Prevalence of Osteoporosis and Osteopenia in People Over 60 Years in Iran: A Systematic Review and Meta‑analysis

Hassan Nourmohammadi, Zahra Abdan, Seyed Mohammad Amin Hashemipour, Diana Sarokhani, Mohsen Abdan, Moloud Fakhri, Ali Hasanpour Dehkordi


Background: Osteoporosis in the elderly has dangerous complications, the most important of which are bone fractures and reduced quality of life in the elderly. The present study was aimed at estimating the prevalence of osteoporosis in Iranian elderly using systematic review and meta‑analysis.

Methods: This search was conducted using authentic Persian and English keywords in national and international databases including Scientific Information Database, Magiran, IranDoc, PubMed, Scopus, Cochrane, Embase, and Web of Sciencewith no time limit until 20.06.2020. Heterogeneity of studies was assessed using I2 index. Data were analyzed using STATA Ver. 15 software.

Results: In 30 studies with a sample size of 13,347 people, the prevalence of osteoporosis and low bone density in people over 60 years in Iran were 34% (95% CI: 27%, 42%) and 47% (95% CI: 41%, 53%), respectively. We also found that 34% of women and 41% of men over the age of 60 suffer from osteoporosis. Prevalence of osteoporosis was in lumbar bone 23% (95% CI: 20%, 26%), spine 25% (95% CI: 19%, 31%), hip 35% (95% CI: 7%, 62%), and femur 23% (95% CI: 15%, 31%). Prevalence of low bone density was in lumbar bone 41% (95% CI: 19%, 63%), spine 30% (95% CI: 15%, 46%), and femur 35% (95% CI: 21%, 48%).

Conclusion: The prevalence of low bone density in people over 60 years is higher than the prevalence of osteoporosis in them. About one‑third of Iranian elderly people suffer from osteoporosis, but about half of them have low bone density.


Age‑related bone loss; elderly; Iran; low bone density; metabolic bone disease; osteopenia; osteoporoses; osteoporosis

Full Text:



Aspray T. Health needs of elderly people. BMJ 1994;309:412.

Diana D, Parvareh M, Dehkordi A, Sayehmiri K, Moghimbeigi A.

Prevalence of depression among Iranian elderly: Systematic

review and meta‑analysis. Iran J Psychiatry 2018;13:55‑64.

Heydarnejad S, Hassanpour‑Dehkordi A. The effect of an

exercise program on the health‑quality of life in older adults.

Dan Med Bull 2010;57:113‑7.

Tajvar M. Aged Care and Reviewing Various Aspects of Their

Lives. Tehran: Nasl Farda Publications; 2004. p. 2.

WHO. World Health Organization launches new initiative to

address the health needs of a rapidly ageing population. Cent Eur

J Public Health 2004;12:210‑6.

Deborah J, Cook D, Guyatt G, Adachi J, Clifton J, Griffith L,

et al. Quality of life issues in women with vertebral fractures due

to osteoporosis. Arthritis Rheum 1993;36:750‑6.

Nikpour S, Habibi A, Seiedoshohadai M, Haghani H. Relation

between Quality of life and socio‑demographic characteristics

among older people in Tehran, Iran. Middle East J Age Aging


Hassanpour‑Dehkordi A, Jalali A. Effect of progressive muscle

relaxation on the fatigue and quality of life among Iranian aging

persons. Acta Med Iran 2016;54:430‑6.

Momenzadeh M, Khosravian M, VKS Lakkakula B. Potential of

renin‑angiotensin system inhibition to improve metabolic bone

disorders. J Nephropharmacol 2021;10:e16.

Habibi A, Nikpour S, Seiedoshohadaei M, Haghani H. Quality of

life and status of physical functioning among elderly people in west

region of Tehran: A cross‑sectional survey. Iran J Nurs 2008;21:29‑39.

Lindsay R. and Cosman F. Harrison’s Principles of Internal

Medicine: Osteoporosis. 18th ed. The McGraw Hill; 2012:3131-6.

Bagheri P, Haghdoost A, Eshagh D, Halimi L, Vafaei Z,

Farhang Nya M, et al. Ultra analysis of prevalence of

osteoporosis in Iranian women “A systematic review and

Meta‑analysis”. Iran J Endocrinol Metab 2011;13:315‑25.

Consensus A. Consensus development conference: Diagnosis,

prophylaxis, and treatment of osteoporosis. Am J Med


Larijani B, Soltani A, Pajouhi M, Bastan hagh MH, Mirfeizi SZ,

Dashti R, et al. Bone mineral density variation in 20‑69 y/o

population of Tehran/Iran. Iran South Med J 2002;5:41‑9.

Morris R, Masud T. Measuring quality of life in osteoporosis.

Age Ageing 2001;30:371‑3.

Canbaz S, Sunter A, Dabak S, Peksen Y. The prevalence of

chronic diseases and quality of life in elderly people in Samsun.

Turk J Med Sci 2003;33:335‑40.

Sturtridge W, Lentle B, Hanley D. Prevention and management of

osteoporosis: Consensus statements from the Scientific Advisory

Board of the Osteoporosis Society of Canada. 2. The use of

bone density measurement in the diagnosis and management of

osteoporosis. CMAJ 1996;155:924‑9.

Zamani B, Ebadi S, Ahmadvand A, Moosavai G. The frequency

of osteoporosis in hip fracture following minor trauma and

the resulting mortality rate and direct treatment costs in

patients over 45 years old in Kashan Naghavi hospital during 2005‑2007. Journal of Kerman University of Medical Sciences


Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A,

Petticrew M, et al. Preferred reporting items for systematic

review and meta‑analysis protocols (PRISMA‑P) 2015 statement.

Syst Rev 2015;4:1.

Delaney M, leboff M. Metabolic bone disease. In: Ruddy S,

Haris E Jr, Sledge CB, editors. Kelleys Text Book of

Rheumatology. 5th ed. United states of America: WB Saunders

Company; 2001. p. 1635‑45.

Von Elm E, Altman D, Egger M, Pocock S, Gotzsche P,

Vandenbroucke J. The Strengthening the Reporting of Observational

Studies in Epidemiology (STROBE) statement: Guidelines for

reporting observational studies. Ann Intern Med 2007;147:573‑7.

Glaser D, Kaplan F. Osteoporosis. Definition and clinical

presentation. Spine (Phila Pa 1976) 1997;22:12‑6.

Karaguzel G, Holick M. Diagnosis and treatment of osteopenia.

Rev Endocr Metab Disord 2010;11:237‑51.

Organisation WH. Definition of an older or elderly person.

WHO, Geneva, Switzerland, 2010.

Cheraghi P, Cheraghi Z, Bozorgmehr S. The Prevalence and risk

factors of osteoporosis among the elderly in Hamadan province:

A cross sectional study. Med J Islam Repub Iran 2018;32:111.

Javad‑Mousavi A, Zavvareii F, Shirani F. Study of osteoporosis

prevalence in men with chronic obstructive pulmonary disease.

Razi Journal of Medical Sciences 2006;12:19‑26.

Esmaeili Shahmirzadi S, Shojaeizadeh D, Azam K, Tol A.

A survey on quality of life in the elderly with osteoporosis.

J Health Syst Res 2013;8:1180‑89.

Mojibian M, Owlia M, Beiki Bandarabadi O,

Kochak Yazdi L. Osteoporosis in postmenopausal women. Iran J

Surg 2006;14:71‑8.

Aghaalikhani M, Taheri Tanjani P, Hosseinpour Azari A,

Mousavi M, Rezapour M, Amin Y, et al. Prevalence of

osteoporosis among above 60 years old subjects referred to

Ayatollah Taleghani hospital in Tehran and its relationship with

age and sex. Scientific Journal of Ilam University of Medical

Sciences 2012;20:315‑25.

Mazloomy mahmoudabad S, Soltani T, Morowatisharifabad M,

Fallahzadeh H. Activities of daily living and prevalence of

chronic diseases among elderly people in Yazd. J TOLOO-EBEHDASHT 2014;13:42‑53.

Aghajanpoor M, Salari A, Karimifar M, Zamani A, Salesi M,

Mottaghi P. Comparison of the prevalence of osteopenia and

osteoporosis in diabetic postmenopausal women with nondiabetic

women. J Isfahan Med School 2014;32:1‑12.

Dana Siadat Z, Rahmani S, Mahmoudian S, Eshaghi S.

Prevalence of osteoporosis risk factors and need to bone mineral

density testing in patients with pathologic fractures: Esfahan

Kashani hospital. Journal of Isfahan Medical School 2011;29:1‑9.

Maddah M, Sharami S, Karandish M. Educational difference

in the prevalence of osteoporosis in postmenopausal women:

A study in northern Iran. BMC Public Health 2011;11:1‑3.

Pourhashem Z, Bayani M, Noreddini G, Bijani A, Hosseini S.

Prevalence of osteoporosis and its association with serum

vitamin D level in older people in Amirkola, North of Iran.

Caspian J Intern Med 2012;3:347‑53.

Abbasi M, Zohal M, Atapour B, Yazdi Z. Prevalence of

osteoporosis and its risk factors in men with COPD in Qazvin.

Int J Chronic Dis 2016:1‑6.

Mojibian M, Kochak Yazdi L, Pakdel S. Osteoporosis In

Postmenopausal women In Yazd . Maturitas 2009 63:91.

Spinal Osteoporosis Rate in Patients With Typical Symptoms

of Lumbar Canal Stenosis. Reza Salman Roghani, Poster 143,


Mobini M, Kashi Z, Bahar A, Taslimi F, Forghanizadeh J,

Abdi R. Osteoporosis and osteoporotic fractures in

postmenopausal women with type 2 diabetes compared with non

diabetic cases. Iran J Diabetes Obesity 2012;4:68‑73.

Rahnavard Z, Zolfaghari A, Hosseinnezhad M, Dastgerdi M,

Valizade A. The incidence of osteoporotic hip fracture: Iranian

multi‑center osteoporosis study (IMOS) Res J Biol Sci 2009;4:171‑3.

Shams M, Homayouni K, Hamidi A, Sadegholvad A, Omrani G.

Leptin and bone mineral density in healthy postmenopausal

Iranian women: A populationbased study. Int J Endocrinol

Metab (IJEM) 2006;4:70‑7.

Heidari B, Muhammadi A, Javadian Y, Bijani A, Hosseini R,

Babaei M. Associated factors of bone mineral density and

osteoporosis in elderly males. Int J Endocrinol Metab (IJEM)


Ebrahimpur M, Sharifi F, Nezhad F, Bagherzadeh M, Ostovar A,

Shafiee G, et al. Effect of diabetes on BMD and TBS values

as determinants of bone health in the elderly: Bushehr elderly

health program. J Diabetes Metab Disord 2019;18:99‑106.

Hosseini S, Cumming R, Kheirkhah F, Nooreddini H, Baiani M,

Mikanik iE, et al. Cohort profile: The Amirkola health and

ageing project (AHAP). Int J Epidemiol 2014;43:1393‑400.

Hasani‑Ranjbar S, Jafari‑Adli S, Payab M, Qorbani M, Ahanjideh F,

Keshtkar A, et al. Association of osteoporosis with anthropometric

measures in a representative sample of Iranian Adults: The Iranian

multicenter osteoporosis study. Int J Prev Med 2019;10:157.

Hemmati F, Sarokhani D, Sayehmiri K, Motadayen M.

Prevalence of osteoporosis in postmenopausal women in Iran:

A systematic review and meta-analysis. The Iranian Journal of

Obstetrics, Gynecology and Infertility, 2018;21:90-102.

Honarvar B, Bagheri Lankarani K, Azadegan M, Khaksar E,

Jafari F, Rahmani Fard T. The prevalence and predictors of sleep

disturbance in the elderly: A population‑based study in Shiraz,

Iran. Shiraz E‑Med J 2019;20:e88349.

Papadimitropoulos E, Coyte P, Josse R, Greenwood C.

Current and projected rates of hip fracture in Canada. CMAJ


Lingard EA, Mitchell SY, Francis RM, Rawlings D, Peaston R,

Birrell FN, et al. The prevalence of osteoporosis in patients with

severe hip and knee osteoarthritis awaiting joint arthroplasty.

Age Ageing 2009;39:234‑9.

Baudoin C, Fardellone P, Bean K, Ostertag‑Ezembe A, Hervy F.

Clinical outcomes and mortality after hip fracture. Bone


Chin DK, Park JY, Yoon YS, Kuh SU, Jin BH, Kim KS, et al.

Prevalence of osteoporosis in patients requiring spine surgery:

Incidence and significance of osteoporosis in spine disease.

Osteoporos Int 2007;18:1219‑24.

Noghabi AAA, Zandi M, Mehran A, Alavian SM, Dehkordi AH.

The effect of education on quality of life in patients under

interferon therapy. Hepatitis Monthly 2010;10:218-22.

Jang N, Choi Y, Choi M, Kang S, Jeong J, Choi Y, et al.

Prevalence and associated factors of osteoporosis among

postmenopausal women in Chuncheon: Hallym Aging

Study (HAS). J Prev Med Public Health 2006;39:389‑96.

Limpaphayom K, Taechakraichana N, Aisamrarn U,

Bunyavejchevin S, Chaikittisilpa S, Poshyachinda M, et al.

Prevalence of osteopenia and osteoporosis in Thai women.

Menopause 2001;8:65‑9.

El Desouki M. Osteoporosis in postmenopausal Saudi women

using dual X ray bone densitometry. Saudi Med J 2003;24:953‑6.