Abstract
Purpose
Osteoporotic fractures impose a vast burden on the health system, especially in countries with an old population or an ageing trend such as Iran. This study reviews the articles published by the Endocrinology and Metabolism Research Institute (EMRI) to map and summarize the evidence, identify key themes and highlight research gaps to plan future research.
Method
We searched for studies affiliated with EMRI on osteoporotic fracture. Scopus, PubMed, Google Scholar, Scientific Information Database (SID) and Persian databases were used, without restricting time and language. All papers published up to December 2019 were retrieved and merged using Endnote software. Two independent researchers reviewed documents, and non-related papers were removed from the collection. The reference lists of the relevant articles were reviewed to avoid missing any publication. All papers addressing any aspects of fragility fractures were included. Meeting abstracts and letters to the editor were excluded. The visualization of the co-authorship network was illustrated with VOSveiwer program software.
Results
The total number of 20 papers, published between 2004 and 2019 were included in our study. “Larijani, B” with 12, “Keshtkar, A”, “Abolhassani, F”, and “Soltani, A” with five papers were the most prolific authors. Six out of 20 (30 %) of the papers were published in the last three years. Among different perspectives of osteoporotic fractures, addressed by EMRI, four main categories of articles were defined including incidence (n = 7), related factors (n = 9), fracture risk assessment (n = 2), and the burden of osteoporotic fractures in Iran (n = 4). There was no updated information about the incidence of osteoporotic fracture and its burden in recent years.
Conclusions
Considering the importance of osteoporotic fractures in Iran with an ageing trend, Osteoporosis Research Centers can play an essential role in providing evidence for policymakers. Worldwide, there is a large care gap to assess bone health and start treatments after fragility fractures. Accordingly, following international recommendations, practical interventions are required to fill this gap. EMRI began developing the “Registry of osteoporosis” and also pilot the “Fracture Liaison Services”, as an operative model to address the existing care gap and implement applied research in this science area.
This is a preview of subscription content, access via your institution.

Data svailability
Not applicable.
References
Johnell O, Kanis J. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int. 2006;17(12):1726–33.
Baddoura R, Hoteit M, Fuleihan GE-H. Osteoporotic fractures, DXA, and fracture risk assessment: meeting future challenges in the eastern Mediterranean region. J Clin Densitom. 2011;14(4):384–94.
Manoochehry S, Rasouli HR. Iranian population policy and aging: new health concerns. Int J Travel Med Glob Health. 2017;5(2):70–1.
EMRI Strategic Plan: Endocrinology and Metabolism Research Institute. 2019. Available from: http://emri.tums.ac.ir/EN/Item/12889, 25/April/2020.
Abolhassani F, Mohammadi M, Soltani A. Burden of osteoporosis in Iran. Iran J Public Health. 2004;33(Supple 1):18–28.
Moayyeri A, Soltani A, Abolhassani F. Incidence of hip fractures among Iranian elderly population. Iran J Public Health. 2004;33:29–33.
Zolfaghari M, Keshtkar AA., Maghbouli J, Kazemnejad A, Ardeshir Larijani MB*. The incidence of osteoporotic hip fracture in 3 years fallow up of Iranian Multicenters Osteoporosis Study (IMOS). J Reprod Infertil Winter 2005;6(1(21)Osteoporosis special issue):37–42.
Abolhassani F, et al. Incidence and characteristics of falls leading to hip fracture in Iranian population. Bone. 2006;39(2):408–13.
Moayyeri A, et al. Epidemiology of hip fracture in Iran: results from the Iranian Multicenter Study on Accidental Injuries. Osteoporos Int. 2006;17(8):1252–7.
Ahmadi-Abhari S, Moayyeri A, Abolhassani F. Burden of hip fracture in Iran. Calcif Tissue Int. 2007;80(3):147–53.
Saghafi H, et al. Osteoimmunological insight in to vertebral fractures in osteoporosis. Iran J Public Health. 2008:7–15.
Aliasgarzadeh A, et al. Incidence of osteoporotic hip fracture in above 50 year old peoples of Tabriz in years 2004–2006. Iran J Endocrinol Metab. 2009;10(6):563–656.
Rahnavard Z, et al. The incidence of osteoporotic Hip fracture: Iranian Multicenter osteoporosis study (IMOS). Res J Biol Sci. 2009;4(2):171–3.
Hossein-Nezhad A, et al. Variation in the COX-2 gene may modify the effect of alendronate on vertebral fracture prevention. Eur J Inf Syst. 2010;8(3):143–9.
Salari P, Abdollahi M. Long term bisphosphonate use in osteoporotic patients; a step forward, two steps back. J Pharm Pharm Sci. 2012;15(2):305–17.
Shahnazari B, et al. Estimating the avoidable burden of certain modifiable risk factors in osteoporotic hip fracture using Generalized Impact Fraction (GIF) model in Iran. J Diabetes Metab Disord. 2013;12(1):10.
Ghafoori S, et al. The risk of osteoporotic fractures and its associating risk factors according to the FRAX model in the Iranian patients: a follow-up cohort. J Diabetes Metab Disord. 2014;13(1):93.
Amininezhad F, et al. Evaluation of the validity of the FRAX® algorithm for predicting risk of osteoporotic fracture in Iran. Osteologie. 2015;24(03):183–6.
Maghbooli Z, et al. Direct costs of osteoporosis-related hip fractures: protocol for a cross-sectional analysis of a national database. BMJ Open. 2017;7(4):e014898.
Sadeghi O, et al. Abdominal obesity and risk of hip fracture: a systematic review and meta-analysis of prospective studies. Adv Nutr. 2017;8(5):728–38.
Malmir H, et al. Adherence to Mediterranean diet in relation to bone mineral density and risk of fracture: A systematic review and meta-analysis of observational studies. Eur J Nutr. 2018;57(6):2147–60.
Malmir H, Larijani B, Esmaillzadeh A. Consumption of milk and dairy products and risk of osteoporosis and hip fracture: a systematic review and Meta-analysis. Crit Rev Food Sci Nutr. 2019;60(10):1722–37.
Salari-Moghaddam A, et al. Metformin use and risk of fracture: a systematic review and meta-analysis of observational studies. Osteoporos Int. 2019;30(6):1167–73.
Khashayar P, et al. FRAX-based intervention and assessment thresholds for osteoporosis in Iran. Osteoporos Int. 2019;30(11):2225–30.
Sharif PS, Abdollahi M. A systematic review on the relationship between β-blockers and bone health. Int J Pharmacol. 2010;6:577–83.
Keshtkar A, et al. The incidence of osteoporotic hip fracture in Iran, a review. Osteoporos Int. 2010;21:S707–S707.
Kung AW, Huang Q. Genetic and environmental determinants of osteoporosis. J Musculoskelet Neuronal Interact. 2007;7(1):26.
Kanis JA, et al. FRAX® and its applications to clinical practice. Bone. 2009;44(5):734–43.
Bliuc D, et al. Risk of subsequent fractures and mortality in elderly women and men with fragility fractures with and without osteoporotic bone density: the Dubbo Osteoporosis Epidemiology Study. J Bone Miner Res. 2015;30(4):637–46.
Center JR, et al. Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet. 1999;353(9156):878–82.
Bliuc D, et al. Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA. 2009;301(5):513–21.
Walters S, et al. Fracture liaison services: improving outcomes for patients with osteoporosis. Clin Interv Aging. 2017;12:117.
Marsh D, et al. Coordinator-based systems for secondary prevention in fragility fracture patients. Osteoporos Int. 2011;22(7):2051–65.
Nakayama A, et al. Evidence of effectiveness of a fracture liaison service to reduce the re-fracture rate. Osteoporos Int. 2016;27(3):873–9.
Wu C-H, et al. Fracture liaison services improve outcomes of patients with osteoporosis-related fractures: A systematic literature review and meta-analysis. Bone. 2018;111:92–100.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest/Competing interests
The authors declare that they have no conflict of interest.
Ethics approval
Not applicable.
Consent for publication
Not applicable.
Code availability
Not applicable.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
ESM 1
(DOCX 15 kb)
Rights and permissions
About this article
Cite this article
Fahimfar, N., Gharibzadeh, S., Sanjari, M. et al. Review of osteoporotic fracture research in Endocrinology and Metabolism Research Institute; where we started and where to go. J Diabetes Metab Disord (2021). https://doi.org/10.1007/s40200-021-00733-2
Received:
Revised:
Accepted:
Published:
DOI: https://doi.org/10.1007/s40200-021-00733-2