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Int J Pharma Res Health Sci. 2017; 5 (2): 1686-1689
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IIIIIIIII© International Journal of Pharma Research and Hea lth Sciences. All rights reserved
DOI:10.21276/ijprhs.2017.02.16
D Timimi et al CODEN (USA)-IJPRUR, e-ISSN: 2348-6465
Original Article
Zinc Status as a Risk of Osteoporosis
Dhia J Al-Timimi 1, *, Samim A Al-Dabbagh 2, Khyria A K Mohammed 2
1Professor, Head, Department of Medical Chemistry, University of Duhok, Iraq
2Dept. of Community and Family Medicine, College of Medicine, University of Duhok, Duhok, Iraq.
A RT I C LE IN F O A B S T R A C T
________
1. INTRODUCTION
Osteoporosis is a disease commonly encountered in the
general practice, and considered a common cause of
fractures mainly among women1.it is also an important
public health problem in elderly men, so about thirty percent
of fractures of hip occur in men2.several risk factors have
been incriminated in the causation of the disease including
age, hypogonadism, drug containing steroid, tobacco
smoking, alcohol intake, lack of physical activity and excess
or lack of certain components of diet3.The organic matrix in
bone is mainly composed of protein and most of the bone
mineral content is calcium4.Moreover, some other minerals
may be needed to maintain a healthy state of the bone,
International Journal of Pharma Research and Health Sciences
Available online at www.pharmahealthsciences.net
Received: 16 Apr 2017
Accepted: 28 Apr 2017
Objectives: There is increasing evi dence on association between lowzinc (Zn) status and
osteoporosis, but the impact of zinc status as a risk of osteoporosis has not been reported.
The aim of the study was to measure the concentration of serum zinc in patients with
osteoporosis, and to ascertain the impact of zinc status on bone mineral density.
Methods: Serum concentration of Zinc and anthropometric parameters (age, gender, and
body mass index) were measured in 55 apparently healthy subjects and 200 patients
completed bone mineral density (BMD)measurements of the hip area and the limber spine
using the dual energy x -ray absorbtiometry(DEXA) scan. Osteoporosis was defined as a
BMD>2.5 SDs below the mean of young subjects (a T-score < -2.5).
Results: Significantly lower zinc concentrations (p= 0.001), together with higher prevalence
of hypozincemia(p=0.01) were found in patients with osteoporosis than in both osteopenic
patients and healthysubjects. There was no statistically significant difference observed
between the osteopenic and healthy subjects with respect to zinc levels. In the osteoporosis
group, a positive correlations of zinc was observed with BMD(p<0.001) and a negative
correlation was observed with age (p=0.01).
Conclusion: The low zinc status in conjunction with abnormal BMD may be strongly
associated with osteoporosis in the studied patients. It thus indicates the need for the
effectiveness of zinc supplements to patients with osteoporosis.
Keywords: zinc, osteoporosis, osteopenia, bone density
Corresponding author *
Dhia J Al-Timimi
Professor, Head, Department of Medical Chemistry
E-mail: altmimidj@yahoo.com.
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IIIIIIIII© International Journal of Pharma Research and Hea lth Sciences. All rights reserved
including zinc, which is an essential trace element of bone
growth and mineralization5.This element may be associated
with bone strength and bone mass6.Since zinc is an
established trace metal of bone health, it is important to
analyze its association with bone mineral density in patients
with osteoporosis.
2. METHODS
Study population
Two hundred patients (ages 45-70 years) who prepared for
diagnostic BMD measurement at osteoporosis unite, Duhok
Center of Rheumatic Disease and Medical Rehabilitation,
Duhok, Kurdistan region, Iraq; were enrolled in the study.On
the basis of patient history, medical history, clinical
examination and radiological assessment, the participants
were included and screened for osteoporosis. Osteoporosis is
defined as BMD score of -2.5 and lower, and osteopenia
between -1 to-2.5 SDs. Participants who had a history of
secondary osteoporosis were excluded from the study, as
well as those who used hormonal replacement therapy, zinc
supplement or none fasting. Fifty five apparently healthy
subjects of comparable age, sex and BMI were also included
in the study.
All the participants provided written informed consent. The
study protocol was approved by the Ethics Committee of the
Medical Faculty, University of Duhok.
Anthropometric Measurements
Anthropometric measurements-body height (cm), body
weight (Kg) were obtained. Body mass index (BMI) was
calculated as weight in kilograms divided by height in meter
squared. Study patients were divided into 3 groups: a normal
weight group (n=29, BMI<25 kg/m20) overweight (n=50,
BMI25-29.9) and an obese (n=121, BMI>30 kg/m2).
Biochemical Measurements
Phlebotomy was performed in the morning 8-10 o’clock,
after a 12-14 h overnight fast. Serum specimens were
collected in tubes containing no anticoagulant. Samples were
allowed to clot for 30 minutes and then centrifuged at 3000
rpm for 10 minutes. Serum samples were divided into
aliquots and stored at -80 c without prior thawing and
refreezing before analysis.
Serum zinc was measured by flame atomic absorption
spectrophotometer (PyeUnicam 2900, PyeUnicam Ltd,
Cambridge, CB12PX, England). The intra- and inter-assay
coefficient of variation (CV) for zinc was 3.0% and 6.5%
respectively.
Statistical Analyses
Statistical analyses were performed using SPSS statistical
package (version 15.0 for windows, SPSS, Chicago, IL,
USA). Data are presented as mean +standard deviation.
Differences between groups were evaluated with Student’s t-
test. A correlation analysis by Pearson’s (r ) correlation
coefficient was used to determine the relationship between
zinc levels and other variables in patient group.Categoral
variables were analyzed by Chi square test. A p value of
<0.05 was considered statistically significant. The power and
sample size were calculated for zinc and BMD score, the
values exceeded 0.90.
3. RESULTS
Table 1 shows the general characteristics of healthy subjects
and patientgroups.No significant differences were found
with respect to age BMI, and gender between the healthy
subjects and patient groups. Significantly lower zinc level
was observed in patient groups compared to healthy
subjects.(p=0.01). A significantly higher prevalence (17.0%)
of hypozincemia (serum zinc<70 ug/dl) was found in the
patient groups compared with (1.8%) in the healthy subjects
(p=0.001).
Table 2, shows the patient groups categorized as
osteoporosis groupexhibited lower zinc levels than did the
osteopenia group ( p=0.01).Significantly higher prevalence
of hypozincemia and lowervalues of BMD score was
observed inosteoporosis group compared to osteopenia
group. The 2 groups were also differ significantly with
respect to age (p=0.01).
To determine which of the anthropometric parameters was
significantly associated with the serum zinc level in patient
groups, we distributed patients according to low and normal
zinc levels.(Table 3).Among the different age groups,
patients in >65 year age group had a higher prevalence of
low zinc levels (41.2%) than those with normal zinc levels
(21.1%). A significantly lower mean zinc level was found in
the patients with age>65 years compared with the other age
groups (p=0.013).No significant difference was found with
respect to gender and BMI between the low and normal zinc
groups.BMD score for the hip and spine were significantly
lower in osteoporotic patients in the lowest serum zinc level
(<70 ug/dl) than in osteoporotic patients with higher serum
zinc concentrations.
The relationship between zinc and related parameters
including age, BMI and BMD score in patient groups is
presented in Table 4.As shown, in the osteoporosis group,
zinc correlated positively with BMD (p=0.001), and
negatively correlated with age(p=0.01).
4. DISCUSSION
This study provided definitive evidence that patients with
osteoporosis had low serum zinc levels. The results confirm
a correlation between hypozincemia and osteoporosis, as the
prevalence of hypozincemia observed in osteoporosis cases
was about 8 times higher than that observed in osteopenia
cases or healthy subjects.These results are in accordance
with previous studies7, 8.Moreover, we reported a significant
relationship between zinc and the BMDmeasurement and
age. In ourstudy, zinc correlated with BMD score in
osteoporosis group: the association was stronger with BMD
score than with age, suggesting that hypozincemia has a role
in accelerating or producing osteoporosis. By contrast, the
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other studies suggested osteoporosis may lead to
hypozincemia 9.However; the impact of zinc deficiency on
the etiology of the disease is still unclear 10.Zinc has been
demonstrated to have a simulator effect on bone formation
and mineralization; the metal activates aminoacyl-tRNA
synthetase in osteoblastic cells, and stimulates cellular
protein synthesis. Moreover, zinc inhibits osteoclastic bone
resorption by inhibiting osteoclast-like cell formation from
marrow cell11.Another study implies that zinc can increase
osteogenic effect by stimulating cell proliferation, alkaline
phosphatase (ALP) activity and collagen synthesis in
osteoblastic cells12.
It is important to note that stronger association between
BMD and zinc values have been reported for women
compared with men13.In our study, patients with
osteoporosis were predominantly women, 125/160(F/M ratio
abut 3.5).This may suggest an important mechanism through
which sex can influence higherrisk of hypozincemia in
patients withosteoporosis. But, however, we did not observe
a significant difference in mean zinc levels between males
and females. These finding maysuggests that gender could
not explain the hypozincemia observed in cases with
osteoporosis.
Mild-moderate zinc deficiency appears to be an important
public health problem in many developing countries
including Iraq14. Several studies have shown that nutritional
zinc deficiency is prevalent in several developing
countries15.This might be due to the commonly consumed
staple foods have low content of zinc and rich in phytate.
The latter inhibit the absorption and utilization of zinc in
GIT.Indeed, patients with osteoporosis are known to be more
vulnerable to zinc depletion and suboptimal zinc status than
other groups16 .A high proportion(17.0%) of patients with
osteoporosis, but not healthy subjects(1.8%) or patients with
osteopenia(2.5%), had serum zinc levels <70 ug/dl. These
results suggest an important mechanism through zinc can
influence higher risk of osteoporosis in our population,
although, measurement of the other relevant minerals has not
been determined, which is a limitation of this study. This
mightunderestimate the definitive conclusion regarding the
role of zincspecifically (or other relevant minerals) related to
these patients with osteoporosis.
Table1: Patient and healthy subject data.
Table2: Demographic data and zinc status in patients with osteoporosis
and osteopenia
Table3: Distribution of osteoporotic patients with low and normal zinc
concentrations by age, gender, BMI and BMD score
Table 4: Pearson’s Correlation Coefficients ( r ) between zinc and age,
BMI and BMDs in osteoporotic patients.
5. CONCLUSION
To our knowledge, ours is the first study to examine the
association of zinc status with measurements of bone
mineral density among patients with osteoporosis, at least in
our population. As expected, BMD score is associated with
lower levels of zinc and unfavorable changes in the zinc
status, suggesting zinc may play a central role in the
pathogenesis of osteoporosis-related pathologies. Inthis
sense, these findings mayindicate the need for the
effectiveness of zinc supplementation.However, its effects
on bone density remain to be evaluated in a large sample
group.
6. ACKNOWLEDGEMENT
This work was supported by the Director General of Health
in Duhok
7. REFERENCES
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Conflict of Interest: None
Source of Funding: Nil
