Iranian Multicenter Osteoporosis Studies (IMOS) during last decade: rationale, main findings, lessons learned and the way forward



Osteoporosis remains a major public health concern, considering its high prevalence along with its association with osteoporotic fractures. It imposes a heavy burden on the society worldwide as the population ages. This paper aims to provide a brief review on Iranian multicenter osteoporosis studies (IMOS) studies and provide some recommendations for improvement.


IMOS studies were conducted to investigate the prevalence of osteoporosis and related risk factors. This paper provides a general view on the Iranian multicenter osteoporosis studies (IMOS), conducted during last decades.


The results showed a high prevalence of osteoporosis and vitamin D deficiency in the Iranian population. Although the study protocols were mainly similar, some differences were observed in terms of the study population and design. The protocol of IMOS-3 was modified to overcome the setbacks noted in the previous studies; however, it was implemented in two cities with noticeably different socioeconomic and geographical characteristics from five cities where the first phase was conducted, resulting in different lifestyles and habits. Although previous IMOS studies have raised major concerns regarding the high prevalence of osteoporosis and vitamin D deficiency, interpretation should be made with caution given the differences, especially in the surveyed cities. Such discrepancies cause problems in trend analysis, and nationally representative samplings are preferably needed to correctly compare the prevalence of osteoporosis and related risk factors.


Considering the aging population and the importance of osteoporosis and its complication, developing a standard surveillance system to obtain valid and nationally representative estimates is recommended.

This is a preview of subscription content, log in to check access.


  1. 1.

    Kanis J. WHO technical report. Sheffield: University of Sheffield.. 2007; 66.

  2. 2.

    Larijani B, et al. Osteoporosis in Iran, overview and management. Iran J Public Health, 2007. p. 1–13.

  3. 3.

    Ahmadi-Abhari S, Moayyeri A, Abolhassani F. Burden of hip fracture in Iran. Calcif Tissue Int. 2007;80(3):147–53.

    CAS  PubMed  Google Scholar 

  4. 4.

    Nations U. World population ageing 2017 Highlights. New York: Department of Economic and Social Affairs; 2017.

    Google Scholar 

  5. 5.

    Reginster J-Y, Burlet N. Osteoporosis: a still increasing prevalence. Bone. 2006;38(2):4–9.

    Google Scholar 

  6. 6.

    El-Hajj Fuleihan G, Adib G, Nauroy L. The middle east & Africa regional audit, epidemiology, costs & burden of osteoporosis in 2011. Int Osteoporos Found. 2011. p. 102011–105000.

  7. 7.

    Salehi I, et al. High prevalence of low bone density in young Iranian healthy individuals. Clin Rheumatol. 2009;28(2):173–7.

    PubMed  Google Scholar 

  8. 8.

    Irani AD, et al. Prevalence of osteoporosis in Iran: A meta-analysis. J Res Med Sci. 2013;18(9):759.

    PubMed  PubMed Central  Google Scholar 

  9. 9.

    Heshmat R, et al. Vitamin D deficiency in Iran: A multi-center study among different urban areas. Iran J Public Health. 2008; 37(suppl).

  10. 10.

    Tabrizi R, et al. High prevalence of vitamin d deficiency among iranian population: A systematic review and meta-analysis. Iran J Med Sci. 2018;43(2):125.

    PubMed  PubMed Central  Google Scholar 

  11. 11.

    Esteghamati A, et al. Third national Surveillance of Risk Factors of Non-Communicable Diseases (SuRFNCD-2007) in Iran: methods and results on prevalence of diabetes, hypertension, obesity, central obesity, and dyslipidemia. BMC Public Health. 2009;9(1):167.

    PubMed  PubMed Central  Google Scholar 

  12. 12.

    Hadavi M, et al. Osteoporosis prevalence and t-score discordance between femur and lumbar spine in iran and some related factors: Imos study. Iran J Diabetes Metab. 2015;14(5):305–14.

    Google Scholar 

  13. 13.

    Meybodi HA, et al. Iranian osteoporosis research network: Background, mission and its role in osteoporosis management. Iran J Public Health. 2008;37(sup):1–6.

    Google Scholar 

  14. 14.

    Rahnavard Z, et al. Vitamin D deficiency in healthy male population: Results of the Iranian multi-center osteoporosis study. Iran J Public Health. 2010;39(3):45.

    CAS  PubMed  PubMed Central  Google Scholar 

  15. 15.

    Larijani B, et al. Peak bone mass of Iranian population: The Iranian multicenter osteoporosis study. J Clin Densitom. 2006;9(3):367–74.

    PubMed  Google Scholar 

  16. 16.

    Keshtkar A, et al. A suggested prototype for assessing bone health. Arch Iran Med. 2015;18(7):411–5.

    PubMed  Google Scholar 

  17. 17.

    Khashayar P, et al. The prevalence of osteoporosis in an Iranian population. J Clin Densitom. 2010;13(1):112.

    Google Scholar 

  18. 18.

    Mohammadi Z, et al. Prevalence of osteoporosis and vitamin D receptor gene polymorphisms (FokI) in an Iranian general population based study (Kurdistan)(IMOS). Med J Islam Repub Iran. 2015;29:238.

    PubMed  PubMed Central  Google Scholar 

  19. 19.

    Moradzadeh K, et al. Normative values of vitamin D among Iranian population: a population based study. Int J Osteoporos Metab Disord. 2008;1(1):8–15.

    CAS  Google Scholar 

  20. 20.

    Meybodi HA, et al. Association between anthropometric measures and bone mineral density: population-based study. Iran J Public Health. 2011;40(2):18.

    Google Scholar 

  21. 21.

    Khashayar P, et al. Awareness of osteoporosis among female head of household: an Iranian experience. Arch Osteoporos. 2017;12(1):36.

    PubMed  Google Scholar 

  22. 22.

    Zamani M, et al. Prevalence of osteoporosis with the World Health Organization diagnostic criteria in the Eastern Mediterranean Region: a systematic review and meta-analysis. Arch Osteoporos. 2018;13(1):129.

    PubMed  Google Scholar 

  23. 23.

    Yee JL, Niemeier D. Advantages and disadvantages: Longitudinal vs. repeated cross-section surveys. Proj Battelle. 1996;94(16):7.

    Google Scholar 

  24. 24.

    Hajipour MJ, et al. Protocol design for large–scale cross–sectional studies of surveillance of risk factors of non–communicable diseases in Iran: STEPs 2016. Arch Iran Med. 2017;20(9).

  25. 25.

    Morley JE, et al. Sarcopenia with limited mobility: an international consensus. J Am Med Dir Assoc. 2011;12(6):403–9.

    PubMed  PubMed Central  Google Scholar 

  26. 26.

    Crepaldi G, Maggi S. Sarcopenia and osteoporosis: a hazardous duet. J Endocrinol Investig. 2005;28(10 Suppl):66–8.

    CAS  Google Scholar 

  27. 27.

    Tarantino U, et al. Sarcopenia and fragility fractures: molecular and clinical evidence of the bone-muscle interaction. JBJS. 2015;97(5):429–37.

    Google Scholar 

  28. 28.

    Cederholm T, Cruz-Jentoft A, Maggi S. Sarcopenia and fragility fractures. Eur J Phys Rehabil Med. 2013;49(1):111–7.

    CAS  PubMed  Google Scholar 

  29. 29.

    Hashemi R, et al. Sarcopenia and its associated factors in Iranian older individuals: Results of SARIR study. Arch Gerontol Geriatr. 2016;66:18–22.

    PubMed  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Afshin Ostovar.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest in the authorship or publication of this contribution.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Fahimfar, N., Gharibzadeh, S., Khashayar, P. et al. Iranian Multicenter Osteoporosis Studies (IMOS) during last decade: rationale, main findings, lessons learned and the way forward. J Diabetes Metab Disord (2020).

Download citation


  • Osteoporosis
  • Iran
  • Prevalence
  • Vitamin D deficiency