 0.124). After adjusting for potential confounders, the mean length of hospital stay was significantly lower during the pandemic period, indicating that patients were discharged sooner (p = 0.019) and the time from admission to surgery was shorter during the pandemic (p = 0.004). Although the increase in the number of hip fracture surgeries per month during the pandemic was not statistically significant (P = 0.132), a higher percentage of patients underwent surgery during the pandemic compared to before (84.8% VS. 79.4%). CONCLUSION: The study suggests that the COVID-19 pandemic did not have a negative impact on hip fracture management in the investigated orthopedic hospital in Iran. further research is needed to explore the effects of the pandemic on other aspects of healthcare services, particularly in general hospitals.

Overlap between Osteosarcopenia and Frailty and their association with poor health conditions: The Bushehr Elderly Health (BEH) Program.

Background: This study investigated the association of osteosarcopenia with frailty and poor health conditions among older Iranian adults. Methods: This cross-sectional study analyzed data from the Bushehr Elderly Health (BEH) Program. Osteosarcopenia was defined as the presence of osteopenia/osteoporosis and sarcopenia, while the Fried criteria were used to assess frailty. We assessed the history of falls and health-related quality of life (HRQoL), including physical and mental component summaries (PCS and MCS, respectively), history of fractures, activities of daily living (ADL), and instrumental activities of daily living (IADL), as indicators of poor health conditions. Results: This study included a total of 2371 older adults. The prevalence rates of osteosarcopenia-only, frailty-only, and osteosarcopenia with frailty were 17.4%, 3%, and 4.8%, respectively. The prevalence of a history of falls, poor ADL, and poor IADL was significantly higher in the frailty-only and osteosarcopenia with frailty groups. Osteosarcopenia with frailty was significantly associated with a history of falls [adjusted odds ratio (adjOR): 1.94, 95% confidence interval (CI) (1.20-3.15)], poor ADL [adjOR: 2.85, 95%CI (1.81-4.50)], and poor IADL [adjOR: 5.09, 95%CI (2.85-9.11)]. However, the frailty-only group also showed an association with falls and poor ADL and IADL. Only osteosarcopenia was associated with an increased OR for fracture. Frailty had the greatest effect on the MCS and PCS scores, whereas osteosarcopenia with frailty had a moderate impact. Conclusions: Osteosarcopenia with frailty significantly increased the odds of falls, poor ADL, poor IADL, and lower HRQoL compared with the robust group. Combined osteosarcopenia and frailty were not associated with poor health. These findings indicate the importance of diagnosing osteosarcopenia and frailty as separate entities to provide appropriate interventions and treatment.

Evaluation of the prevalence of cardiometabolic disorders (diabetes, hypertension, and hyperlipidemia) diagnosed, undiagnosed, treated, and treatment goal in the elderly: Bushehr Elderly Health Program (BEH).

As the population ages, the global burden of cardiometabolic disorders will increase. This study aimed to investigate the prevalence of cardiometabolic disorders (diabetes, hypertension, and hyperlipidemia) in elderly and to evaluate the effects of various variables including age, sex, education, marital status, smoking, income, physical activity, dementia and depressed mood on untreated cardiometabolic disorders. This was a cross sectional study conducted in Bushehr Elderly Health Program. A total 2381 participants were included. Medical data were collected by trained interviewers. The mean age of the study participants was 69.34 years. Proportions of diabetes, hypertension, hyperlipidemia and hypercholesterolemia were 43.25%, 75.71%, 64.74% and 35.31% respectively. Untreated diabetes prevalence was higher for males (OR = 1.60, 95%CI = 1.20-2.15), older adults (OR = 1.02, 95%CI = 1.00-1.05), and pre-frail status (OR = 0.69, 95%CI = 0.52-0.92). Males (OR = 2.16, 95%CI = 1.64-2.84) and current smokers (OR = 1.42, 95%CI = 1.05-1.93), in contrast to married participants (OR = 0.25, 95%CI = 0.08-0.78), people with higher education levels (OR = 0.51, 95%CI = 0.29-0.89) and dementia (OR = 0.78, 95%CI = 0.61-1.00) were more likely to have untreated HTN. Untreated dyslipidemia is more common in smokers (OR = 1.78, 95%CI = 1.19-2.66) and males (OR = 1.66, 95%CI = 1.21-2.27), while untreated hypercholesteremia is more common in males (OR = 3.20, 95%CI = 1.53-6.69) and is reported lower in people with dementia (OR = 0.53, 95%CI = 0.28-1.01).

The association between quality of life and diabetes: the Bushehr Elderly Health Program.

BACKGROUND AND OBJECTIVE: Considering the importance of diabetes and its increased prevalence with aging, this study aimed to evaluate the association between diabetes status and quality of life (QOL) and the determining factors in individuals over 60. METHODS: Two thousand three hundred seventy-five individuals including 819 (34.5%) with diabetes, aged 69.4 ± 6.4, from Bushehr Elderly Health Program (BEHP) were enrolled. We categorized the participants as non-diabetic, controlled diabetic, and poorly controlled diabetic. The QOL was assessed using the SF-12 questionnaire. The physical (PCS) and mental (MCS) component summaries of QOL were estimated. We compared the SF-12 domains and components between the categories using ANOVA. Further, the association of diabetes status with PCS and MCS was assessed after adjustment for possible confounders including age, sex, depression, cognitive impairment, physical activity, and other relevant factors using linear regression analysis. RESULTS: Individuals with diabetes had lower PCS (40.9 ± 8.8 vs. 42.7 ± 8.6, p-value < 0.001), and MCS scores (45.0 ± 10.2 vs. 46.4 ± 9.4, p-value < 0.001) compared to participants without diabetes. No significant differences were observed in PCS or MCS scores between controlled or poorly controlled individuals with diabetes. Diabetes status was associated with PCS and MCS scores in univariable analysis. Regarding physical component of QOL, after adjusting for other confounders, poorly controlled diabetes was significantly associated with PCS [beta: -1.27 (-2.02, -0.52)]; some other determinants include depression [-7.66 (-8.51, -6.80)], male sex [3.90 (3.24,4.57)], and good physical activity [1.87 (1.17,2.57)]. As for the mental component, controlled diabetes was significantly associated with MCS [-1.17 (-2.13, -0.22)]; other contributing factors include depression [-14.35 (-15.34, -13.37)], male sex [1.97 (1.20,2.73)], good physical activity [-1.55 (-2.35, -0.75)], and smoking [-1.42 (-2.24, -0.59)]. BMI had an inverse association with PCS [-0.19 (-0.26, -0.13)] and a direct association with MCS [0.14 (0.07,0.21)]. CONCLUSION: Individuals with diabetes exhibited reduced QOL scores. Upon adjusting for other variables, it was found that uncontrolled diabetes correlated with decreased PCS scores, whereas controlled diabetes was linked to lower MCS scores. Factors such as depression and being female were identified as contributors to diminished QOL in both physical and mental aspects. These results have the potential to guide healthcare decision-making, facilitating the creation of tailored interventions aimed at improving the QOL for individuals with diabetes, with a specific focus on women and depression.

Dietary total, plant, and animal protein intake in relation to cardiovascular outcomes and inflammatory factors in elderly men: A cross-sectional study.

The source and amount of protein intake may influence cardiovascular and inflammatory risk, especially in elders who are often more vulnerable. However, findings on elders have been contradictory. Therefore, we examined the association between dietary total, plant, and animal protein intake in relation to cardiovascular outcomes and inflammatory factors in elderly men. The present cross-sectional study included 357 elderly men. A validated and reliable food frequency questionnaire (FFQ) was used to assess dietary intake. All biochemical factors including triglycerides (TG), fasting blood sugar (FBS), high-sensitivity C-reactive protein (hs-CRP), interleukin 6 (IL6), and tumor necrosis factor-α (TNF-α) were measured. Waist circumference (WC) and blood pressure (BP) were also assessed. A significant inverse association was found between animal protein intake and systolic blood pressure (SBP; OR: 0.62; 95% CI: 0.42, 0.91; ptrend = .014). There were significant inverse associations between plant protein intake and WC (OR: 0.34; 95% CI: 0.17, 0.68; ptrend < .001), FBS (OR: 0.51; 95% CI: 0.29, 0.89; ptrend = .018) and Hs-CRP (OR: 0.39; 95% CI: 0.21, 0.70; ptrend = .002). Moreover, significant inverse associations were also found between total protein intake and SBP (OR: 0.54; 95% CI: 0.33, 0.86; ptrend = .010) and total protein and Hs-CRP (OR: 0.50; 95% CI: 0.28, 0.88; ptrend = .015). In elderly men, a high dietary intake of plant protein was associated with lower odds of having high WC, FBS, and Hs-CRP. In addition, high dietary intake of animal protein was associated with higher odds of having a high SBP level, which was explained by higher intake of dairy products.

The association between anti-diabetic agents and osteoporosis, sarcopenia, and osteosarcopenia among Iranian older adults; Bushehr Elderly Health (BEH) program.

PURPOSE: Various risk factors are mentioned for osteoporosis, sarcopenia, and osteosarcopenia. Our aim is to assess the impacts of anti-diabetic drugs on these disorders. METHODS: To perform this study, the participants' data was extracted from the Bushehr Elderly Health (BEH) program in Iran. Afterward, the data were categorized into three subgroups: osteoporosis, sarcopenia, and osteosarcopenia, based on WHO and European Working Group on Sarcopenia in Older People (EWGSOP-2) working group definitions. Demographic characteristics, anthropometric measures, past medical history, and current medications were recorded. Pearson chi-squared and simple/multiple logistic regression using Python (3.11.4) and R (4.3.1) programming software assessed the association between anti-diabetic agents and these bone disorders. RESULTS: Out of 1995 participants, 820, 848, and 404 had osteoporosis, sarcopenia, or osteosarcopenia, respectively. Among all types of anti-diabetic drugs, a significant protective association between osteoporosis and consumption of second-generation sulfonylureas was found; Adjusted Odd Ratio (AOR) = 0.65 ([95% CI: 0.45-0.94], p-value = 0.023). No associations were found between sarcopenia and consumption of anti-diabetic agents. A significant association was observed between using Meglitinides and the risk of osteosarcopenia; AOR = 4.98 ([95% CI: 1.5-16.55], p-value = 0.009). CONCLUSION: In conclusion, a protective association between consumption of second-generation sulfonylureas and osteoporosis was found. Moreover, a positive association was found between the consumption of meglitinides and osteosarcopenia. However, to support these findings, further studies are recommended.

Mind the osteoporosis care gap with timely diagnosis: an executive summary of nationwide osteoporosis Campaigns 2019-2021.

Background: The World Osteoporosis Day inaugurate on October 20 every year by the International Osteoporosis Foundation to initiate bone health and osteoporosis as a global health agenda for policymakers, health care providers, and the public. The reported the campaigns activities in three years 2019, 2020, and 2021. The aim of this campaigns was to promote the osteoporosis awareness to close osteoporosis care and data gaps. Methods: World Osteoporosis Day campaigns were held during three consecutive years 2019-2021 through "structuring" and "implantation" phases. The slogan of "early detection and timely diagnosis of osteoporosis" was followed in different public awareness and healthcare professional educational events. Also, a short survey regarding the knowledge of women aged ≥ 50 years of osteoporosis was used in campaigns to gather data for future planning. These nationwide campaigns was supported by the Osteoporosis Research Center in collaboration with the non-communicable diseases management office of Iran's Ministry of Health. Results: All activities stablished to close the "data" and "awareness" gap in osteoporosis care. 1972, 1881, and 2538 women aged ≥ 50 were participated in the world osteoporosis campaigns and educated in 2019, 2020, and 2021, respectively. More than thousands of online and published educational materials were provided and disseminated in group and face-to-face and virtual education via celebration meetings in primary healthcare facilities, parks and shopping malls. The wide-ranging health slogans and massages was distributed by way of SMS, press conferences on television, radio, and other social media platforms. In addition, the in-person and virtual events such as up-date osteoporosis symposiums, national osteoporosis research network meetings, osteoporosis essential courses, and subspecialty one-day seminars provided knowledge for health care teams and policy makers. Conclusion: Closing the osteoporosis treatment gap was approached by nationwide campaigns to make an appropriate intervention to emphasize early diagnosis and awareness of osteoporosis to close the care gap. Supplementary Information: The online version contains supplementary material available at 10.1007/s40200-023-01257-7.

Prevalence of osteosarcopenic obesity and related factors among Iranian older people: Bushehr Elderly Health (BEH) program.

Osteosarcopenic obesity is a new syndrome that has been recently discussed in the scientific community. It is a condition that affects the elderly and involves the loss of bone, muscle, and fat tissue. The few studies that have been done on this disease showed that it has a high prevalence among the elderly and can cause various complications. This study was the first one to investigate this syndrome in Iran, and found that its prevalence was 19.83%. BACKGROUND: Osteosarcopenic obesity syndrome (OSO) is a condition that involves osteopenia/osteoporosis, sarcopenia, and obesity. It leads to a reduction in the quality of life of the elderly and an increase in hospitalization which has attracted the attention of physicians. This study aimed to determine the prevalence and risk factors of osteosarcopenic obesity in people over 60 years of age in Bushehr. MATERIALS AND METHODS: We used data from the Bushehr study, which included 2426 participants aged ≥ 60 years. We assessed osteoporosis/osteopenia based on T-score; sarcopenia based on hand grip strength, skeletal muscle mass index (SMI), and walking speed; and obesity based on fat mass and BMI for diagnosing OSO. We first examined the factors related to OSO in the univariable analysis and then fitted the multiple logistic regression model, separately for women and men. The result was summarized as adjusted odds ratios with a 95% confidence interval. RESULTS: In total, 2339 elderly were examined in our study, of which 464 elderly were suffering from osteosarcopenic obesity. The standardized prevalence of OSO was 23.66% (95% CI: 21.15-26.16) in women and 18.53% (95% CI 16.35-20.87) in men. Age was positively linked to osteosarcopenic obesity in both genders and so was diabetes in men. However, education, physical activity, and protein intake were negatively linked to osteosarcopenic obesity in both genders, as well as hypertriglyceridemia and hypertension in women. CONCLUSION: The prevalence of OSO among men and women of Bushehr city is high and is related to increasing age, low levels of education, physical activity, and protein intake among women and men.

The burden of rheumatoid arthritis and low back pain in North Africa and Middle East from 1990 to 2019: Results from the Global Burden of Disease Study 2019.

BACKGROUND: Rheumatoid arthritis (RA) and low back pain (LBP) are among the most prevalent musculoskeletal disorders (MSDs). The need for investigation of regional and local patterns of these two MSDs seems inevitable for better policy-making. The current study presents updated results of the Global Burden of Disease (GBD) Study 2019 and reports the burden of RA and LBP in North Africa and Middle East (NAME) countries from 1990 to 2019. METHODS: Incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and risk factors, including high body mass index, occupational ergonomic factors, and smoking, were extracted based on the GBD 2019 data. RESULTS: The age-standardized prevalence and mortality of RA were 120.6 (95% uncertainty interval [95% UI] 107.0-135.7) and 0.1 (95% UI 0.1-0.2) per 100 000 population in 2019 with 28.3% (95% UI 25.5%-30.9%) increase and 7.5% (95% UI -37.5% to 32.5%) decrease since 1990, respectively. Turkey had the highest age-standardized incidence, prevalence, and DALYs of RA in 2019. All RA burden measures were higher for women; however, the incidence was almost the same at ages greater than 65 years. The age-standardized prevalence and DALYs of LBP were 7668.2 (95% UI 6798.0-8636.3) and 862 (95% UI 605.5-1153.3) in 2019, which had decreased by 5.8% (95% UI -7.4% to -4.3%) and 6.0% (95% UI -7.7% to -4.2%) since 1990, respectively. Moreover, although Turkey had the highest incidence and prevalence in 1990, Iran was at the top in 2019. The regional age-standardized DALY rates due to RA and LBP attributed to smoking were 1.7 (95% UI 0.5-3.2) and 139.4 (95% UI 87.3-198.8) in 2019, respectively, which had decreased 2.2% (95% UI -19.2% to 13.7%) and 15.4% (95% UI -19.4% to -10.5%) since 1990, respectively. CONCLUSION: RA still imposes a significant burden in the NAME region as the burden measures have increased from 1990 to 2019. On the other hand, regarding LBP, a decreasing pattern was observed. Differences among the countries and between ages and genders can have implications, and the results of this study may be helpful for policy-makers in the NAME countries.

Trend in global burden attributable to low bone mineral density in different WHO regions: 2000 and beyond, results from the Global Burden of Disease (GBD) study 2019.

Background: We aimed to document the current state of exposure to low bone mineral density (BMD) and trends in attributable burdens between 2000 and 2019 globally and in different World Health Organization (WHO) regions using the Global Burden of Disease (GBD) study 2019. Methods: We reviewed the sex-region-specific summary exposure value (SEV) of low BMD and the all-ages numbers and age-standardized rates of disability-adjusted life years (DALYs), years lived with disability (YLDs), years of life lost (YLLs), and deaths attributed to low BMD. We compared different WHO regions (Africa, the Eastern Mediterranean Region, Europe, Region of the Americas, Southeast Asia, and Western Pacific), age categories, and sexes according to the estimates of the GBD 2019 report. Results: The global age-standardized SEV of low BMD is estimated to be 20.7% in women and 11.3% in men in 2019. Among the WHO regions, Africa had the highest age-standardized SEV of low BMD in women (28.8% (95% uncertainty interval 22.0-36.3)) and men (16.8% (11.5-23.8)). The lowest SEV was observed in Europe in both women (14.7% (9.9-21.0)) and men (8.0% (4.3-13.4)). An improving trend in the global rate of DALY, death, and YLL was observed during 2000-2019 (-5.7%, -4.7%, and -11.9% change, respectively); however, the absolute numbers increased with the highest increase observed in global YLD (70.9%) and death numbers (67.6%). Southeast Asia Region had the highest age-standardized rates of DALY (303.4 (249.2-357.2)), death (10.6 (8.5-12.3)), YLD (133.5 (96.9-177.3)), and YLL (170.0 (139-197.7)). Conclusions: Overall, the highest-burden attributed to low BMD was observed in the Southeast Asia Region. Knowledge of the SEV of low BMD and the attributed burden can increase the awareness of healthcare decision-makers to adopt appropriate strategies for early screening, and also strategies to prevent falls and fragility fractures and their consequent morbidity and mortality.

The prevalence and predictors of geriatric giants in community-dwelling older adults: a cross-sectional study from the Middle East.

The term "geriatric giants" refers to the chronic disabilities of senescence leading to adverse health outcomes. This study aimed to investigate the prevalence and predictors of geriatric giants in Southern Iran. The participants were selected from Bushehr city using a multistage cluster random sampling method. Demographic data were collected through interviews. Frailty, incontinence, immobility, depression, cognitive impairment, and malnutrition were measured by questionnaires and instruments. Finally, data from 2392 participants were analyzed. The prevalence of fecal incontinence was less than 1% among all participants and similar in men and women. In contrast, compared with men, women had higher prevalence of urinary incontinence (36.44% vs. 17.65%), depression (39.05% vs. 12.89%), anorexia and malnutrition (2.35% vs. 0.82%), immobility (8.00% vs. 2.5%), frailty (16.84 vs. 7.34), and pre-frailty (54.19 vs. 38.63%). The prevalence of dependence and cognitive impairment was also higher in women and considerably increased with the age of participants. In total, 12.07% of subjects were frail, and 46.76% were pre-frail. The prevalence of frailty exponentially increased in older age, ranging from 4.18% among those aged 60-64 years to 57.35% in those aged ≥ 80 years. Considering 95% confidence interval (CI), multivariate logistic regression revealed that low physical activity [odds ratio (OR) 31.73 (18.44-54.60)], cancer (OR 3.28 (1.27-8.44)), depression [OR 2.42 (1.97-2.98)], age [OR 1.11 (1.08-1.14)], waist circumference [OR 1.03 (1.01-1.06)], BMI [OR 1.07 (1.01-1.14)], MNA score [OR 0.85 (0.79-0.92)], polypharmacy [OR 2.26 (1.30-3.95)] and male gender [OR 0.63 (0.42-0.93)] were independently associated with frailty. White blood cell count (WBC), smoking, marital status, and number of comorbidities were not independently associated with frailty. Low physical activity was the strongest predictor of frailty, which may need more attention in geriatric care. Frailty, its predictors, and other components of geriatric giants were considerably more common among women and older ages.

Osteoporosis medication adherence tools: a systematic review.

Poor adherence reduces the effectiveness of osteoporosis treatment, resulting in lower bone mineral density and subsequently higher fracture rates. Reliable and practical tools are needed to measure medication adherence. The aim of this systematic review was to find osteoporosis medication adherence measurement tools and assess their applicability. Osteoporosis adherence measurement tools and all their related keywords in PubMed, Embase, Web of Science, and Scopus databases were searched on 4 December, 2022. After excluding duplicates in the Endnote software, two researchers independently investigated the remaining articles and included all those that used a method for measuring adherence to osteoporosis pharmacotherapy. Articles that did not specify the medications evaluated or if the primary focus was not adherence excluded. Two common measures of adherence, i.e., compliance and persistence were included. Four separate tables were designed, one for direct methods, one for formulas, one for questionnaires, and one for electronic methods of measuring adherence to treatment. Quality assessment was performed for selected articles by the Newcastle-Ottawa Quality Assessment Scale (NOS). A total of 3821 articles were found, of which 178 articles met the inclusion and exclusion criteria. In general, five types of methods were observed to measure medication adherence of osteoporosis, including direct methods (n = 4), pharmacy records (n = 17), questionnaires (n = 13), electronic methods (n = 1), and tablet counting (n = 1). The most commonly used adherence measurement tool, based on pharmacy records, was medication possession ratio (MPR). Among questionnaires, Morisky Medication Adherence Scale was mostly used. Our findings show what tools have been used to measure medication adherence in osteoporosis patients. Among these tools, direct methods and electronic methods are the most accurate methods. However, due to their high cost, they are practically not used in measuring osteoporosis medication adherence. Questionnaires are the most popular among them and are mostly used in osteoporosis.

Health-Related Quality of Life in Osteoporosis Patients with and without Fractures in Tehran, Iran.

BACKGROUND: This study aimed to measure the health-related quality of life (HRQOL) of patients with osteoporosis with and without fractures in Tehran, the capital city of Iran. METHODS: We surveyed a sample of 478 patients with osteoporosis aged over 50 years. Participants with fractures included patients referred to hospitals due to osteoporotic fractures which were alive 6 months after the fracture. Participants without fractures were randomly selected from patients with a definite diagnosis of osteoporosis admitted to 3 outpatient clinics in Tehran. Data were collected using the EuroQol 5-dimensional 5-level questionnaire. Statistical differences between patients with and without fracture were tested with Pearson's χ2 test, Student's t-test, and the Mann-Whitney U-test. The association between HRQOL and other variables was evaluated using a multiple linear regression model. RESULTS: The patients' mean age±standard deviation was 67.3±11.9 years, and 74.1% were women. One hundred and seventeen (23%) patients had hip fractures, 56 (11%) had vertebral fractures, 127 (25%) had forearm fractures, and 178 (40%) had no fractures. The median (interquartile range) values of HRQOL scores of those with hip, vertebral, and forearm fractures and those with no history of fracture were 0.53 (0.22), 0.60 (0.28), 0.64 (0.26), and 0.64 (0.27), respectively. The multiple regression model revealed a significant relationship between the HRQOL scores and sex, marital status, employment status, presence of any chronic illness in addition to osteoporosis, and type of fracture. CONCLUSIONS: Osteoporosis and its related fractures can reduce the HRQOL.

Relationship between caffeine intake and small for gestational age and preterm birth: a dose-response meta-analysis.

Our meta-analysis aimed to determine the dose-response relationship between caffeine intake and risk of small for gestational age (SGA) and preterm birth (PB). A systematic search of PubMed, Web of science and Scopus was done from inception to January 2023 using relevant keywords. All case-control and cohort studies reported in English were included if the exposure of interest was caffeine intake during pregnancy, the outcome of interest was spontaneous SGA and PB, and multivariable-adjusted odds ratios (ORs) or risk ratios were provided or could be calculated. In all, 22 studies (15 cohort studies and seven case-control studies) were included in this review. Examining the association of caffeine intake with risk of PB, no significant relationship was found (Pooled ES: 1.04; 95% CI: 0.95 to 1.14, P = 0.019). Findings from this meta-analysis demonstrated that caffeine intake had a significantly higher risk of SGA respectively (Pooled ES: 1.28; 95% CI: 1.16 to 1.41, P < 0.001). A dose-response analysis proposed that an increase of 100 mg caffeine per day was associated with a 13% greater risk of SGA. This study confirmed that caffeine intake raises the risk of SGA. However, the risk of PB was not found to be reliably associated with maternal caffeine consumption.

The Trend of Risk for Cardiovascular Diseases During the Past Decade in Iran, Applying No-Lab and Lab-Based Prediction Models.

Background: As a surrogate for all relevant risk factors, it is preferable to show trends in the mean cardiovascular disease(CVD) risk rather than to examine each risk factor trend separately. Objectives: Using national representative data, this study aimed to determine the changes in the World Health Organization (WHO) CVD risk during the last decade considering both laboratory and non-laboratory risk scoring. Methods: We used data from five rounds of the WHO STEPwise approach to surveillance surveys (2007-2016). In all, 62,076 (31,660 women) participants aged 40-65 years were included and their absolute CVD risk were calculated. The generalized linear model was performed to assess the trend of CVD risk in men and women, and also in diabetic and non-diabetic individuals. Results: We showed significant declining trends in the mean CVD risk in the laboratory (from 10.5% to 8.8%) and non-laboratory (10.1% to 9.4%) models in men. In women, a significant reduction was observed in the laboratory-based model (from 8.4% to 7.8%). The laboratory model showed a greater decrease in men than women (P-for interaction < 0.001) and in diabetic patients (from 16.1% to 13.6%) than non-diabetic individuals (from 8.2% to 7%) (p-for interaction = 0.002). The proportion of high-risk individuals (risk ≥ 10%) decreased from 40% in 2007 to 31.5% in 2016 in men and from 29.8% to 26.1% in women based on the laboratory-model. Conclusions: During the last decade, CVD risk had a significant decrease in men and women. The reduction was more evident in men and diabetic population. However, still, one-third of our population is considered high-risk.

The Association of Cardiovascular Diseases Risk Scores and Osteosarcopenia Among Older Adult Populations: The Results of Bushehr Elderly Health (BEH) Program.

Considering the association of cardiovascular disease (CVD) with both osteoporosis and sarcopenia, this study aimed to explore the association between a newly developed CVD risk score and osteosarcopenia in the elderly population. Participants in the second phase of the Bushehr Elderly Health (BEH) program were included. Osteosarcopenia was defined as having both osteopenia/osteoporosis and sarcopenia. The 10-year CVD risk score was estimated using the WHO lab-based model. The participants were considered as high-risk if the CVD risk was ≥ 20%. The estimated risks were compared in individuals with and without osteosarcopenia. The association of CVD risk and osteosarcopenia was investigated using a logistic regression model, adjusted by potential confounders. In all, 2392 participants (1161 men) with a mean age of 69.3 (± 6.3) years were studied and 532 [242 (45.5%) men] individuals were diagnosed with osteosarcopenia. The median (IQR) CVD risks were 0.340 (0.214) and 0.229 (0.128) in men with and without osteosarcopenia, respectively (P < 0.001); In women, the corresponding values were 0.260 (0.147) and 0.207 (0.128), respectively (P < 0.001). Adjusted by confounders, CVD risk ≥ 20% in women, increased the odds of osteosarcopenia by 72%. Body mass index showed an inverse association with osteosarcopenia in both men (0.81, 95%CI: 0.78-0.85) and women (0.66, 95%CI: 0.62-0.70). Considering the area under the ROC curve, the models showed a discriminative ability of 82% in men and 89% in women. This study displayed a significant association between WHO CVD risk score and osteosarcopenia. Due to the difficult diagnosis of osteosarcopenia, the high association of cardiovascular risk score with this disease can help identify high-risk individuals and refer them for further diagnostic procedures. Considering the high prevalence of osteosarcopenia and its complications in the older population, comprehensive strategies are needed to find high-risk populations.

Assessment of quality of life and its affecting factors in osteosarcopenic individuals in the Iranian older adult population: Bushehr Elderly Health (BEH) program.

Objectives: This cross-sectional study, conducted as part of the Bushehr Elderly Health program stage II in Bushehr, Iran, aimed to evaluate health-related quality of life (HR-QoL) in individuals aged ≥ 60 with osteosarcopenia, a condition characterized by the co-occurrence of osteopenia/osteoporosis and sarcopenia. Given the increasing elderly population worldwide, understanding the HR-QoL of this demographic is crucial, with osteosarcopenia being a significant factor. Methods: The study enrolled 2369 participants aged ≥ 60 and collected demographic and anthropometric data. Various questionnaires, including the Short Form 12, Patient Health Questionnaire-9, Activities of Daily Living, and Instrumental Activities of Daily Living, were administered. Comparisons were made between individuals with and without osteosarcopenia. Regression models were employed to identify variables associated with HR-QoL in those with osteosarcopenia. Results: Key findings revealed that 22.5% of participants had osteosarcopenia. Significantly different HR-QoL measures were observed between the 2 groups, especially in physical functioning and physical component summary scores. Male gender, advanced age, and chronic illnesses were linked to lower physical and mental HR-QoL scores among those with osteosarcopenia. In female participants, a history of fractures and physical disability were associated with reduced quality of life. Conclusions: This study underscores the negative impact of osteosarcopenia on HR-QoL, particularly in male participants, with a focus on physical aspects. It also highlights age and chronic disease as contributing factors to diminished HR-QoL in individuals with osteosarcopenia. These findings emphasize the importance of addressing osteosarcopenia in the elderly population to improve their overall well-being.

The Association of Coronary Artery Calcium Score and Osteoporosis in Postmenopausal Women: A Cross-Sectional Study.

BACKGROUND: The association between osteoporosis, a common metabolic bone disorder, and atherosclerosis has been reported in different studies. In this study, we aimed to investigate the association between the coronary artery calcium score (CACS) and bone mineral density (BMD) at different sites and bone biomarkers in postmenopausal women. METHODS: A total of 184 participants were enrolled in this study. The CACS and BMD at different sites, including the spinal, total hip, and femoral neck, were measured using computed tomography angiography and dual energy X-ray absorptiometry, respectively. Serum levels of osteocalcin, ß-C-terminal telopeptide (ß-CTX), parathyroid hormone, and 25-hydroxy-vitamin D were measured. RESULTS: A negative association between CACS and bone biomarker levels (osteocalcin, P=0.021; ß-CTX, P=0.013) was noted. The univariable model showed an association between CACS and osteoporosis of the femoral neck (P=0.03). It was found that with an increase of 10 U in CACS, the odds of osteoporosis at the femoral neck escalates by 2% (odds ratio=1.02, 95% confidence interval, 1.002-1.03) using the multivariate logistic regression model, while such an association with osteoporosis could not be found at the spinal site. The best cutoff point of the calcium score was estimated to be 127. CONCLUSIONS: The results suggest that in postmenopausal women, coronary atherosclerosis is independently associated with osteoporosis of the femoral neck, but such an association could not be detected with spinal osteoporosis. The importance of screening for osteoporosis in patients with cardiovascular disease and the implications of preventive measures in the primary care setting were highlighted considering the common risk factors.

Breast cancer risk factors in Iranian women: a systematic review and meta-analysis of matched case-control studies.

BACKGROUND: Identifying breast cancer risk factors is a critical component of preventative strategies for this disease. This study aims to identify modifiable and non-modifiable risk factors of breast cancer in Iranian women. METHODS: We used international databases (PubMed/Medline, Scopus, Web of Knowledge, and Embase) and national databases (SID, Magiran, and ISC) to retrieve relevant studies until November 13, 2022. The odds ratio (OR) with a 95% confidence interval using the random-effect model was used to estimate the pooled effect. The publication bias was assessed by the Egger and Begg test. A sensitivity analysis was conducted to evaluate the effect of each included study on the final measurement. RESULTS: Of the 30,351 retrieved articles, 24 matched case-control records were included with 12,460 participants (5675 newly diagnosed cases of breast cancer and 6785 control). This meta-analysis showed that of the known modifiable risk factors for breast cancer, obesity (vs normal weight) had the highest risk (OR = 2.17, 95% CI 1.47 to 3.21; I2 = 85.7) followed by age at marriage (25-29 vs < 18 years old) (OR = 2.00, 95% CI 1.53 to 2.61; I2 = 0), second-hand smoking (OR = 1.86, 95% CI 1.58 to 2.19; I2 = 0), smoking (OR = 1.83, 95% CI 1.41 to 2.38; I2 = 18.9), abortion history (OR = 1.44, 95% CI 1.02 to 2.05; I2 = 66.3), oral contraceptive use (OR = 1.35, 95% CI 1.11 to 1.63; I2 = 74.1), age at marriage (18-24 vs < 18 years old) (OR: 1.22, 95% CI 1.02 to 1.47; I2 = 0). Of non-modifiable risk factors, history of radiation exposure (OR = 3.48, 95% CI 2.17 to 5.59; I2 = 0), family history of breast cancer (OR = 2.47, 95% CI 1.83 to 3.33; I2 = 73), and age at menarche (12-13 vs ≥ 14 years old) (OR = 1.67, 95% CI 1.31-2.13; I2 = 25.4) significantly increased the risk of breast cancer. CONCLUSIONS: Since most risk factors related to breast cancer incidence are modifiable, promoting healthy lifestyles can play an influential role in preventing breast cancer. In women with younger menarche age, a family history of breast cancer, or a history of radiation exposure, screening at short intervals is recommended.