1. INTRODUCTION:

Osteoporosis is a disease that is characterized by low bone mass, deterioration of bone tissue, and disruption of bone microarchitecture: it can lead to compromised bone strength and an increase in the risk of fractures [1]. It is more common in Caucasians, women, and older people. Osteoporosis affects an enormous number of people, of both sexes and all races, and its prevalence will increase as the population ages.

It is a silent disease until fractures occur, which causes important secondary health problems and even death [2]. Menopause and advancing age cause an imbalance between resorption and formation rates (resorption becomes higher than absorption), thereby increasing the risk of fracture [3]. This include general factors that relate to aging and sex steroid deficiency, as well as specific risk factors such as use of glucocorticoids (which cause decreased bone formation and bone loss), reduced bone quality, and disruption of microarchitectural integrity. Fractures result when weakened bone is overloaded, often by falls or certain daily chores [4]. With advancing age, the bone mineral density (or BMD) decreases and prevalence of osteoporosis increases. In the United States, Europe and Japan, osteoporosis affects about 75 million people [5]. Using the WHO criteria, 30% of postmenopausal Caucasian women have osteoporosis at the hip, lumbar spine or distal forearm. This is comparable with the risk of fracture for a 50 year old woman at one of these three sites [6]. The prevalence of osteoporosis is high among Middle East and North Africa population and is associated with a wide range of risk factors and medical conditions. The overall prevalence of OP in Algeria was 35.8% [7]. Treatment should be offered to postmenopausal women with vertebral fractures, those with non-vertebral fractures associated with low BMD, and those with osteoporosis. Calcium andvitamin D are an important nutrient in the prevention and treatment of osteoporosis. Hormone replacement therapy (HRT) stops bone loss in early, late, and elderly postmenopausal women by inhibition of bone resorption [8]. The objective of our study is to identify the risk and the protective factorsof osteoporosis in postmenopausal womenof Guemar (Algeria) region.

2. MATERIALS AND METHODS:

2.1. Subjects of Study:

Ethical approval was obtained from the ethics committee (14 EC/DCMB/FNSL/EU2019) of the department of cellular and molecular biology, Faculty of Natural Sciences and Life, University of El Oued. The study was based on 241 voluntary individuals divided into healthy women reserved as control with average age of 49.23± 3.73 years old and osteoporosis disease womenpatients with average age of 49.97±3.21 years old. All of the volunteers (control and patients) in this study live in the Guemar (El Oued) area located in the south east of Algeria. Therefore, their social and demographic information including age, sex, BMI, social case, job and blood group were collected by completing the questionnaires from their medical records or through a direct discussion with patients.

2.2. Inclusion and Exclusion Criteria:

Osteoporosis disease (OP) patients were selected based on clinical diagnosis by specialist doctors who confirmed OP suffering at least three months. In addition, patients have no any other type of chronic disease treatment for 30 days were included. Control were healthy people not suffering from chronic or acute diseases and consume no drug for 30 days. All other types of Diseases were excluded.

2.3. Statistical Analysis:

Values were expressed as percent per population or as the mean±Standard Deviation (SD). Data were presented using frequency tables. Chi-square test was used to test for association between risk factors and osteoporosis. Relative risks and Odds ratios were calculated by Cochran's and Mantel Haenszel statistics using SPSS 16. Odds ratios >1 and P<0.05 indicate a significant risk factor. OR<1 and P<0.05 indicate a significant protective factor.

3. RESULTS:

3.1. Description of the Study Population

The general data of socioeconomic characteristics of the two groups of subjects include age, IMC, number of children, social case, job, educational level, and blood group. These indicators do not have any statistically significant differences (as shown in Table 1), at P > 0.05.

Table 1. Socioeconomic description of control and osteoporosis patients.

		Control	Patients
Age (years)		49.23±3.733	49.972±3.218
Body Mass Index (BMI)		25.52±4.21	27.46±4.24
Number of children		5.33±2.000	6.064±6.393
Social case	Married%	81	96
	Single%	7	2
	Divorced%	10	1
	Widow%	2	1
Job	Worker%	25	10
Job	Housewife %	75	90
Blood group	A%	43.33	20
	B%	10	10
	AB%	6.67	13
	O%	40	57

3.2. Study of Socioeconomic and Clinic Factors:

Odds Ratio (OR) values for socioeconomic factors (Table 2) and clinic-pathological factors (Table 3) show that thyroid problems, hormonal alternatives, menstrual perturbations and vitamin D deficiency before menopause are shown to be significant risk factors for osteoporosis (OR = 6.682; p = 0.005, OR = 5.688; p = 0.000, OR = 5.516; p = 0.000 and OR = 5.394; p = 0.000), respectively. Menopause before 42 years old (OR = 4.846; p = 0.029), stress (OR = 3.841; p = 0.000) and calcium deficiency before menopause (OR = 3.305; p = 0.001) are also highly significant predictors of osteoporosis. In addition, obesity, hormonal perturbations before menopause, anemia, tap water, taking contraceptive pills, digestive problems and milk mixed with coffee are all predictive factors (OR ranging from 1.803 to 2.538, p <0.05). Also, bone problems before menopause and family history are considered to be very important risk factors in the study population, with the highest OR value (OR = 65.646; p = 0.000 and OR= 41.152; p=0.000). In contrast, milk, fish diet, legumes, fresh vegetables and fruits, sunshine exposure, long distance walks and menopause after 50 years old are protective factors for osteoporosis in the study population (OR ranging from 0,029 to 0.463, p <0.038). In addition, our results indicate that filtered water, pure milk, pure coffee, soft drinks, excessive thinness, standing up too long, ovarian cysts, kidney problems, liver problems, diabetes, hypertension, puberty before 12 years old, age of marriage after 30 years old, first birth after 30 years old, childbearing less than 2 years old, breastfeeding less than 1 year old, normal birth, caesarean birth, self-medication, medications for menstrual pain and herbal remedies are not considered as predictors of osteoporosis in our population since the OR values obtained are not significant.

Table 2. Comparison of the Socioeconomic features of osteoporosis patients and control group (N=241)

	Control %	Patient %	OR	CI95%	P
Tap water			2.220	0.945-5.214	0.048
Positive	3.73	10.37
Negative	37.75	48.15
Filtered water			0.800	0.316-2.024	0.407
Positive	37.75	51.87
Negative	3.73	6.65
Milk			0,029	0.013-0.065	0,000
Positive	33.60	6.24
Negative	7.88	52.28
Milk mixed with coffee			1.803	0.969-3.355	0.043
Positive	26.97	44.81
Negative	14.52	13.70
Fish diet			0.091	0.011-0.724	0.005
Positive	4.14	0.82
Negative	37.34	57.70
Legumes			0.124	0.035-0.431	0.000
Positive	40.24	46.88
Negative	1.24	11.64
Fresh vegetables and fruits			0.227	0.062-0.830	0.014
Positive	40.24	51.45
Negative	1.24	7.07
Sunshine exposure			0.463	0.263-0.815	0.005
Positive	24.06	22.82
Negative	17.42	35.70
Soft drinks			1.079	0.502-2.322	0.500
Positive	6.22	9.56
Negative	35.26	48.96
Obesity			2.538	1.133-5.687	0.016
Positive	4.14	12.86
Negative	37.34	45.66
Long distance walks			0.077	0.037-0.159	0.000
Positive	26.55	7.05
Negative	14.93	51.47

Table 3. Comparison of the Clinico-pathological features of osteoporosis patients and control group (N=241)

	Control %	Patient %	OR	CI95%	P
Calcium deficiency before menopause			3.305	1.544-7.073	0.001
Positive	4.56	17.03
Negative	36.92	41.49
Vitamine D deficiency before menopause			5.394	2.565-11.342	0.000
Positive	4.56	23.26
Negative	36.92	35.26
Menstrual perturbations			5.516	2.559-11.890	0.000
Positive	25.72	52.69
Negative	15.76	5.83
Ovariancysts			1.949	0.901-4.217	0.063
Positive	4.97	12.44
Negative	36.51	46.08
Thyroidproblems			6.682	1.455-30.685	0.005
Positive	0.82	7.05
Negative	40.66	51.47
Digestive problems			2.005	1.138-3.533	0.011
Positive	19.50	37.34
Negative	21.99	21.17
Anemia			2.444	1.150-5.196	0.014
Positive	4.97	14.54
Negative	36.51	43.98
Stress			3.841	2.077-7.102	0.000
Positive	19.91	45.64
Negative	21.57	12.88
Boneproblemsbeforemenopause			65.646	19.338-222.852	0.000
Positive	1.24	39.02
Negative	40.24	19.50
FamilyHistory			41.152	12.211-138.679	0.000
Positive	1.24	32.78
Negative	40.24	25.74
Hormonal perturbations beforemenopause			2.448	1.366-4.387	0.002
Positive	12.03	29.05
Negative	29.46	29.46
Hormonal alternatives			5.688	2.930-11.039	0.000
Positive	6.63	30.70
Negative	34.85	27.82
Pubertybefore 12 years old			0.960	0.922-0.999	0.061
Positive	0	2.07
Negative	41.49	56.44
Menopausebefore 42 years old			4.846	1.020-23.028	0.029
Positive	0.82	5.39
Negative	40.66	53.13
Age of marriage after 30 years old			0.563	0.251-1.263	0.114
Positive	7.46	6.24
Negative	34.02	52.28
First birth after 30 years old			0.638	0.314-1.296	0.142
Positive	9.54	9.54
Negative	31.95	48.97
Contraceptive pills			2.071	1.179-3.640	0.008
Positive	17.42	34.85
Negative	24.06	23.67
Self-medication			3.128	0.616-15.886	0.140
Positive	0.82	3.75
Negative	40.66	54.77
Medications for menstrual pain			1.222	0.701-2.128	0.286
Positive	19.91	31.14
Negative	21.57	27.38

4. DISCUSSION:

In our study, we examined the association between some risk factors linked with menopause which may cause osteoporosis. We found that family history is significantly associated with the risk of having osteoporosis in menopausal women of our region; the genetic predisposition to osteoporosis is the end result of multiple gene polymorphisms and gene-by-environment interactions, each contributing a small amount to BMD (bone mineral density) variance [9]. Besides, the results of our study shows that bone problems before menopause were significantly associated with osteoporosis risk; the unfavorable effects of low premenopausal bone mass and accelerated loss of bone after menopause are additive, and these individuals are the highest risk for fracture [10]. Bone mineral density measurements have shown that bone loss begins to increase in normal women before the menopause. Indeed, Riggs et al., in a well-designed longitudinal study, reported that more than 50% of all vertebral bone loss occurred before the menopause [11]. Also, our study shows that vitamin D deficiency and calcium deficiency are associated with osteoporosis risk; vitamin D plays an important role in the maintenance of calcium and phosphorus metabolism and thus in bone health so vitamin D deficiency have long-term detrimental effects such as increased risk of low bone mass and osteoporosis [12]. In addition thyroid problems are associated with osteoporosis risk; the thyroid hormone is essential for many physiological processes [13] and for normal bone maturation and it increases calcium release from fetal rat long bone cultures, and increases osteoclast number and activity [14]. In vivo, thyroid hormone also stimulates osteoblast activity [15]. T3 receptor has been demonstrated in osteoblasts, but not osteoclasts, suggesting that increased osteoclast activity in bone cultures with T3 treatment is secondary to osteoblast activation. Impaired functioning of the thyroid gland has long been known to accelerate bone turnover and thus increase the risk for developing osteoporosis, especially in peri-and postmenopausal women [16]. In our study it was observed that obesity can possibly affects bone metabolism through several mechanisms. Because both adipocytes and osteoblasts are derived from a common multipotentialmesenchymal stem cell, obesity may increase adipocyte differentiation and fat accumulation while decrease osteoblast differentiation and bone formation [17]. The results of our study revealed that stress is related to osteoporosis; Psychosocial factors such as personality traits and depression may alter immune and endocrine function, [18]. a new study demonstrates how anxiety levels are linked to an increased risk of bone fractures in postmenopausal women [19]. Additionally, in our study it was observed that taking contraceptive pills is associated with osteoporosis risk; the use of oral contraceptive within the perimenopausal years prevents the activation of bone metabolism and the decrease in bone mass. Recent data suggest that the oral contraception may impede the development of peak bone mass, particularly when started within the teen years. Initiation of oral contraceptive within the first 3 years after menarche would be a strong determinant of bone mass acquisition impairment [20]. Our study shows that early post menopause is associated with osteoporosis risk; earlypost-menopausal women are more prone to osteoporosis due to reduction in estrogen which may further lead to elevation of oxidative stress and lipid accumulation which will promote osteoblasts apoptosis [21]. In our study, hormonal perturbation before menopause is associated with osteoporosis risk;sex hormone deficiency is a major factor contributing to postmenopausal osteoporosis. Estrogen deficiency increases the rate of bone remodeling and leads to an imbalance between bone desorption and formation, resulting in a net bone loss and possibly osteoporosis [22]. Cytokines such as interleukin-1 (IL-1), tumor necrosis factor-a (TNF-α), interleukin-6, interleukin-11, and macrophage colony-stimulating factor may be involved in bone desorption by facilitating the recruited and maturation of osteoclast precursors [23]. Our study shows that anemia is related with osteoporosis risk; it is associated with bone mass density scores by chronic hypoxia is likely to interfere with bone metabolism. Increased oxidative stress and extracellular acidification under hypoxic conditions are estimated to influence bone formation and remodeling [24]. Our results showed that healthy diet is a protective factor of osteoporosis; many studies that have used factor or principal component analysis have empirically derived a “healthy” or “prudent” food pattern that is high in fruits, vegetables, fish, low-fat foods, fiber, legumes, etc. positively correlated with BMD [25], and decreased the risk for osteoporosis increase potassium, calcium and vitamin D high intake [26]. Antioxidants may play an important role in the prevention of oxidative stress [27] related osteoclasto-genesis and bone desorption. As well as, our result indicated that sunshine exposure is a protective factor of osteoporosis, adequate exposure to the sun is vital as it is the main source of vitamin D for the body coming not from the food consumed [28]. Also, our study revealed that long distance walks is a protective factor of osteoporosis; walking in combination with others forms of exercise (jogging, stair-climbing, stepping), can provide some protection against bone loss, by the benefits of walking on aerobic fitness on body composition and cardio-metabolic health [29].

5. CONCLUSION:

In this study it was found that bone problems before menopause, family history, tap waterand obesity are shown to be majors risk factors for Osteoporosis, which indicates the importance of social behavior and the clinical factor of osteoporosis disease involvement. In contrast, milk, fish diet, legumes, fresh vegetables and fruits, sunshine exposure and walking sportare protective factors for Osteoporosis in the study population.

6. ACKNOWLEDGEMENTS:

We thank the members of Lab of Faculty of Sciences of Nature and Life, University of El Oued, Algeria, for the permission to utilize the institute facilities to make this work.

7. CONFLICT OF INTEREST:

The authors declarethat they have no conflicts of interest.

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Received on 30.01.2020 Modified on 23.02.2020

Asian J. Res. Pharm. Sci. 2020; 10(2):79-84.

DOI: 10.5958/2231-5659.2020.00015.6