or212f-T1

Table 1: Studies cover blood zinc levels.
First author, year	Study design	Setting	Inclusion criteria	Exclusion criteria	Number of subjects (M-F)	Micronutrient serum concentration osteoporosis	Micronutrient serum concentration osteopenia	Micronutrient serum concentration normal	Micronutrient serum reference value	Primary outcomes	Results
Gur A, 2002	Clinical trial	Department of Physical Therapy and Rehabilitation of Dicle University Hospital	Women were eligible for our study if they were 50 years of age or older and in good general health as determined by medical history and routine clinical blood analysis (complete blood counts and differential count)	Women were excluded if they (1) had used any drug or had any disease or condition known to affect bone or calcium metabolism; (2) had taken corticosteroid medications during the previous 6 months; (3) had a history of chronic renal, hepatic, or gastrointestinal disease or lumbar compression fracture; or (4) had evidence of collapsed or focal vertebral sclerosis	100 post- menopausal women: 70 osteoporotic and 30 non-osteoporotic	Zinc serum level : 0.61 ± 0.425 (test pre- supplementation of calcitonin)		Zinc serum level: 1.22 ± 0.31 (test pre- supplementation of calcitonin)		To determine whether the mineral profile was different between 70 osteoporotic and 30 non-osteoporotic postmenopausal women and to evaluate the efficacy of calcitonin therapy for 6 months on these trace minerals in postmenopausal osteoporotic women	Zn levels in the serum of patients with postmenopausal osteoporosis were lower than those in the control group
Okyay E, 2013	Cross- sectional study	Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gyne-cology at Dokuz Eylul University School of Medicine, Izmir, Turkey	Postmenopausal women between age 45 and 80 were included inthe study	Women with a history of drug abuse or alcohol con-sumption (to drink at least ≥ 2 days per week z), and highly intake ofcaffeinated coffee (> 2 cups per day), laboratory tests or radiogra-phy of any bone metabolism disorder were excluded. Any otherdisease or drugs that effect bone metabolism were excluded	728 post- menopausal women	Women at 45-59 years: (p value < 0.05) - L1-L4 OP Zinc (μg/ml): 82.6 ± 21.7 Women at 60-80 years: (p value < 0.05) - L1–L4 OP Zinc (μg/ml): 84.2 ± 17.7		Women at 45-59 years: (p value < 0.05) - L1-L4 non OP Zinc (μg/ml): 88.1 ± 15.8 Women at 60-80 years: (p value < 0.05)- L1-L4 non OP Zinc (μg/ml): 90.3 ± 14.9		To determine the relationship between serum main minerals and postmenopausal osteoporosis.	low serum levels of Zn were independent risk factors for development of OP especially in early menopausal period
Mutlu M, 2007	Cross- sectional study	Orthopaedics Department of the Erciyes University Medical Faculty	Women post-menopausal if they were > 55 years of age and there had been no menstruation for ≥ 6 months prior to entry into the study. Women 50-55 years of age were classified as postmenopausal if their plasma follicle stimulating hormone (FSH) level was > 50 IU/l and their plasma estradiol concentration was < 100 pmol/l		120 post- menopausal women	Zinc (mg/l) 0.47 ± 0.1	Zinc (mg/l) 0.63 ± 0.09	Zinc (mg/l) 0.82 ± 0.13		To investigate the changes of Zinc in osteoporotic, osteopenic and normal postmenopausal women	Mean concentration of zinc were significantly lower in osteoporotic women than in both osteopenic women and normal women. In addition, zinc concentration in osteopenic women were significantly lower than in normal women
Arikan DC, 2011	Case– control study	Department of Gynecology and Obstetrics of the Medical Faculty of Kahramanmaras Sutcu Imam (Kahramanmaras, Turkey)	Natural menopause for more than 6 months	Surgical menopause and secondary osteoporosis or other medical conditions that might affect bone metabolism or trace element status such as kidney disease, diabetes mellitus or drug use (e.g. diuretics). Patients who were treated with bisphosphonates, calcitonin, anabolic steroids, hormone replacement therapy, calcium or vitamin D up to six months before the investigation were also excluded	107 post- menopausal women divided into three groups according to BMD; 35 healthy 37 osteopenic and 35 osteoporotic	Zn (μg/dl) 106.25 ± 36.45	Zn (μg/dl) 116.48 ± 35.46	Zn (μg/dl) 127.53 ± 45.04		To investigate serum zinc (Zn) levels in postmenopausal women with osteoporosis, osteopenia and in healthy controls, and to determine the relationship between Zn and bone mineral density (BMD)	Plasma Zn levels were higher in the healthy group when compared to the osteopenic and osteoporotic groups but the difference was not statistically significant (p > 0.05)
Mahdavi- Roshan, 2015	Cross- sectional study	Rheumatology clinic in Tabriz, Islamic Republic of Iran	women > 50 years old who had been no menstruation for ≥ 6 months prior to entry into the study, having no history of hormone replacement therapy, other bone disease, kidney stones, endocrine disorders or any medical conditions that could influence on the mineral status	use of mineral supplements, having history of hormone replacement therapy, bone disease, kidney stones, endocrine disorders or any medical conditions that could influence on the mineral status.	A total of 51 post- menopausal women		Serum Zinc (μg/dl) 70.44 ± 4.5	Serum Zinc (μg/dl) 63.3 ± 4.8		Investigate and compare the mineral status between osteopenic and osteoporotic postmenopausal women in Tabriz, Islamic Republic of Iran.	No statistically significant differences were observed between the osteopenic and osteoporotic groups with respect to serum levels of zinc
Atik OS, 1983	Case– control study	Department of Orthopedic Surgery of Hacettepe University Hospital.	Osteoporosis for cases and non osteoporosis for controls		22 patients (with senile Osteoporosis and controls)	Zinc in Serum (μg/dl) 53.5 ± 2.8		Zinc in serum (μg/dl) 75.9 ± 4.1		to determine the zinc ion levels in serum and bone tissue of patients with senile osteoporosis.	zinc levels in serum of the patients with senile osteoporosis were lower than those of the control group
Relea P, 1995	Cross- sectional study	Clinic of the Rheumatology Unit of the University Hospital “Princepe de Asturias”, Madrid	No pharmacological treatment, haven’t any condition that might affect calcium metabolism, such as liver disease , diabetes or renal dysfunction		60 post- menopausal women (30 controls and 30 with osteoporosis)	Zinc serum: (mg/dl) 72.7 ± 9.9 [Urinary zinc (μg/g Cr): 5.5 ± 1.9]		Zinc serum: (mg/dl) 74.9 ± 18.4 [Urinary zinc (μg/g Cr): 4,0 ± 2.0]		To evaluate the correlation between the concentrations of plasmatic zinc and urinary zinc with bone mass	Plasma zinc levels did not differ between the women with postmenopausal osteoporosis and the healthy postmenopausal controls, but urinary zinc excretion was higher (p=0.002) in the woman with postmenopausal osteoporosis
LIU SZ, 2009	Cross- sectional study	Xi’an urban area	45 to 65-year-old females of Chinese Han Nationality who had lived in the Xi’an urban area more than 10 years, and had been in natural menopause for more than half a year, with no diseases which might influence bone metabolism, no other severe chronic diseases which needed long-term therapy, no gynecological diseases which could influence the secretion of female sex hormones, and no hormone drugs intake and osteoporosis treatment six months before investigation		290 women	Zn serum (mg/l): 0.9168 ± 0.2557	Zn serum (mg/l): 0.9181 ± 0.3177	Zn serum (mg/l): 0.9345 ± 0.2726		to investigate the correlation between serum macroelement and trace element contents and bone mineral density (BMD) as well as the occurrence of osteoporosis	There exist significant correlations between the contents of serum elements such as calcium, phosphonium, sodium, potassium, magnesium, zinc, iron, copper, and selenium, but no significant differences in these elements contents between the osteoporosis group, osteopenia group, and healthy group