DOI: https://doi.org/10.53350/pjmhs2216345 ORIGINAL ARTICLE P J M H S Vol. 16, No. 03, MAR 2022 45 Association of Bone Mineral Density Status with Ethnicity and Parity in females of Karachi MADEEHA SADIQ 1 , MUBINA LAKHANI 2 , SANTOSH KUMAR SIDHWANI 3 , ROSHEENA NABEEL KHAN 4 , , NABILA RASHEED 5 , NUZHAT HASSAN 6 1,2 Assistant Professor, Department of Anatomy, Ziauddin University, Karachi 3 Assistant Professor, Department of Anatomy, United Medical and Dental College, Karachi 5 Assistant Professor, Department of Anatomy, RYK Medical and Dental College, Rahim Yar Khan 6 Professor, Department of Anatomy, Ziauddin University, Karachi Correspondence to Dr. Madeeha Sadiq, Email: madeeha.sadiq@zu.edu.pk, Cell: 0345-3105201 ABSTRACT Aims: To assess the association of BMD (bone mineral density) with ethnicity and parity in females of Karachi, Pakistan. Study design: Cross Sectional. Place and duration of study: Department of Anatomy & Nuclear Medicine, Ziauddin Hospital, Clifton Campus, Karachi, Pakistan between March and August 2016. Methods: 200 females aged 40 years and above were included. Average age was 60.7 years (±10.52). BMD assessment was done on DXA scans. Participants were interviewed to obtain baseline demographic characteristics. Statistical Package for Social Sciences (SPSS) version 20 was used to analyze data. Results: No significant association was found between BMD and the different ethnicities or parity in our study population. Conclusion: Bone mineral density is not affected by the number of pregnancies or ethnicity. Keywords: bone mineral density, ethnicity, parity, Karachi. INTRODUCTION The word “osteoporosis” literally means "porous bones”. It is defined as “decreased bone mass that is severe enough to significantly increase the risk of fractures” 1 . Osteoporosis is associated with an imbalance in skeletal turnover so that the level of bone resorption exceeds bone formation 2 . Radiologically, osteoporosis is considered as bone mass at least 2.5 standard deviations below mean peak bone mass in young adults and osteopenia as bone mass between 1 to 2.5 standard deviations below the mean 1 . The International Osteoporosis Foundation conducted an ultrasound based survey in Pakistan in 2009 and reported a 16% prevalence of Osteoporosis while that for Osteopenia was found to be 34% among the adult population aged 45 to 70 3 . A study conducted in Rawalpindi using DXA scanning reported the frequency of osteopenia to be 35% while that of osteoporosis to be 31.5% among adult Pakistanis 4 . Bone is a metabolically active tissue and bone turnover is a constant process. The rate of bone turnover affects the rates of bone deposition and resorption which in turn alter the BMD. This turnover rate and BMD is associated with BMI, age, menopausal status, ethnicity, endocrine diseases and other factors. Karachi is a city where people from diverse ethnic backgrounds reside 5 . the knowledge of differences in BMD among different ethnic populations in Pakistan is lacking. Despite Pakistan's high incidence of osteoporosis and osteopenia, there is a lack of data on the prevalence of osteoporosis-related fractures and the disease's burden 6 . Well known risk factors need to be addressed and clinical referrals should be made accordingly in high risk individuals. Studies on projections for hip fracture rates in men and women for 2050 in Asian countries suggests that the rates are increasing. Compared to 2018, in 2050 the hip fracture rates in both genders are projected to increase due to the demographic shift of asian populations towards an ageing population and increasing urbanisation of the population which tend to increase hip fracture rates 7 . In our study a sample of 200 females above 40 years of age were included. These females were both pre and postmenopausal and were recruited from the gynecology OPD. The objectives of our study were to study the determinants and predictors of bone mineral density in Pakistani women. ----------------------------------------------------------------------------------------- Received on 03-10-2021 Accepted on 23-02-2022 The objective of the study was to study the relationship of BMD with parity and ethnicity in Pakistani women. METHODOLOGY After receiving approval from Ziauddin University's Ethics Review Committee, this cross-sectional study was done in first half of 2017 at the Department of Nuclear Medicine, Ziauddin Hospital, Clifton Campus, Karachi. 200 females over the age of forty were recruited from Ziauddin Hospital's Gynecology OPD using a consecutive sampling technique. Patients with any prior diagnosis or treatment for osteoporosis, malignancies with bone metastases, or with a history of oophorectomy with or without hysterectomy, as well as pregnant females, were excluded. All participants' height, weight, and BMI were measured after they gave their informed consent. All participants were questioned and given a questionnaire that included demographic information as well as risk factors for low BMD. The Hologic Discovery Wi (S/N 88577) DXA Scanner was used to do DXA scanning and calculate BMD. The hip, spine (L1 to L4), and 33 percent of the distal forearm (one third radius) were used to determine BMD. According to WHO standards, the lowest T score found for any of the three tested sites was used to diagnose low BMD. According to the guidelines of International Society for Clinical Densitometry (ISCD) criteria, participants were categorized as normal, osteopenic, or osteoporotic. T scores, which represent the standard deviations difference by which the measured BMD differs from the mean BMD of a comparable gender young adult, were used to categorize postmenopausal women. For premenopausal females, Z scores were employed. Normal ladies with a T score of -1 SD, osteopenic females with a T score of -1 to -2.5, and osteoporotic females with a T score of 2.5 SD were the three groups of postmenopausal women studied. On the basis of Z score, premenopausal females were separated into two groups: normal BMD (Z score up to 1.9 SD) and low BMD (Z score -2 SD). Statistical analysis: SPSS version 20 was used for data analysis. For defining the characteristics of sample, descriptive statistics (means, standard deviations, frequencies and percentages) were used. Mean and Standard Deviation were calculated for quantitative variables (age, menopausal age, height, weight, BMI, BMD and T-score for Hip, Spine, Forearm and Femoral neck). Frequencies and percentages were calculated for qualitative variables (BMD status, ethnicity, parity, menstrual status). Chi