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عضویت

جستجوی مقالات مرتبط با کلیدواژه "osteoporosis" در نشریات گروه "پزشکی"

  • Sedigheh Reisian, Shokoufeh Bonakdaran, Ali Moradi Phd, Mohammad Ali Yaghoubi *

    A rare case of severe prolonged persistent Teriparatide-induced hypercalcemia (14.3mg/dL on admission) in an osteoporotic patient after ceasing the Teriparatide is reported. This 67-year-old female was admitted with polyuria, xerostomia, constipation, progressive weakness, and a history of Triparatide use due to a previous osteoporotic fracture. Her serum calcium, PTH, and vitamin D levels had been normal before starting Teriparatide. Ninety six hours after ceasing the Teriparatide along with rehydration and Calcitonin treatment, the patient's serum calcium levels returned to normal. Severe Teriparatide-induced hypercalcemia does not follow any defined pattern and may persist for days and can usually be controlled through ceasing the Teriparatide, rehydration, and close monitoring of the serum calcium level and symptoms.
            Level of evidence: IV

    Keywords: Hypercalcemia, Osteoporosis, Teriparatide
  • Morteza Nakhaei Amroodi, Khatere Mokhtari, Mojtaba Baniasadi, Saeedreza Amiri, Mansour Karimi, Pouria Tabrizian*

    The intricate orchestration of cell types and developmental processes in multicellular organisms hinges upon signaling pathways, such as Wnt, which play a pivotal role in embryonic development and adult tissue homeostasis. Over the past four decades, significant efforts have been made to elucidate the complexities of the Wnt signaling pathway and its diverse physiological functions. Wnt signaling has emerged as a crucial regulator in orthopedic contexts, particularly in fracture healing and osteoarthritis. This review delves into the intricate involvement of the Wnt pathway in these orthopedic conditions and explores its impact on bone formation, chondrogenesis, and joint pathologies. Moreover, it examines the therapeutic potential of targeting Wnt signaling in the treatment of osteoporosis, highlighting the promising avenues opened by advancements in understanding rare bone disorders, such as sclerosteosis and van Buchem disease. By elucidating the multifaceted roles of Wnt signaling in orthopedic health and disease, this review offers insights into potential therapeutic strategies to enhance fracture healing, mitigate osteoarthritis progression, and address bone-related disorders.

    Keywords: Wnt Signaling Pathway, Orthopedic Conditions, Fracture Healing, Osteoarthritis, Osteoporosis, Sclerosteosis, Bone Formation, Chondrogenesis, Targeted Therapy-Orthopedic Disorder
  • محمدمهدی ابراهیمی نسب، علی شبیب، پویا طباطبایی ایرانی*، تقی بغدادی

    در سال های اخیر، آگاهی از پوکی استخوان در کودکان افزایش یافته است، وضعیتی که می تواند منجر به ضعیف شدن استخوان ها و افزایش خطر شکستگی در کودکان شود. ضروری است که پزشکان کودکان در مورد این مسئله آگاهی داشته باشند تا بتوانند بیماران مبتلا به پوکی استخوان یا در معرض خطر را شناسایی و درمان کنند. عوامل ژنتیکی و اختلالات مختلف در تشکیل و کیفیت استخوان نقش دارند. استئوژنز ایمپرفکتا شایع ترین وضعیت ژنتیکی مرتبط با پوکی استخوان اولیه است. پوکی استخوان ثانویه می تواند در کودکان مبتلا به بیماری های مزمن رخ دهد. اشعه ایکس می تواند به تشخیص این وضعیت کمک کند. پیشگیری در مدیریت پوکی استخوان کودکان کلیدی است، زیرا درک توسعه طبیعی استخوان ها امکان تشخیص و درمان زودهنگام را فراهم می کند. داروها می توانند به جلوگیری از از دست دادن استخوان در بیماران کودکان کمک کنند. تعریف پوکی استخوان کودکان شامل توده استخوانی کم و شکستگی های قابل توجه است. عواملی مانند ژن ها، داروها، کمبود حرکت و استفاده از کورتیکواستروئیدها می توانند به پوکی استخوان در کودکان کمک کنند. گزینه های درمانی برای پوکی استخوان کودکان محدود است، اما عوامل آنابولیک و بیسفوسفونات ها ممکن است استفاده شوند. نظارت و پیگیری دقیق برای جلوگیری از شکستگی های بیشتر ضروری است. مهم است که پزشکان کودکان تشخیص و درمان پوکی استخوان کودکان، همچنین عوامل سبک زندگی و اثربخشی روش های درمانی را درک کنند.

    کلید واژگان: پوکی استخوان در کودکان, استئوژنز ایمپرفکتا, شکستگی ها در کودکان, ویتامین D
    Mohammadmahdi Ebrahiminasab, Ali Shbeeb, Pouya Tabatabaei Irani *, Taghi Baghdadi

    In recent years, there has been a growing awareness of pediatric osteoporosis, a condition that can lead to weakened bones and a higher risk of fractures in children. It is essential for pediatricians to be knowledgeable about this issue so that they can identify and treat patients with osteoporosis or those at risk for it. Genetic factors and various disorders play a role in bone formation and quality. Osteogenesis imperfecta is the most common genetic condition linked to primary osteoporosis. Secondary osteoporosis can occur in children with chronic illnesses. X-rays can help diagnose the condition. Prevention is key in managing pediatric osteoporosis, as understanding normal bone development allows for early detection and treatment. Medications can help prevent bone loss in pediatric patients. The definition of pediatric osteoporosis involves low bone mass and significant fractures. Factors such as genes, medications, lack of movement, and corticosteroid use can contribute to osteoporosis in children. Treatment options for pediatric osteoporosis are limited, but anabolic agents and bisphosphonates may be used. Close monitoring and follow-up are crucial to prevent further fractures. It is important for pediatricians to understand the diagnosis and treatment of pediatric osteoporosis, as well as lifestyle factors and the effectiveness of treatment approaches.

    Keywords: Osteoporosis, Pediatric, Osteogenisis Imperfecta, Fractures In Children, Vitamine D
  • مهدی عسگری*، محمدرضا سلامت
    مقدمه

    جذب سنجی اشعه ی ایکس با انرژی دوگانه یا دگزا با توانایی نمایش تغییرات تراکم استخوانی به عنوان استاندارد طلایی در تشخیص پوکی استخوان و سایر بیماری های مرتبط با استخوان تبدیل شده است. این مقاله به بررسی و تشریح اهمیت توجه به رعایت اصول حافظت در برابر پرتوهای یون ساز برای گروه های مختلف از جمله بیماران، پرتوکاران، کودکان، زنان باردار و جنین در حین اسکن دگزا جهت بررسی وضعیت تراکم استخوان پرداخت.

    روش ها

    با توجه به تعداد محدود مقالات منتشر شده، مقالات بدون محدودیت زمانی تا سال 2024 با جستجو در پایگاه های اطلاعاتی ISI Web of Science، Science Direct، Scopus، PubMed و Google Scholar جمع آوری و محتوای آن ها مورد استفاده قرار گرفت.

    یافته ها

    برای دستگاه های پرتو مدادی دگزا دوز موثر ناچیز و کمتر از 1 میکروسیورت است. با این حال، دوزها برای دستگاه های پرتو بادبزنی متناسب با مدل و سازنده دستگاه معمولا بالاتر از 15 میکروسیورت است. برای مواجهه های پزشکی، هیچ محدودیتی در تعداد اسکن ها وجود ندارد. استفاده از یک پروتکل بالینی استاندارد و ثابت طراحی شده برای بزرگسالان منجر به مواجهه پرتویی بیش از حد در استفاده دگزا برای کودکان و نوجوانان می شود.

    نتیجه گیری

    دوزهای تابشی دگزا در قیاس با دیگر روش های تصویربرداری بسیار کم است با این حال، قرار گرفتن در معرض تشعشعات یونیزان خطرات بالقوه ای به همراه دارد و باید توجه ویژه ای به توجیه پذیری و بهینه سازی با در نظر گرفتن تمام اقدامات حفاظتی در برابر تشعشع برای تمام گروه های ذینفع انجام گیرد.

    کلید واژگان: جذب سنجی اشعه ی ایکس با انرژی دوگانه, دگزا, دوز, پوکی استخوان
    Mahdi Asgari *, Mohammad Reza Salamat
    Background

    Dual-energy X-ray absorptiometry, or DXA, has become the gold standard for diagnosing osteoporosis and other bone-related diseases due to its ability to show changes in bone density. This article discusses the importance of following ionizing radiation safety principles during DXA scanning for various groups, including patients, radiographers, children, pregnant women, and fetuses.

    Methods

    Due to the limited number of published articles, data with no time limit until 2024 were collected using the ISI Web of Science, Science Direct, Scopus, PubMed, and Google Scholar databases.

    Findings

    The effective dose for pencil beam DXA devices is less than 1 μSv. However, doses from fan beam devices can reach up to 15 μSv, depending on the device's model and manufacturer. For medical exposures, there is no restriction on the number of scans. The use of a standard DXA clinical technique developed for adults leads to excessive radiation exposure in the use of DXA for children and adolescents.

    Conclusion

    Radiation doses in DXA are very low compared to other medical imaging methods. However, ionizing radiation carries potential risks, and special attention should be paid to its justification and optimization, considering all radiation protection measures for patients, radiographers, children, pregnant women, and fetuses.

    Keywords: Dual-Energy X-Ray Absorptiometry, DXA, Dose, Osteoporosis
  • Seyyed Mostafa Arabi, Mahla Chambari, Leila Sadat Bahrami, Ali Jafari, Hossein Bahari, Željko Reiner, Amirhossein Sahebkar*
    Purpose

     Statin therapy is widely used for the management of dyslipidemia and the prevention of cardiovascular diseases (CVDs). However, there is a growing concern about its potential effects on bone metabolism markers and mineral density. The aim of this systematic review and meta-analysis was to investigate the effect of statin therapy on these parameters.

    Methods

     PubMed/MEDLINE, Scopus, and Clarivate Analytics Web of Science databases were searched from inception to August 2023, using MESH terms and keywords.

    Results

     After screening 2450 articles, 16 studies that met the inclusion criteria were included, of which 12 randomized controlled trials (RCTs) were used for meta-analysis. The findings showed that statin therapy significantly reduced bone-specific alkaline phosphatase (B-ALP) levels (WMD=-1.1 U/L; 95% CI -2.2 to -0.07; P=0.03; I2=0%,), and bone mineral density (BMD) at different sites (WMD=-0.06 g/cm2 ; 95% CI -0.08 to -0.04; P<0.001; I2=97.7%, P<0.001). However, this treatment did not have a significant effect on osteocalcin, serum C-terminal peptide of type I collagen (S-CTx), serum N-telopeptides of type I collagen (NTx) concentration, or overall fracture risk.

    Conclusion

     This systematic review and meta-analysis provide evidence that statin therapy is associated with a significant reduction in B-ALP levels and BMD at different sites of the skeleton. Further studies are needed to investigate the long-term effects of statin therapy on bone health and to identify the potential underlying mechanisms.

    Keywords: Atorvastatin, Bone Markers, Bone-Specific Alkaline Phosphatase, Osteoporosis, Meta-Analysis, Statins
  • Yuanyuan Zhou, Shujuan Wang *, Yuanyuan Hu
    Objective (s)

    Osteoporosis is a significant public health concern due to its association with fragility fractures. Despite experiencing such fractures, many patients remain at high risk of future fractures due to inadequate management and treatment of their underlying osteoporosis. This research presents a comprehensive intervention to enhance osteoporosis management in patients with fragility fractures. The intervention involves a thorough personalized assessment of fracture risk using clinical factors and bone density testing, followed by customized treatment based on the individual’s fracture risk level. It also addresses non-compliance through patient education, counseling, reminders, and improved care coordination among acute, primary, and specialty providers. 

    Materials and Methods

    The aim is to create and characterize sodium alginate/hydroxyapatite (HA) scaffolds reinforced with zinc oxide nanoparticles (ZnO-NP) for bone tissue engineering. Freeze-drying was used to produce scaffolds with 0–15% ZnO-NP. Analyses confirmed the composite structure, uniform ZnO-NP distribution, and decreasing pore size with higher ZnO-NP content. Mechanical testing showed increased compressive strength with greater ZnO-NP. 

    Results

    The scaffolds exhibited over 70% porosity, neutral pH, and increased apatite deposition and bioactivity with higher ZnO-NP. They also demonstrated decreased swelling and strong antibacterial activity against Escherichia coli and Staphylococcus aureus, making them a promising candidate for bone regeneration. 

    Conclusion

    Additionally, the researchers used an artificial neural network (ANN) to better understand the relationships between various scaffold properties, and the ANN-based predictions showed that changes in pore size and porosity affect the other properties, with acceptable error compared to experimental results.

    Keywords: Biodegradable Scaffolds, Fragility Fractures, Intervention Strategy, Osteoporosis, Personalized Assessment
  • Zahed Ahmadi *

    This article discusses regarding the impact of night shift work on osteoporosis using evidences from epidemiological evidences. Nowadays, night shift work is characterized as a common risk factors which contributes in decrease of bone mineral density (BMD) content as well as increase of bone fracture risk (1). Osteoporosis is defined by the National Institutes of Health (NIH) as "a skeletal disorder characterized by compromised bone strength, predisposing a person to an increased risk of fracture." BMD, a measure of bone strength, is assessed via dual-energy X-ray absorptiometry (DXA), with fractures most common in the hip, spine, and forearm. According to the International Osteoporosis Foundation, approximately 9 million low-energy fractures occur globally each year, affecting more than 200 million women, especially those over the age of 60 (1-2).In conclusion, the findings from current evidences support an association between night shift work and osteoporosis. Based on the available evidence shift work could impacted on mineral bone density through various mechanism such as normal homostasis, dysregulation of endocrin-hormones and immune system to alternating the bone mineral density content. However, the current body of research is limited, and further studies are needed to clarify the link between night shift work and osteoporosis, as well as the underlying biological mechanisms.

    Keywords: Shift Workers, Bone Mineral Density, Bone Fracture, Osteoporosis
  • ساجده سجودی، فرشید صابری، بهرام پاکزاد، منصور کریمی فر*
    مقدمه

    کاهش تراکم مواد معدنی در استخوان، باعث کاهش مقاومت مکانیکی استخوان ها می شود و این روند بتدریج، منجر به پیدایش پوکی استخوان می گردد. در خانم ها هنگام بارداری به علت برداشت کلسیم و سایر مواد معدنی از استخوان ها و پس از یائسگی، بدلیل کاهش ترشح استروژن، پوکی استخوان و شکستگی شایع تر از مردان دیده می شود. مطالعه ی حاضر به منظور، بررسی عوامل خطر پوکی استخوان، در خانم های یائسه صورت گرفت.

    روش ها

    از بین خانم های کمتر از 65 سالی که طی سال های 1397 و 1398 به منظور بررسی تراکم استخوان به بیمارستان الزهرا (س) اصفهان مراجعه کرده بودند، پرونده ی پزشکی 384 نفر مورد بررسی قرار گرفت. اطلاعات لازم با استفاده از چک لیست هایی که حاوی اطلاعات دموگرافیک بیماران شامل سن، قد، وزن، سن یائسگی، سن اولین قاعدگی، بیماری های زمینه ای (هایپرتیروئیدی، بیماری انسدادی مزمن ریه، نارسایی کلیه، دیابت نوع یک، هایپرپاراتیروئیدی اولیه، پرولاکتینما)، مصرف الکل، مصرف سیگار، مصرف کورتیکو استروئید، لووتیروکسین، داروهای ضد انعقاد خون و فعالیت بدنی بودند جمع آوری شد.

    یافته ها

    یافته های این پژوهش نشان می دهند که، T-Score سنجش تراکم استخوان بیماران، با مصرف کورتیکو استروئیدها (1/17 ± 4071/1-)، لووتیروکسین (1/49 ± 9441/1-)، سیگار (0/3876 ± 6421/1-) و بیماری های زمینه ای (1/2 ± 4511/1-) رابطه ی معنی داری در کاهش تراکم استخوان داشت (0/05 > P).

    نتیجه گیری

    از آن جا که کاهش تراکم استخوان می تواند منجر به موربیدیتی و مورتالیتی گردد، بخصوص در افراد با مصرف طولانی کورتیکو استروئید، لووتیروکسین، سیگار و نیز داشتن بیماری های زمینه ای، نداشتن فعالیت بدنی مناسب (50 درصد)، کهنسالی و بانوانی که باردارهای های مکرر را تجربه می نمایند، توجه ویژه ای در خصوص پایش تراکم استخوان و درمان به موقع آن نیاز دارند.

    کلید واژگان: پوکی استخوان, یائسگی, تراکم استخوان
    Sajede Sojudi, Farshid Saberi, Bahram Pakzad, Mansoor Karimifar *
    Background

    Decreased bone mineral density (BMD) reduces the mechanical resistance of bones, and this process gradually leads to osteoporosis. In women, osteoporosis and fractures are more common than men during pregnancy due to calcium and other minerals being removed from the bones and after menopause due to the decrease in estrogen secretion. The present study was conducted to investigate the risk factors of osteoporosis in postmenopausal women.

    Methods

    Among women under 65 who visited Al-Zahra Hospital in Isfahan during 2017 and 2018 to check for BMD, the medical records of 384 people were examined. Necessary information using checklists that contain demographic information of patients including, age, height, weight, age of menopause, age of first menstruation, underlying diseases (hyperthyroidism, chronic obstructive pulmonary disease, renal failure, type 1 diabetes mellitus, primary hyperparathyroidism, prolactinoma), alcohol consumption, smoking, corticosteroid, levothyroxine, anticoagulants drugs use and reduced physical activity were collected.

    Findings

    The findings of this research show that the T-Score of measuring the bone density of patients with the use of corticosteroids (-1.4071 ± 1.17), levothyroxine (-1.9441 ± 1.49), smoking (-1.6421 ± 0.3876) and underlying diseases (-1.4511 ± 1.2) had a significant relationship in reducing bone density (P < 0.05).

    Conclusion

    Since BMD reduction can lead to morbidity and mortality, especially in people with long-term use of corticosteroids, levothyroxine, smoking, as well as underlying diseases, lack of proper physical activity (50%), old age, and women who experience frequent pregnancies, need special attention, regarding BMD monitoring and timely treatment.

    Keywords: Osteoporosis, Menopause, Bone Density
  • Seyed Mohammad Mohammadi, Nadia Saniee, Sajedeh Mousaviasl, Esmat Radmanesh, Amirhossein Doustimotlagh
    Background

    Osteoporosis is the most common systemic skeletal disease worldwide. We aimed to review the latest studies related to osteocalcin and osteoporosis to clarify this relationship more precisely.

    Methods

    A systematic literature search was performed to review studies on the effects of osteocalcin on osteoporosis, on studied published between January 2013 and January 2023. We systematically reviewed Web of Science, PubMed, ProQuest, Scopus, and Google Scholar.

    Results

    The search yielded 4903 records, including 1063 from PubMed, 2307 from Scopus, 1084 from Web of Science, 408 from ProQuest, and 41 from Google Scholar, and twelve articles were included for data extraction and quality assessment. A significant increase in the serum level of osteocalcin was observed in postmenopausal women with osteoporosis (P<0.05), and there was a negative correlation between bone mineral density and the serum level of osteocalcin.

    Conclusion

    Osteocalcin could be a promising marker for the diagnosis and screening of patients with osteoporosis.

    Keywords: Bone Mineral Density, Postmenopausal Women, Osteocalcin, Osteoporosis
  • نازنین بی آزار، زهرا شریعتی*، شیما مصلی نژاد، مهدی افکار، بسیم نیکتا
    سابقه و هدف

    پوکی استخوان مشکل شناخته شده ای در بیماران مبتلا به اسپوندیلوآرتروپاتی است که ممکن است حتی در مراحل اولیه بیماری شروع شود و باعث عوارض ناتوان کننده شود. هدف از این مطالعه بررسی ارتباط شدت بیماری و دانسیته استخوانی پایین در بیماران مبتلا به اسپوندیلوآرتروپاتی محوری بود.

    روش بررسی

    در این مطالعه 65 بیمار مبتلا به اسپوندیلوآرتروپاتی محوری وارد مطالعه شدند و داده های مورد نظر از جمله سن، جنس، BMI، CRP ، 25(OH)D ، HLAB27، MRI از مفصل ساکروایلیاک و هیپ دوطرفه ، طول مدت بیماری، فعالیت بیماری و اخرین تست BMD از پرونده آنها استخراج شد و با نرم افزار آماری تحت تجزیه و تحلیل قرار گرفت. 

    یافته ها

    میانگین و انحراف معیار سن بیماران 9/5±5/37 سال، BMI 8/1 ±7/24 kg/m2، طول مدت بیماری 5/33±9/73 ماه، CRP 2/3 ±2/14و ASDAS-CRP 5/0 ±2/2 بود. 5/21% بیماران استئوپروز، 8/90 % HLAB27 مثبت، 5/78 % درگیری مفاصل ساکروایلیاک و 2/66% کمبود ویتامین D داشتند. جنسیت (75/0=p)، سن (11/0=p)، درگیری مفاصل ساکروایلیاک (13/0=p) و HLAB27 مثبت (75/0=p) در بیماران با و بدون استئوپروز تفاوت معنی داری نداشت. در حالی که کمبود ویتامین D (001/0>p)، BMI (001/0>p)، طول مدت بیماری (01/0=p)، CRP (001/0>p) و فعالیت بیماری (004/0=p) در بیمارانی که استئوپروز داشتند به طور معنی داری بیشتر بود.

    نتیجه گیری

    نتایج این مطالعه نشان داد که فعالیت بیماری، CRP، طول مدت بیماری، BMI و سطح ویتامین D با استئوپروز در این بیماران ارتباط دارد. بنابراین بیمارانی که این ریسک فاکتورها را داشته باشند باید در اولویت جهت بررسی تراکم استخوان قرار گیرند.

    کلید واژگان: اسپوندیلوارتروپاتی محوری, پوکی استخوان, ویتامین دی
    Nazanin Biazar, Zahra Shariati*, Shima Mosalanejad, Mehdi Afkar, Basim Nikta
    Background

    Osteoporosis is a well-known problem in patients with spondyloarthropathy that may begin even in the early stages of the disease and cause debilitating complications. The aim of this study was to investigate the relationship between disease severity and low bone density in patients with axial spondyloarthropathy.

    Materials and methods

    In this study, 65 patients with axial spondyloarthropathy were included in the study, and the data including age, gender, BMI, CRP, 25(OH) vit.D, HLAB27, MRI of the sacroiliac joint and bilateral hip, disease duration, disease activity and the last BMD test was extracted from their records and analyzed with statistical software.

    Results

    Mean (and standard deviation) age, BMI, the duration of the disease, CRP, and ASDAS- CRP were 37.5±5/9 years, 24.7±1.8 kg/m2, 73.9±33.5 months, 14.2±3.2, and 2.2±0.5, respectively. 21.5% of patients had osteoporosis, 90/8% were HLAB27 positive, 78.5% had sacroiliac joint involvement and 66.2% had vitamin D deficiency. Gender (p=0.75), age (p=0.11), involvement of sacroiliac joints (p=0.13) and positive HLAB27 (p=0.75) were not significantly different in patients with and without osteoporosis. While, vitamin D deficiency (p<0.001), BMI (p<0.001), disease duration (p=0.01), CRP (p<0.001), and disease activity (p=0.004) were significantly higher in patients with osteoporosis.

    Conclusion

    The results of this study showed that disease activity, CRP, disease duration, BMI and vitamin D level are related to osteoporosis in these patients. Therefore, patients who have these risk factors should be prioritized to check bone density.

    Keywords: Axial Spondyloarthropathy, Osteoporosis, Vitamin D
  • Mozhdeh Zabihiyeganeh, Aryan Rezaee, Amir Aminiana, Mohammadreza Bahaeddini, Mahmoodreza Sarikhani*, Alireza Mirzaei
    Background

    Osteoporosis is a skeletal disorder characterized by reduced bone strength leading to an increased risk for fracture. Patients with osteoporotic fractures are at an increased risk for refracture. Understanding the crucial importance of preventing recurring fractures to maintain physical activity and improve the quality of life (QoL) for individuals with osteoporosis underscores the necessity of precisely examining the factors that contribute to these fractures. 

    Objectives

    This study evaluates the prevalence and risk factors associated with recurrent osteoporotic fractures, emphasizing the critical importance of targeted interventions for fracture prevention and overall well-being.

    Methods

    This observational prospective cohort study focused on patients with osteoporosis-related fractures attending the Fracture Liaison Service (FLS) Clinic of Shafa Yahyaeian Orthopedic Hospital in Tehran City, Iran, from 2021 to 2023. The hospital is affiliated with Iran University of Medical Sciences. The census-based sampling method included all eligible patients with a history of osteoporotic fractures. Demographic and clinical information were collected.

    Results

    Out of 1532 osteoporotic patients with a fracture history, 282(18.4%) experienced refractures between 2021 and 2023. Regression analysis demonstrated that higher age (P=0.005; OR=1.033) and female gender (P=0.010; OR=0.437) were the only factors significantly associated with refracture (R2=0.040). Fracture Recency evaluation indicated an mean interval of 2.8±2.5 (range: 0.5-12) years between the last two fractures. Furthermore, recurrent fractures after the index fracture occurred in 41% of patients during the first year.

    Conclusion

    The prevalence of refracture was 18.4%, with higher age and female gender as independent predictive factors. Notably, fracture recency was mainly observed in the first year.

    Keywords: Prevalence, Risk Factors, Osteoporosis, Osteoporotic Fracture, Refracture
  • بهار موسس غفاری، سیامک درخشان*، برهان مراد ویسی، فریما ذکریایی، محمد عزیز رسولی
    زمینه و هدف

    بیماران مبتلا به تالاسمی نیاز به تزریق مکرر خون دارند و اختلالات استخوانی در این بیماران شایع هستند. هدف این پژوهش بررسی میزان تراکم استخوان در این بیماران بود.

    روش بررسی

    در این مطالعه مقطعی هفتادونه بیمار مبتلا به تالاسمی اینترمدیت یا ماژور که در سال 1400 برای سنجش تراکم استخوان به بیمارستان کوثر سنندج ارجاع داده شده بودند مورد بررسی قرار گرفتند. بیماران به دو گروه تقسیم شدند: گروه الف شامل 20 بیمار (9 مذکر و 11 مونث) که کمتر از 20 سال سن داشتند و گروه ب شامل 59 بیمار (32 مذکر و 27 مونث) که سن آن ها مساوی یا بیش از 20 سال بود. در هر دو گروه اندازه گیری تراکم استخوان بروش اندازه گیری جذب اشعه ایکس با انرژی دوتایی انجام شد. در گروه الف تراکم استخوان های کل بدن بدون سر و ناحیه مهره های کمری و در گروه ب تراکم استخوان های هیپ، گردن فمور و مهره های کمری اندازه گیری شدند.

    نتایج

    در 7/55% از بیماران، Z-score کمتر از میزان مورد انتظار برای سن بیمار بود. شیوع Z-score غیر طبیعی در دو گروه الف و ب تفاوت آماری معنی داری نداشت (0/942=P). ارتباط معنی داری بین جنسیت و نیز سابقه شکستگی با Z-score غیر طبیعی مشاهده نشد (P value به ترتیب 0/069 و 0/066). متوسط Z-score مهره های کمری در گروه الف (1/5 ± 1/7-) پایین تر از گروه ب (1/2 ± 1/6-) بود؛ ولی این تفاوت معنادار نبود(0/639=P). در گروه الف متوسط Z-score مهره های کمری از متوسط Z-score کل استخوان های بدن بدون سر (7/1 ± 7/0) کمتر بود. به همین ترتیب، در گروه ب متوسط Z-score مهره های کمری کمتر از متوسط Z-score هیپ (0/1 ± 0/9-) و گردن فمور (0/1 ± 0/5-) بود.

    نتیجه گیری

    کاهش تراکم استخوان در بیماران تالاسمی شایع بود. اندازه گیری تراکم استخوان در مهره های کمری احتمالا دقت بیشتری نسبت به تراکم استخوان های کل بدن بدون سر، تراکم استخوان هیپ و گردن فمور در بررسی توده استخوانی در بیماران مبتلا به تالاسمی داشت.

    کلید واژگان: تراکم معدنی استخوان, کاهش تراکم استخوان, پوکی استخوان, تالاسمی
    Bahar Moassesghafari, Siamak Derakhshan*, Borhan Moradvaisi, Farima Zakaryaei, Mohammad Aziz Rasouli
    Background and Aim

    Patients with beta-thalassemia need frequent blood transfusions and bone disorders are common in these patients. The objective of this study was to evaluate bone mineral density (BMD) in these patients.

    Material and Methods

    In this cross-sectional study, seventy-nine patients, with intermediate and major thalassemia who had referred for bone mineral densitometry to Kowsar Hospital in Sanandaj in 2021, were assessed. The patients were divided into two groups: group A including 20 patients (9 males, 11 females) who were less than 20 years of age, and group B including 59 patients (32 males and 27 females) that were equal to or older than 20 years old. In both groups, bone mineral density (BMD) was measured by dual energy X-ray absorptiometry (DXA) method. Total body less head (TBLH) and lumbar spine BMDs were measured in group A. In group B, total hip, femoral neck and lumbar spine BMDs were measured.

    Results

    In 55.7 % of the patients, the Z-score was below the expected range for the age. Prevalence of the abnormal Z-score in the two groups showed no statistically significant difference (P value=0.942). Gender and history of fracture showed no statistically significant relationship with abnormal Z-score (P values 0.069 and 0.066, respectively).  The mean lumbar spine Z-score in group A was lower (-1.7±1.5) than that in group B (-1.6±1.2) but the difference was not statistically significant (P value= 0.639). The mean lumbar spine Z-score was lower than the mean Z-score of TBLH (0.7±1.7) in group-A patients. Likewise, in group B patients, the mean lumbar spine Z-score was lower than the mean Z-scores of total hip (-0.9±1.0) and femoral neck (-0.5±1.0).

    Conclusions

    Low bone mineral density was common in the thalassemia patients. Measurement of lumbar spine BMD was more reliable than TBLH, total hip and femoral neck BMDs for evaluation of bone mass in these patients.

    Keywords: Bone Mineral Density, Low Bone Density, Osteoporosis, Thalassemia
  • Ramin Niknam, Keyvan Nowrouzi, Laleh Mahmoudi, Nasrin Motazedian, Fardad Ejtehadi, Shahrokh Sadeghi Boogar, Ali Zamani
    Background

    Celiac disease (CD) is an autoimmune disease characterized by inflammation in the intestine, causing atrophy of the mucosal villi of the small intestine. Celiac disease can manifest with various signs and symptoms, including extra-intestinal symptoms such as osteopenia and osteoporosis.

    Objectives

    Our study aimed to determine the frequency of osteopenia/osteoporosis in newly diagnosed CD cases and to evaluate the effect of different independent variables on the development of osteopenia/osteoporosis in these patients.

    Methods

    Adult patients with CD who were referred to a celiac clinic were evaluated for osteopenia/osteoporosis using dual-energy X-ray absorptiometry. This cross-sectional analytical study took place from October 2017 to July 2022. Logistic regression analysis was used to assess the odds ratio (OR) of different independent variables for osteopenia/osteoporosis.

    Results

    A total of 302 patients enrolled in this study, with 64.2% being female and 35.8% male. The mean ± SD age was 29.73 ± 12.39. Overall, 71.2% of patients had osteopenia or osteoporosis. The odds of developing osteopenia/osteoporosis were significantly higher in participants older than 30 years (OR: 2.19; 95% CI: 1.22 - 3.92; P = 0.008), underweight patients (OR: 2.38; 95% CI: 1.30 - 4.34; P = 0.005), and those with histologically severe atrophy (OR: 2.22; 95% CI: 1.14 - 4.32; P = 0.019). The mean ± SD serum levels of 25-hydroxy vitamin D in CD patients without and with osteopenia/osteoporosis were 34.0 ± 17.1 ng/mL and 25.8 ± 14.2 ng/mL, respectively. Participants with normal levels of 25-hydroxy vitamin D had a significantly lower OR of developing osteopenia/osteoporosis than patients with vitamin D deficiency (OR: 0.37; 95% CI: 0.21 - 0.62; P < 0.001). Other variables, including gender, anti-tTG levels, and GI manifestations, did not significantly increase the OR of developing osteopenia/osteoporosis.

    Conclusions

    The present study showed that increasing age, weight loss, severe villous atrophy, and low levels of vitamin D can significantly increase the OR of developing osteopenia/osteoporosis in CD patients. Until further studies are conducted, bone mineral density (BMD) evaluation is especially recommended in these high-risk subgroups of CD patients.

    Keywords: Celiac Disease, Osteoporosis, Osteopenia, Bone Density, Histology
  • Y. Li, H. Zhang, Y. Qian, Zh. Gao, Zh. Han, M. Zhan, Ch. Xu*
    Background

    To explore the radiomics features of osteoporotic and malignant neoplastic vertebral compression fractures (VCFs), and to analyze the application value of radiomics in differential diagnosis of osteoporotic and malignant neoplastic VCFs.

    Materials and Methods

    Fifty-one patients with VCFs caused by malignant tumors and forty-nine patients with osteoporosis-induced VCFs treated in the Xiaoshan Hospital Affiliated to Hangzhou Normal University from January 2020 to June 2023 were retrospectively collected into a training set (70 cases) and a verification set (30 cases) according to a stratified random sampling design and a 7:3 ratio. The radiomics parameters of T2WI images of the diseased vertebral bodies were extracted, and the parameters with statistical differences were screened out by dimensionality reduction, so as to build a prediction model. Receiver operating characteristic (ROC) curves were drawn to evaluate the differential diagnosis performance of radiomics for the etiology of vertebral fractures.

    Results

    Eight radiomics features were obtained after dimensionality reduction using the LASSO algorithm. The constructed model was effective in differentiating osteoporotic and malignant neoplastic VCFs, with an area under the ROC curve (AUC) of 0.95; while the AUC for the validation set was 0.84.

    Conclusions

    The radiomics features of T2WI images of vertebral fractures have high efficiency in the differential diagnosis of fracture etiology.

    Keywords: Agnetic Resonance Imaging, Osteoporosis, Compression Fractures, Neoplasms
  • Mohammad Bidkhori, Mahdi Akbarzadeh, Noushin Fahimfar, Reihane Seifi Moroudi, Sepideh Hajivalizadeh, Bagher Larijani, Iraj Nabipour, Afshin Ostovar, Kourosh Holakouie-Naieni
    Background

    Sclerostin, a protein encoded by the SOST gene, is an important genetic risk factor for osteoporosis in postmenopausal women. This study was conducted on the Iranian postmenopausal women, to investigate the association between this gene and the Trabecular Bone Score (TBS) as a novel index used for assessing osteoporosis.

    Methods

    The present study, conducted in 2024, was performed on 1071 women aged 60 years and older who participated in the Bushehr Elderly Health (BEH) program. The associations between seven independent Single Nucleotide Polymorphisms (SNPs) within the SOST gene and mean TBS of L1 to L4 were examined using the additive, dominant, and recessive models. Genetic risk scores (GRS) were calculated for each postmenopausal woman based on the coefficient regressions derived from the additive and dominant models. The relationship between the GRS quartiles and TBS was evaluated using a linear regression model.

    Results

    After adjusting for age and Body Mass Index (BMI), the associations between the rs2023794-C and TBS were significant in the additive (β = 0.03, P= 4.7×10-5, PFDR= 0.0003) and dominant (β = 0.032, P= 5×10-5, PFDR= 0.0003) models. The GRS derived from both additive and dominant models were related to TBS (P<0.05). For the additive model GRS, TBS showed an average increase of 0.022 score for the fourth quartile in comparison with the first quartile, adjusted for age, BMI, type 2 diabetes mellitus (T2DM), and smoking status (P=0.001).

    Conclusion

    SOST gene is associated with TBS and may have implications for personalized medicine. Targeting sclerostin through SOST could offer a therapeutic approach in managing osteoporosis in high-risk postmenopausal women.

    Keywords: Trabecular Bone Score, Sostgene, Sclerostin, Osteoporosis, Postmenopausal Women
  • Amir Sheikholeslami, Amir Behnam Kharazmi*, Tahereh Sabaghian, Mohammad Javad Nasiri
    Background

    Osteoporosis is a significant concern, especially for individuals undergoing renal transplantation, as it disrupts bone health and increases the risk of fractures. Interventions for osteoporosis aim to address bone-related challenges in patients with renal transplantation, yet concerns persist regarding both efficacy and potential adverse events.

    Materials and Methods

    We searched PubMed/MEDLINE, EMBASE, and the Cochrane CENTRAL databases until December 15, 2023, seeking studies that evaluated the efficacy and adverse events of osteoporosis medications in patients with renal transplantation. The Cochrane tool was utilized to assess the quality of the studies. The statistical analysis was performed using Comprehensive Meta-Analysis software, version 3.0.

    Results

    We enrolled 594 participants from 7 randomized controlled trials. Combining trial results reveals that using anti-osteoporotic agents (Ibandronate, Risedronate, and Pamidronate) reduces the risk of vertebral fractures compared to the placebo. However, the reduction was not statistically significant (OR: 0.49, CI 95%: 0.20-1.22). Additionally, lumbar spine, femoral neck, and total hip BMD showed no significant differences between anti-osteoporotic agents (Denosumab, Zoledronic acid, Ibandronate, Risedronate, and Pamidronate) and placebo. Moreover, there were no significant differences in adverse events between the interventions and placebo.

    Conclusion

    The study suggests that anti-osteoporotic agents in renal transplantation patients may be associated with a non-significant lower risk of vertebral fractures compared to a placebo. Findings also indicate no significant differences in adverse events between interventions and placebos. Caution is advised in interpreting these results due to the absence of statistically significant differences, emphasizing the need for further research to enhance our understanding of efficacy and safety in renal transplantation.

    Keywords: Osteoporosis, Renal Transplantation, Adverse Events, Efficacy
  • نرگس جهانتیغ اکبری، هدا نیکنام*، صدیقه سادات نعیمی، ناهید طحان، بیژن دانش شهرکی، علی جهانتیغ اکبری، یوسف نوشیراوانی، نگار اسعد سجادی

    هدف

    پوکی استخوان به عنوان یک بیماری اسکلتی سیستماتیک تعریف می شود. این بیماری درنتیجه کاهش توده استخوانی و کاهش قدرت عضلانی ایجاد می شود. شکستگی به دنبال آن با درد و کاهش کیفیت زندگی همراه است. بنابراین هدف این مطالعه، بررسی تاثیر تمرین درمانی بر قدرت عضلانی، تراکم استخوان و کیفیت زندگی زنان یائسه مبتلا به پوکی استخوان بود. 

    روش بررسی

    جست وجو از منابع موجود با استفاده از پایگاه های اطلاعاتی پابمد، کاکرین، ساینس دایرکت و گوگل اسکالر انجام شد. مطالعات درصورتی که شامل 1) کارآزمایی های تصادفی کنترل شده باشند؛ 2) بر روی زنان یائسه مبتلا به پوکی استخوان انجام شده باشند؛ 3) تمرین درمانی به عنوان مداخله باشد و 4) قدرت عضلانی، تراکم مواد معدنی استخوان و کیفیت زندگی به عنوان متغیر در نظر گرفته شده باشند، وارد مطالعه شدند. مقالات به طور مستقل از نظر کیفیت توسط دو نویسنده با استفاده از مقیاس پایگاه شواهد فیزیوتراپی (PEDro) بررسی شدند. اندازه اثر کوهن با تقسیم میانگین تفاوت های استانداردشده بر انحراف معیار برای تعیین اثر درمان ازجمله تمرین درمانی محاسبه شد.

    یافته ها

    هفت مقاله برای ورود به مطالعه انتخاب شدند. نمرات PEDro از 6 تا 9 (از 10) متغیر بود. تفاوت میانگین اندازه اثر درنتیجه مداخله تمرین درمانی بین 0/32 تا 0/63 بود که نشان دهنده اثرات کوچک تا متوسط در بهبود زنان یائسه مبتلا به پوکی استخوان است. پنج مطالعه اندازه اثر کم و 2 مطالعه اندازه اثر متوسط را گزارش کردند. نتایج مطالعه حاکی از اثر تمرینات تعادلی، قدرتی، کششی، ثباتی و کنترل حرکتی بر متغیرهای قدرت عضلانی و تراکم استخوان در زنان یائسه مبتلا به پوکی استخوان بود.

    نتیجه گیری

    نتایج حاکی از آن است که مداخلات با استفاده از تمرین درمانی تاثیر مفیدی بر قدرت عضلانی، تراکم استخوان و کیفیت زندگی زنان یائسه مبتلا به پوکی استخوان دارند. برای اعتبار بخشیدن به این فرضیه، مطالعات با کیفیت بیشتری موردنیاز است.

    کلید واژگان: تمرین درمانی, قدرت عضلانی, تراکم ماده معدنی استخوان, پوکی استخوان
    Narges Jahantigh Akbari, Hoda Niknam*, Sedigheh Sadat Naimi, Nahid Tahan, Bijan Danesh Shahreki, Ali Jahantigh Akbari, Yousef Nooshiravani, Negar Asad-Sajjadi
    Objective

    Osteoporosis is a widespread skeletal condition due to decreased muscle strength and bone density. The most common complications are fractures followed by pain and reduced quality of life (QoL). Therefore, this research aimed to examine the effect of exercise therapy on muscle strength, QoL, and bone mass in osteoporotic women.

    Materials & Methods

    Available literature was reviewed using ScienceDirect, PubMed, Google Scholar, and Cochrane. Studies were considered eligible if they were randomized controlled trials (RCT) conducted on postmenopausal osteoporotic women, used exercise therapy as an intervention, and investigated muscle strength, QoL, and bone mass as outcomes. Two authors independently assessed the quality of the articles using the physiotherapy evidence database (PEDro) scale. The Cohen’s d effect size was computed by dividing the mean standardized difference by the standard deviation to measure the treatment effect, which includes exercise therapy.

    Results

    Seven papers were chosen to be included in this research. Their PEDro scores varied between 6 and 9 out of a possible 10. The effect size mean differences, resulting from exercise therapy, ranged from 0.32 to 0.63, indicating “small” to “moderate” effects in enhancing the condition of osteoporotic postmenopausal women. It was reported that there was a small effect size in 5 studies and a medium effect size in 2 studies. The research findings suggested the effect of balance, strengthening, stretching, stability, and motor control exercises on bone mass and muscle strength in osteoporotic postmenopausal women.

    Conclusion

    Findings indicate that exercise therapy interventions positively affect muscular strength, QoL, and bone mass in osteoporotic postmenopausal women. Additional well-conducted research is required to support this assumption further.

    Keywords: Exercise Therapy, Muscle Strength, Bone Mass, Osteoporosis
  • Zahra Abasian, Mahnoosh Fatemi *, Fereshte Ghandehari
    Background

    Osteoporosis is a chronic metabolic disease that leads to decreased bone mass due to an imbalance in bone resorption/formation. The aim of this research was to evaluate the effect of Lactobacillus rhamnosus and propranolol on disorders caused by this disease.

    Methods

    Forty female rats (250±15 g) were divided into control and ovariectomy groups, as well as ovariectomy treated with probiotics, propranolol, and probiotics with propranolol groups. Blood parameters, concentration of parathyroid hormone, alkaline phosphatase (ALP) activity, and bone calcium (Ca) and phosphorus (P) levels were measured after the treatment period. The histopathological changes in bone were compared among the experimental groups.

    Results

    No significant changes were observed in the blood parameters among the groups. Despite the significant increase in the parathyroid hormone and ALP levels in ovariectomized rats, in the treatment groups (especially treatment with both probiotics and propranolol), the level of these two factors decreased significantly. Ca and P concentrations also showed a significant increase in the treatment group with probiotics and propranolol compared to the ovariectomy group. Histopathological studies demonstrated an increase in the thickness of trabeculae, the number of bone cells, and the repair of the diaphysis in rats treated with probiotics and propranolol.

    Conclusion

    It seems that L. rhamnosus and propranolol, by inhibiting the stimulation of the sympathetic system and increasing the reabsorption of minerals from the intestine, led to the inhibition of osteoclastogenesis and the increase of the bone mineral content, followed by the improvement of disorders caused by osteoporosis.

    Keywords: Lactobacillus Rhamnosus, Propranolol, Osteoporosis, Rats
  • خدیجه کلان فرمانفرما، اسماعیل فخاریان، مجتبی صحت، فائزه عسگری ترازوج، سودابه یارمحمدی*
    زمینه و هدف

    پوکی استخوان شایع ترین بیماری در سالمندان است که منجر به شکستگی استخوان و دردهای شدید می شود. این مطالعه با هدف تعیین روند شکستگی های مشکوک به پوکی استخوان در سالمندان انجام گرفته است.

    روش بررسی

    این مطالعه توصیفی- مقطعی در مورد 448 سالمند بالای 60 سال مبتلا به تروماهای لگن، هیپ، دیستال دست و ستون فقرات، در بازه زمانی 1396 تا 1400 در سال 1403 در شهرستان کاشان انجام گرفته است. متغیرهای بررسی شده شامل اطلاعات جمعیت شناختی، شدت آسیب و فراوانی شکستگی ها بود که از سامانه ثبت ملی ترومای ایران استخراج و با یکدیگر مقایسه شدند. داده ها با استفاده از آنالیز واریانس و کای دو در سطح معناداری 05/0 تجزیه و تحلیل شد.

    یافته ها

    از 448 سالمند مورد مطالعه، 244 نفر زن (5/54%) بودند و میانگین سنی سالمندان مبتلا به استئوپروز بیش از 75 سال بود. بیش ترین نوع شکستگی شامل شکستگی هیپ و لگن 331 نفر (9/73%)، شکستگی دیستال دست 71 نفر (8/15%) و شکستگی ستون فقرات 65 نفر (5/14%) بود. همچنین، میانگین نمره شدت آسیب از 80/2±43/8 به 77/2±96/8 طی سال 1396 تا 1400 افزایش یافت. در این بازه زمانی، تغییرات قابل توجهی در روند سنی سالمندان گزارش نشد، اما جمعیت مردان حدود 6% افزایش یافت.

    نتیجه گیری

    یافته های این مطالعه نشان دهنده افزایش فراوانی شکستگی لگن در سالمندان کاشان است که برای کاهش شکستگی ها، لازم است سالمندان به طور فعال از نظر عوامل خطر پوکی استخوان غربالگری شوند.

    کلید واژگان: شکستگی ستون فقرات, پوکی استخوان, سالمندان, شکستگی لگن, شکستگی فمور
    Khadijeh Kalanfarmanfarma, Esmaeil Fakharian, Mojtaba Sehat, Faezeh Asgari Tarazoj, Soudabeh Yarmohammadi*
    Background & Aim

    Osteoporosis is a common condition in the elderly, contributing to fracture incidence and associated pain. This study aims to analyze trends in osteoporosis-related fractures within the elderly population from 2017 to 2021.

    Methods & Materials: 

    A descriptive cross-sectional study was conducted in 2024 involving 448 elderly people over 60 who experienced pelvic, hip, distal hand, or spinal injuries during 2017-2021 in Kashan. Data were extracted from the National Trauma Registry of Iran, including demographic information, injury severity, and frequency of fractures. The data were analyzed using analysis of variance and chi-square tests, with a significance level set at P<0.05.

    Results

    Among the 448 participants, 244 were female (54.5%), with an average age exceeding 75 years among those diagnosed with osteoporosis. The most common fracture types included hip and pelvic fractures, affecting 331 individuals (73.9%), followed by distal hand fractures in 71 individuals (15.8%), and spinal fractures in 65 individuals (14.5%). The average injury severity score increased from 8.43±2.80 in 2017 to 8.96±2.77 in 2021. No significant changes were observed in the age distribution of the elderly population during this period; however, the proportion of males increased by approximately 6%.

    Conclusion

    The study results indicate a rising trend in hip fractures among the elderly in Kashan. To reduce fracture incidence, it is recommended to implement proactive screening for osteoporosis risk factors in this population.

    Keywords: Spinal Fracture, Osteoporosis, Elderly, Hip Fracture, Femoral Fracture
  • Yerda Özkan Karasu, Ozkan Miloglu*, Zerrin Orbak, Recep Orbak, Gulsum Akkaya, Abubekir Laloğlu, Nebiha Hilal Bilge
    Background

    Diabetes mellitus (DM) disrupts bone metabolism, leading to slowed bone development, poor bone quality, and osteoporosis.

    Objectives

    The aim of this study was to examine changes in the bones of adolescents with type-1 diabetes mellitus (T1DM) using fractal dimension (FD) analysis method and panoramic radiomorphometric indices.

    Methods

    Fractal dimension values and radiomorphometric measurements of 36 children with T1DM and 36 healthy individuals were compared using panoramic radiographs. The panoramic mandibular index (PMI), mental index (MI), mandibular cortical width (MCW), amount of alveolar bone resorption (AABR), antegonial index (AI), and gonial index (GI) were measured. Mandibular cortical index (MCI) was recorded as C1, C2, and C3 classes.

    Results

    For the angulus and corpus regions, the T1DM patient group had lower FD values, and there was a statistically significant difference between the T1DM patient group and the control group (P = 0.003, P = 0.029). Mental index, MCW, and AI values were higher in the control group than in the T1DM patient group and were statistically significant (P = 0.014, P = 0.001, P < 0.001, respectively).

    Conclusions

    In this study examining the mandible in pediatric patients with T1DM using radiomorphometric measurements and fractal analysis method, it can be concluded that T1DM affects bone morphology and trabecular structure

    Keywords: Fractal Dimension, Type-1 Diabetes Mellitus, Osteoporosis
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