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.

Iranian Multi-center Osteoporosis Study (IMOS), 2021-2022: the study protocol.

BACKGROUND: This paper presents the protocol of the 4th round of Iranian Multi-center Osteoporosis Study (IMOS), a national survey with the primary objective of estimating the prevalence of osteoporosis and sarcopenia and their risk factors in a representative sample of urban and rural populations. METHODS: The target population of the survey is all individuals ≥ 50 years in Iran. A multi-stage random sampling method has been used in the study. We stratified the 31 provinces of the country into 5 strata based on the distribution of their potential risk factors for osteoporosis and randomly selected one or two provinces from each stratum. Then, we invited 2530 people aged ≥ 50 years recruited in the 8th National Survey of None Communicable Diseases (NCD) Risk Factors (STEPs-2021) in the selected provinces to participate in IMOS. Body composition measurements including bone mineral density, muscle mass, and fat mass are measured through Dual-energy X-ray Absorptiometry (DXA) method using HOLOGIC (Discovery and Horizon) devices; and Trabecular Bone Score (TBS) is measured on the DXA scans using iNsight software. Anthropometric measurement and physical examinations are made by a trained nurses and other required information are collected through face-to-face interviews made by trained nurses. Laboratory measurements are made in a central lab. The prevalence of osteoporosis and sarcopenia will be estimated after applying sampling design, non-response, and post-stratification weights to the data. DISCUSSION: IMOS will provide valuable information on the prevalence and determinants of osteoporosis and sarcopenia at the national level, and the results can be used in evaluating health system interventions and policymaking in the field of musculoskeletal diseases.

Health information-seeking behavior and self-care in women with osteoporosis: a qualitative study.

The main findings of this study on the self-care behaviors contain "identification of knowledge gaps," "established networking for seeking information," "information from trust-to-distrust," "information-seeking inhibiting factors," "information-seeking facilitating factors," and "self-care behaviors based on required knowledge." PURPOSE: Health information-seeking behavior affects self-care and could promote quality of life and life expectancy. This study aimed at assessing health information-seeking and self-care behaviors of women with osteoporosis in Iran. METHODS: This study was conducted using a content analysis approach. Data were collected through semi-structured interviews with 15 women with osteoporosis aged above 50 years. The participants were selected by purposeful sampling. The data were analyzed by the conventional content analysis method using MAXQdata software version 10. RESULTS: From in-depth descriptions of the participants' experiences, 246 primary codes were extracted. Subsequently, constant comparison analysis was done and 35 sub-categories and 6 main categories have appeared from the data. DISCUSSION: Based on the experiences of women with osteoporosis, they received limited information from the health care providers, so they were seeking reliable information sources to meet their information needs. They obtained most of their information from other patients, family members, and network of friends. In the process of seeking information, they face various barriers such as lack of time in the health care team that affect their ability to self-care. CONCLUSION: The results can guide health policymakers, patient educators, health care providers, information specialists, and patients and their families.

Four Years of Diagnostic Challenges with Tetrahydrobiopterin Deficiencies in Iranian Patients.

Hyperphenylalaninemia (HPA) is a condition caused by tetrahydrobiopterin (BH4) and phenylalanine hydroxylase (PAH) deficiencies. It is essential that differential diagnosis be conducted to distinguish these two causes of HPA, because BH4 deficiency is a more severe disease involving progressive neurologic deterioration. Based on the biological findings, HPA is defined as a plasma phenylalanine level of >2.0 mg/dl (>120 µmol/l). The National Biochemistry Reference Laboratory at the Pasteur Institute of Iran initiated BH4 deficiency screening tests for the first time during the implementation of a nationwide phenylketonuria (PKU) screening program. Measurement of blood phenylalanine and urinary neopterin and biopterin was conducted by high-performance liquid chromatography in 617 patients with HPA. Dihydropteridine reductase (DHPR) activity was measured in all patients by kinetic spectrophotometry. Differential diagnosis was conducted for PKU, transient HPA, and BH4 deficiencies.Our results indicated that out of 76 cases involving BH4 deficiencies, 37 had 6-pyruvoyl-tetrahydropterin synthase (PTPS) deficiency, 35 had DHPR deficiency, 1 case had pterin-4a-carbinolamine dehydratase (PCD) deficiency, and 3 cases had GTP cyclohydrolase I (GTPCH) deficiency. In this study, 1 novel deletion mutation and 18 novel missense mutations were reported in addition to mutations that had previously been identified and registered in BIOMDB. At present, the screening program for PKU in Iran includes tests that detect different forms of BH4 deficiency presenting with HPA. Newborns that are BH4-deficient benefit from the availability of the tests because they can receive necessary care before being clinically affected.