1 Science, Justice, and Health Equity: The Overlooked Legacy of Ayatollah Khamenei https://brieflands.com/journals/semj/articles/171777 10.5812/semj-171777 1 This article has no abstract regards to the type of article 1 2 Kamran B Lankarani Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran Iran lankaran@sums.ac.ir No Keyword 1.pdf [0]Lankarani K.Health in Iran; 40 Years After the Islamic Revolution. Shiraz E-Medical Journal. 2019;In Press(In Press). doi: 10.5812/semj.89606.##[1]Lankarani KB, Alavian SM, Peymani P.Health in the Islamic Republic of Iran, challenges and progresses. Med J Islam Repub Iran. 2013;27(1):42-9. [PubMed ID: 23479501]. [PubMed Central ID: PMC3592943].##

1 Anti-TNF-α Therapy on Bone Mineral Density in Patients with Inflammatory Bowel Disease: An Expanded Cross-sectional Analysis https://brieflands.com/journals/semj/articles/168706 10.5812/semj-168706 1 Background :Patients with inflammatory bowel disease (IBD) experience a disproportionately high burden of low bone mineral density (BMD) and osteoporosis compared with the general population. Chronic inflammation, nutritional deficiencies, corticosteroid exposure, and changes in body composition all contribute to impaired bone health. Objectives :We aimed to investigate the bone metabolism in cases with anti-tumor necrosis factor-alpha (anti-TNF-α) agents which are widely used to control moderate-to-severe IBD. We examinedd the association between anti-TNF-α therapy and BMD in a cohort of IBD patients receiving care at a tertiary center. Methods :This cross-sectional study enrolled 58 patients with ulcerative colitis or Crohn’s disease were enrolled (29 receiving anti-TNF-α and 29 receiving azathioprine-based therapy). Clinical history, medication exposure, cumulative corticosteroid dose, nutritional supplementation, vitamin D levels, disease activity, and lifestyle factors were recorded. Dual-energy X-ray absorptiometry (DEXA) was used to measure lumbar and femoral BMD. Multivariable logistic regression was performed to identify independent predictors of osteoporosis. Resultss :Overall, 43.1% of participants met criteria for osteoporosis based on Z-scores, with markedly higher prevalence among anti-TNF-α users (65.5% vs. 20.7%, P = 0.01). After adjusting for confounders, anti-TNF-α therapy (OR 3.50; 95% CI 1.20 - 10.20), lower BMD (OR 2.00; 95% CI 1.10 - 3.60), higher cumulative corticosteroid exposure (OR 1.50; 95% CI 1.10 - 2.00), and lower BMI (OR 1.20; 95% CI 1.05 - 1.40) were independently associated with osteoporosis. Conclusions :These findings demonstrate a significant association between anti-TNF-α therapy and lower bone mineral density in patients with inflammatory bowel disease. Given the cross-sectional design, causal relationships cannot be established, and residual confounding by disease severity and treatment indication remains likely. Larger prospective and longitudinal studies are required to clarify the temporal and mechanistic relationships between anti-TNF-α therapy and bone metabolism. 1 9 Zahra Shokati Eshkiki Alimentary Tract Research Center, Clinical Sciences Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran Iran karbalai.m2011@gmail.com Abolfazl Akbari Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran Iran abolfazl.akbari@gmail.com Mahshad Eghbalmanesh Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran Iran mahshad.eghbalmanesh@yahoo.com Elham Pishgar Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran Iran pishgar.e@iums.ac.ir No Keyword 2.pdf [0]Attauabi M, Madsen GR, Holm JP, Bendtsen F, Møller S, Seidelin JB.Incidence of Osteoporosis and Osteopenia in Newly Diagnosed Inflammatory Bowel Disease: A Population-Based Cohort Study. Inflammatory Bowel Diseases. 2025;2025:izaf063. [PubMed ID: 40198007]. doi: 10.1093/ibd/izaf063.##[1]Lee JS, Lee HS, Jang BI, Kim ES, Kim SK, Kim KO.Low bone mineral density in young patients newly diagnosed with inflammatory bowel disease. Digestive Diseases and Sciences. 2021;66(2):605-11. [PubMed ID: 32222926]. doi: 10.1007/s10620-020-06220-7.##[2]Hu Y-Q, Jin X-J, Lei S-F, Yu X-H, Bo L.Inflammatory bowel disease and osteoporosis: Common genetic effects, pleiotropy, and causality. Human Immunology. 2024;85(5):110856. [PubMed ID: 39018711]. doi: 10.1016/j.humimm.2024.110856.##[3]Kitaura H, Marahleh A, Ohori F, Noguchi T, Nara Y, Pramusita A.Role of the interaction of tumor necrosis factor-α and tumor necrosis factor receptors 1 and 2 in bone-related cells. International journal of molecular sciences. 2022;23(3):1481. [PubMed ID: 35163403]. [PubMed Central ID: PMC8835906]. doi: 10.3390/ijms23031481.##[4]Peng C-H, Lin W-Y, Yeh K-T, Chen H, Wu W-T, Lin M-D.The molecular etiology and treatment of glucocorticoid-induced osteoporosis. Tzu Chi Medical Journal. 2021;33(3):212-23. [PubMed ID: 34386357]. [PubMed Central ID: PMC8323641]. doi: 10.4103/tcmj.tcmj_233_20.##[5]Vernia F, Valvano M, Longo S, Cesaro N, Viscido A, Latella G.Vitamin D in inflammatory bowel diseases. Mechanisms of action and therapeutic implications. Nutrients. 2022;14(2):269. [PubMed ID: 35057450]. [PubMed Central ID: PMC8779654]. doi: 10.3390/nu14020269.##[6]Zhang Y, Jia X, Liu X, An W, Li J, Zhang W.Relationship between different body composition and bone mineral density in Qinhuangdao city. Revista da Associação Médica Brasileira. 2022;68(4):445-9. [PubMed ID: 35649065]. doi: 10.1590/1806-9282.20210669.##[7]Baban YN, Edicheria CM, Joseph J, Kaur P, Mostafa JA.Osteoporosis Complications in Crohn's Disease Patients: Factors, Pathogenesis, and Treatment Outlines. Cureus. 2021. [PubMed ID: 35103143]. [PubMed Central ID: PMC8772394]. doi: 10.7759/cureus.20564.##[8]Maeda K, Yoshida K, Nishizawa T, Otani K, Yamashita Y, Okabe H.Inflammation and bone metabolism in rheumatoid arthritis: molecular mechanisms of joint destruction and pharmacological treatments. International Journal of Molecular Sciences. 2022;23(5):2871. [PubMed ID: 35270012]. [PubMed Central ID: PMC8911191]. doi: 10.3390/ijms23052871.##[9]Alvarez-Ayala EG, Gamez-Nava JI, Saldaña-Cruz AM, Gonzalez-Ponce F, Contreras-Haro B, Ramirez-Villafaña M.Bone Mineral Density and Serum Levels of Bone Remodeling Markers in Ankylosing Spondylitis Treated with Anti TNF-α Agents. Medical Sciences. 2025;13(3):189. [PubMed ID: 40981186]. [PubMed Central ID: PMC12452767]. doi: 10.3390/medsci13030189.##[10]Jura-Półtorak A, Szeremeta A, Olczyk K, Zoń-Giebel A, Komosińska-Vassev K.Bone metabolism and RANKL/OPG ratio in rheumatoid arthritis women treated with TNF-α inhibitors. Journal of clinical medicine. 2021;10(13):2905. [PubMed ID: 34209821]. [PubMed Central ID: PMC8267676]. doi: 10.3390/jcm10132905.##[11]Veerappan SG, Healy M, Walsh B, O'Morain CA, Daly JS, Ryan BM.A 1-year prospective study of the effect of infliximab on bone metabolism in inflammatory bowel disease patients. European Journal of Gastroenterology & Hepatology. 2016;28(11):1335-44. [PubMed ID: 27508327]. doi: 10.1097/MEG.0000000000000719.##[12]Sugimoto K, Ikeya K, Iida T, Kawasaki S, Arai O, Umehara K.An increased serum N-terminal telopeptide of type I collagen, a biochemical marker of increased bone resorption, is associated with infliximab therapy in patients with Crohn's disease. Digestive diseases and sciences. 2016;61(1):99-106. [PubMed ID: 26254083]. doi: 10.1007/s10620-015-3838-y.##[13]Zerbini C, Clark P, Mendez-Sanchez L, Pereira R, Messina O, Uña C.Biologic therapies and bone loss in rheumatoid arthritis. Osteoporosis International. 2017;28(2):429-46. [PubMed ID: 27796445]. doi: 10.1007/s00198-016-3769-2.##[14]Hakimian S, Kheder J, Arum S, Cave DR, Hyatt B.Re-evaluating osteoporosis and fracture risk in Crohn's disease patients in the era of TNF-alpha inhibitors. Scandinavian Journal of Gastroenterology. 2018;53(2):168-72. [PubMed ID: 29235392]. doi: 10.1080/00365521.2017.1416161.##[15]Veerappan SG, Healy M, Walsh BJ, O'Morain CA, Daly JS, Ryan BM.Adalimumab therapy has a beneficial effect on bone metabolism in patients with Crohn's disease. Digestive Diseases and Sciences. 2015;60(7):2119-29. [PubMed ID: 25732718]. doi: 10.1007/s10620-015-3606-z.##[16]Olczyk M, Frankowska A, Tkaczyk M, Socha-Banasiak A, Stawerska R, Łupińska A.RANKL/OPG Axis and Bone Mineral Density in Pediatric Inflammatory Bowel Disease. Journal of Clinical Medicine. 2025;14(15):5440. [PubMed ID: 40807060]. [PubMed Central ID: PMC12347904]. doi: 10.3390/jcm14155440.##[17]Palatianou ME, Karamanolis G, Tsentidis C, Gourgiotis D, Papaconstantinou I, Vezakis A.Signaling pathways associated with bone loss in inflammatory bowel disease. Annals of Gastroenterology. 2023;36(2):132. [PubMed ID: 36864939]. [PubMed Central ID: PMC9932862]. doi: 10.20524/aog.2023.0785.##[18]Sandra MdA, Wahrlich V, Mafra D.Association between body composition and bone mineral density in men on hemodialysis. The American Journal of the Medical Sciences. 2015;350(4):286-9. [PubMed ID: 26418381]. doi: 10.1097/MAJ.0000000000000553.##