International Journal of Current Research and Review
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IJCRR - 14(1), January, 2022

Pages: 46-56

Date of Publication: 03-Jan-2022


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Effects of Endocrine Disorders on Bone Mineral Density - A Narrative Review of Literature

Author: Ranjani Thillaigovindan, Vetriselvan Abirami, Ponsekar Abraham

Category: Healthcare

Abstract:Introduction: Hormones are primary messengers that regulate the physiological and behavioral aspects of the body. Bone, a dynamic connective tissue, forms the framework of the body alongside its contribution in maintaining homeostasis and hosting the bone marrow. Disturbances in hormonal levels disrupt bone health thereby leading to impaired quality of life. Aim: To encapsulate the effects of various endocrine disorders on bone mineral density based on previous clinical studies. Methodology: An electronic search was conducted across PubMed, EMBASE, CINAHL, Google Scholar and Cochrane databases during the period of March to July 2021 by two reviewers independently using Medical Subject Headings (MeSH) terms. Result: The search yielded a total of 208 articles and further screening based on selection criteria resulted in inclusion of 19 studies to elicit the effects of commonly prevalent endocrine disorders on bone mineral density. Studies revealed that most hormonal imbalances have a negative impact on the bone mineral density (BMD) at varying degrees. Conclusion: Endocrine disorders have become highly prevalent at present deteriorating the life standards, especially the middle-aged and elderly population. Any disruption in this normality will lead to altered bone mineral density and further risks of fracture or immobility. Constant monitoring of hormonal levels and bone health is required to enhance the quality of living alongside an increased life expectancy.

Keywords: Endocrine disorders, Bone Mineral Density, Parathormone, Diabetes Mellitus, Calcitonin, Hormones

Full Text:

INTRODUCTION

The endocrine system is composed of various glands that secrete a set of chemical messengers called hormones, which are instrumental in regulating growth and development, metabolism, electrolyte balance, reproduction and several other important functions.1 The terms endocrine and hormone are derived from Greek words ‘endokrinein’ and ‘hormaein’ respectively. The actual word hormone meant ‘to arouse’ or ‘to excite’, which was later defined by Starling (1905) as “the chemical messengers which speed from cell to cell along the bloodstream, may coordinate the activities and growth of different parts of the body”.2 The endocrine system is principally controlled by the hypothalamus which secretes the releasing and inhibiting hormones that in turn influence the release of stimulating hormones from the pituitary gland.1 These hormones released into the bloodstream may stimulate other glands or directly target distant tissues to bring about cellular changes. Hormonal imbalance, per se, has become a quotidian term in recent times, and is reported with a high incidence rate. Various physical, psychological and social stresses in day-to-day life have had an adverse impact on the endocrine system leading to multiple systemic manifestations.3 It has led to a growing concern to keep a watch over the hormonal levels not only among the elderly but also among the younger age groups. There is a need to reinstate the former ways of living, with appropriate diet balance, adequate exercise and a relaxed state of mind, body and soul in order to maintain a healthy life. This requires serious attention in maintaining good bone health in order to sustain a quality living. 

METHODOLOGY

An electronic search was conducted across PubMed, EMBASE, CINAHL, Google Scholar and Cochrane databases during the period of March to July 2021 by the two reviewers independently. The search methodology used a combination of Medical Subject Headings (MeSH) words and keywords such as "Type 2 Diabetes mellitus", "Estrogen disorders", "Vitamin D deficiency", "Osteoporosis", "Parathormone", "Thyroid disorders" AND "Bone mineral density "considering synonyms, alternative spelling, and related terms. 

Inclusion criteria                    

  1. Articles published dating from 1999 to 2020

  2. Clinical trials on humans, cross-sectional retrospective or prospective studies 

  3. Studies assessing the effects of Type II Diabetes Mellitus, Estrogen, Vitamin D, Osteoporosis, Parathormone & Thyroid dysfunction on bone mineral density.

  4. Gender neutral as well as gender-specific studies included

  5. Studies done on adult participants alone

Exclusion Criteria

  1. Animal trials, In-vitro studies, Case reports, Literature or Systematic reviews

  2. Population having any comorbidities or multiple factors affecting bone mineral density.

  3. Studies that had methods of measuring bone quality other than Bone mineral density.

  4. Publications made in languages other than English

A structured electronic search was conducted by two reviewers independently using the Keywords and MeSH terms yielding a total of 208 articles. Initial screening consisted of a check for duplication during which a total of 56 articles were excluded based on the titles and authors. This was followed by assessment of title and abstract based on article type which led to the exclusion of 73 articles. The final phase of screening involved full text reading based on selection criteria and exclusion of 60 articles was done. A total of 19 studies were included for the final review. The search methodology has been summarized in Figure 1. 

PHYSIOLOGICAL BONE REMODELLING

Bone is a highly dynamic connective tissue that undergoes constant remodeling throughout the lifetime. It serves two crucial roles, provision of skeletal support and maintenance of mineral homeostasis. Bone contains three major types of differentiated cells, namely the osteoblasts or the bone-forming cells, osteocytes and the osteoclast or bone-resorbing cells. Bone rigidity and density depends on the deposition of calcium and phosphorus as hydroxyapatite during mineralization. The inorganic content composed of the minerals sum up to 70% while the remaining 30% consist of organic matter, especially Type 1 collagen. The outer layer consists of a dense cortical bone that provides structural support while the inner trabecular bone forms the reservoir for the bone marrow hosting the active process of bone remodeling.4 Bone remodeling is a sequence of seven phases: quiescence, activation, resorption, reversal, formation, mineralization and termination. This activity of deposition and resorption is influenced by local and systemic factors. The major role is played by the systemic factors that include hormones and growth factors. The list of hormones and growth factors that majorly affect the remodeling of bone is mentioned in (Table 1).

BONE MINERAL DENSITY (BMD)

Bone mineral density, in the literal sense, would mean the mass per unit volume of mineralized bone without the organic portion or adjacent tissue. But clinical investigations simply reveal the apparent bone mineral density inclusive of the bone marrow and the overlying tissues. However, bone mineral density is a reliable and non-invasive biophysical parameter that aids in measuring bone quality. It is one of the major diagnostic tools for bone disorders like osteopenia, osteoporosis etc. Investigatory techniques for determining the BMD include: (i) Dual energy X-Ray absorptiometry (DXA), (ii) Single energy absorptiometry (SXA), (iii) Quantitative Computed Tomography (QCT), (iv) High-resolution peripheral quantitative computed tomography (HR-pQCT), (v) Peripheral quantitative computed tomography (pQCT) and (vi) Quantitative Ultrasonography (QUS). DXA is the most popularly used technique for the assessment of BMD, which operates by propagation of two low dose X-ray that provide the density profiles of hard and soft tissues thereby aiding in determination of BMD. Measurements are commonly done at four sites namely, lumbar spine, femoral neck, trochanteric region and Ward’s triangle.

The most widely accepted parameter for measuring the BMD is the T-score, which is a unitless value that is calculated as a ratio of the difference between the observed bone mineral density (BMD) and the expected young normal value (YN) to the standard deviation of the population. It is used to compare the BMD of an individual with the healthy, young population of the same gender.

According to WHO5, four general diagnostic categories had been established for women as follows:

1. Normal: Value of BMD within 1 SD below the young adult reference mean (T-score ≥ -1)

2. Low bone mass (osteopenia): Value of BMD ranging from 1 to 2.5 SD below the young adult mean (T-score < -1 and > -2.5)

 3. Osteoporosis: Value of BMD more than or equal to 2.5 SD below the young normal (T-score ≤ -2.5)

4. Severe osteoporosis: Value of BMD more than 2.5 SD below young adult mean (T-score ≤ 2.5) with the presence of one or more fragility fractures.

While yet another scoring system is the Z-score that compares the BMD of two individuals of the same age and gender. It aids in determining the presence of secondary causes of osteoporosis which is indicated when the score goes below -2.5.

A constant monitoring of the BMD among various age groups that are commonly vulnerable to bone fragility due to endocrine disorders is required in order to prevent disabilities in early stages. Women of perimenopausal age groups and infants lacking adequate nourishment are to be treated with special care to prevent the occurrence of endocrine disorders. Hormones are governed by various internal as well as external factors of which diet, livelihood as well as state of mind plays a crucial role in balancing the homeostasis. Hence, it is necessary to sustain a healthy way of living for a quality life.

ENDOCRINE DISORDERS AND BONE MINERAL DENSITY

  1. PARATHORMONE

There are normally two pairs of parathyroid glands, namely, the superior and inferior parathyroid situated in the posterior aspect of the two lobes of thyroid gland. Although the parathyroid glands are small in size, they secrete parathormone that plays a crucial role in Calcium homeostasis. Parathormone (PTH) acts as a scavenger of Calcium ions thereby maintaining a high serum Calcium level by resorbing the bone, preventing loss of Calcium ion through urine and also increasing the intestinal absorption of dietary Calcium ions. PTH acts by induction of osteoclast formation that is mediated through the osteoblast by stimulation of RANKL and inhibition of OPG mRNA expression.6 The release of Parathormone normally occurs when there is a decrease in normal serum Calcium levels. Increased level of parathormone in blood leads to bone resorption in order to raise the serum Calcium levels thereby decreasing the bone mineral density.

  1. CALCITONIN

Calcitonin is secreted from the parafollicular cells of the thyroid gland that couples with PTH in order to maintain calcium homeostasis in blood. Calcitonin has a hypocalcemic effect that counteracts the activity of parathormone. The normal serum Calcium levels range from 8.5 to 11.5mg/dl. Calcitonin acts by binding to specific receptors located at the sealing area leading to the loss of ruffled border of the osteoclasts required for resorbing bone surface.7 These receptors are known as Calcitonin Receptors (CTR) which cause loss of mobility of osteoclasts (Q-effect) and also lead to retraction (R-effect). Calcitonin acts by two known signaling mechanisms: one using cyclic adenosine monophosphate (cAMP) as the secondary messenger and the other using phospholipase C pathway that aids in influx of serum calcium ions promoting bone deposition.8 Calcitonin is usually absent or deficient in patients who have undergone thyroidectomy, which often leads to decreased serum calcium levels, decreased PTH levels and reduced bone formation rates. Capelli et al. 9 reported that osteocalcin showed decreased bone formation with an increased turnover rate signified by the presence of resorption markers like deoxypyridinoline and N-terminal telopeptide of type I collagen thereby decreasing the bone mineral density.

  1. VITAMIN D

Vitamin D is a fat soluble vitamin that is also categorized under steroid hormones since its active form is synthesized in the body. Vitamin D is obtained from the exposure of skin to Ultraviolet rays of sunlight. It undergoes hydroxylation in the liver initially to form 25-hydroxyvitamin D (25(OH)D) and later in the kidney to form an active metabolite as 1,25-dihydroxyvitamin D (1,25(OH)2D). Vitamin D plays a major role in Calcium and bone homeostasis and has an inverse relation with PTH levels in the blood, thereby counteracting the effects of PTH. Vitamin D binds to the Vitamin D receptor (VDR) on the osteoblasts that increases the Receptor Activator for Nuclear Factor κB Ligand (RANKL) expression which in turn leads to the binding of RANK on the preosteoclasts. This aids in the conversion of preosteoclasts into mature osteoclasts which release hydrochloric acid that demineralize bone.10Chronic vitamin D insufficiency results in hypocalcemia and hyperparathyroidism, thereby a lowered bone mineral density which can contribute to high incidence of osteoporosis and fractures especially in the elderly population. Epidemiological studies by Palacios C et al. 11 show that in the United States having vitamin D deficiency sum up to 35% of the total adult population while Pakistan, India, and Bangladesh show about 80% prevalence. Meanwhile, the prevalence of Vitamin D among the elderly population relates to aboutn61% in the United States, 90% in Turkey, 96% in India, 72% in Pakistan, and 67% in Iran. Hence Vitamin D levels need to be monitored constantly over age. Khadijeh J. Menai et al., in a study assessing the effect of Vitamin D on performance of adult footballers revealing its extended relation on skeletal muscle due the necessity of Vitamin D3 on maintaining serum Calcium levels that aid in adequate contraction of skeletal muscle.12

  1. ESTROGEN

Estrogen is an important sex hormone produced predominantly from the ovaries in females and present in trace amounts in males. Apart from its role in regulating the human reproductive system, it also has its influence on the bone, neuroendocrine and adipose tissues. Estrogen has a down regulatory effect on tumor necrosis factor-α (TNF-α), Interleukin-1 and 6 (IL-1, IL-6), Macrophage Colony Stimulating Factor (M-CSF) and prostaglandin-E2 (PGE2) that leads to decreased resorption. Estrogen acts on the bone by modulating both osteoclast and osteoblast cells, which result in inhibition of RANKL/M-CSF induced activator protein-1-dependent transcription, thereby preventing osteoclast differentiation.6 Vargas et al.13 found that TNF-α is the most important mediator in bone resorption by experimenting on TNF-Receptor 1 (TNF-R1) deficient mice which resulted in normal bone physiology even under estrogen deficiency. Post-menopausal women experience a rapid drop in the levels of estrogen produced by the body often leading to osteoporosis and risks of fracture due to the increased activity of the osteoclast stimulating factors and decreased bone mineral density. 

  1. INSULIN

Insulin, a polypeptide hormone secreted by the pancreas plays a crucial role in regulating glucose levels in blood. It is the only hypoglycemic hormone synthesized by the human body. The normal serum insulin level ranges between 6-15µIU/ml. Diabetes mellitus (DM) is of two types: Insulin-dependent DM (Type I DM) and Non-Insulin dependent DM (Type II DM). Type II DM is highly prevalent among the adult population accounting for 85% of the total diabetic population,14 while Type I DM, which is often a hereditary type, has a trail of concrete evidence in causing retinopathy, neuropathy, cardiovascular disorders, periodontal problems and many other complications. However, studies in recent years revealing the effects of insulin on bone metabolism have led to further prospective research to establish the exact correlation. Wang et al. 15 reported that insulin acted by reducing the osteoprotegerin(OPG) to RANKL ratio, thereby decreasing the osteoblastic and osteoclastic activity in bone resorption. Hence a decrease in insulin leads to Further, hyperglycemia may also induce the formation of advanced glycation end-products (AGEs) through non-enzymatic pathways which have a negative effect on bone quality, affecting the extracellular matrix and the vessels by increasing osteocytic expression of sclerostin, a negative regulator of bone formation.16

  1. THYROID HORMONE

The thyroid is a butterfly-shaped gland that is normally bilobed and is connected by an isthmus. Histologically, it consists of the follicular cells that secrete thyroxine (T4) and triiodothyronine (T3) and the parafollicular cells which secrete Calcitonin, the release of which is regulated by the Thyroid Stimulating Hormone(TSH) secreted from the pituitary gland. Thyroid hormones play a major role in maintaining basal metabolism. Its effect on bone density is still a debatable topic till date. Studies have stated that hypothyroidism reduces osteoblast formation and thereby increases the rate of osteoclastic resorption resulting in a slowed bone remodeling process.6 On the other hand hyperthyroidism increases osteoblast and osteoclast activity raising the bone turnover with an impaired bone formation cycle favoring rapid resorption. In adults, hyperthyroidism leads to reduced bone mineral density (BMD), and increased fracture risk, especially in postmenopausal women. 

  1. GLUCOCORTICOIDS

Glucocorticoids are a class of steroid hormones that are secreted from the zona fasciculata region of the adrenal cortex. They play an important role in immunosuppression as well as metabolic activities. Excess glucocorticoids decrease the bone remodeling rate primarily by reducing the levels of gonadotropins causing an estrogen-deficient state. This results in elevated levels of tumor necrotizing factor-α (TNF-α), increased RANK-RANKL interaction alongside colony-stimulating factor (CSF-1) stimulating osteoclastogenesis and suppressing osteoprotegerin (OPG), a decoy receptor.17 Glucocorticoids are also known to stimulate the release of matrix metalloproteinases (MMPs) that destroy the collagen matrix of bone leading to further resorption. Weinstein et al.18 reported that increased levels of glucocorticoids also destroy the osteoblast progenitor cells immensely compared to osteoclast precursors. 

  1. GROWTH HORMONE

Growth hormone (GH) or somatotropin is a protein hormone made of 190 amino acids and is synthesized and secreted from the adenohypophysis or anterior pituitary gland. It is controlled by Growth hormone-releasing hormone (GHRH) that stimulates the secretion of GH from the pituitary and Somatostatin (SS) counteracts the GHRH by inhibiting the secretion of GH. Ghrelin is yet another peptide hormone secreted by the epithelial cells of the stomach that binds to the growth hormone secretagogue receptor (GHS-R) of somatotroph cells that aids in the synthesis and secretion of GH. GH acts through either direct or indirect mechanisms on the target cells. GH acts on the bone majorly through Insulin-like Growth factor (IGF1& IGF2) that induce chondrocyte proliferation and differentiation as well as increase the formation of osteoblasts thereby, their activity by OPG expression. They also enhance calcium and phosphate absorption by increasing the activity of calcitriol (D3), thereby elevating the rate of reabsorption of phosphate in the renal tubules.19 This in turn increases the bone mineral density by increasing the bone mineralization. Murray et al. 20 conducted a study with 125 adults having growth hormone deficiency (GHD) revealing higher number of younger adults (<30 year) having a BMD Z-score < -2.0   compared to the older patients (30 to 40, 40 to 60, >60 years) denoting that the effect of GHD on BMD was less severe among the elderly. This causes an increased risk of fracture of the long bones as well as vertebral column. While in acromegaly, a state of excess GH production in the adults, the bone turnover rate was higher with increased formation and resorption as well as increased bone mineral density at the femoral neck region compared to insignificant change in lumbar spine region as reported by Maffezzoni et al.21 which also results in high rates of vertebral fractures especially in males with hypogonadism. 

DISCUSSION

Endocrine disorders, once widely been considered as hereditary disorders, have now become a common encounter in the medical field with changing lifestyles disrupting the circadian rhythm and basal metabolism of the body. Apart from their effects on growth, development and regulation of homeostasis, their role in balancing the dynamic remodeling of bone tissue and serum Calcium levels which in turn aid in preserving the functional state of the body. The most commonly prevalent endocrine disorders among the general adult population include Type II diabetes mellitus, hypovitaminosis of VITAMIN D, thyroid and parathyroid disorders among the general population and estrogen deficiency disorders and osteoporosis common among post-menopausal women as listed in Table 2.

Type II Diabetes Mellitus (T2DM) has become an ubiquitous metabolic disorder of the present age, threatening the overall health having a long trail of comorbidities affecting most of the organs. Many studies have been done on the adult population assessing the effect of Insulin-resistant diabetes on bone mineral density. Isaiah et al.22 and Gerdhem et al.23 had illustrated a decrease in BMD in patients with T2DM compared to the healthy control groups. In contrast to these results, Bonds et al.24 and Schwartz et al.25 demonstrated an increase in BMD with increased risks of fractures. These are common in both male and female populations though the women of perimenopausal age have a higher predilection for bone disorders with multiple risk factors in play.

The role of sex hormones on bone remodeling has been undoubtedly proven by many. Studies by Ho Pham et al.26 revealed that the effects of Estrogen levels on BMD are more pronounced compared to the Testosterone levels thereby reasserting the risk of decreased BMD with reducing estrogen levels among post-menopausal women when compared to the men of similar age. Cauley et al.27 and Popat et al.28 expressed the direct positive correlation between Estrogen levels and BMD and also proved that supplements of Estrogen combined with Progestin greatly improved the BMD and reduced the risks of fractures.

Hypovitaminosis of Vitamin D3 commonly measured in its active form as Calcitriol that was once a concern among countries that are located at the tropical or temperate zones with insufficient exposure to sunlight has now become common among the population in equatorial regions due to the growing sedentary lifestyles inside closed, non-ventilated rooms. Studies by Arya et al.29 and Grados et al.30 reveal that there is a decrease in BMD with decrease in serum Vitamin D levels and vice versa that is contrary to the findings of Brot et al.31 who stated that there was an increased bone turnover with increase in Vitamin D3 levels thereby decreasing the BMD. Aloia et al.32 and Nieves et al.33 demonstrated that there were no significant changes in the BMD with Vitamin D3 supplements.

Siris et al.34 and Pressman et al.35 demonstrated the inverse relation between the severity and chronicity of osteoporosis with the BMD, with high female predisposition increasing the risks of fracture in long bones among post-menopausal women. Osteoporosis has perturbed the health status among the older population thereby resulting in disabilities. Rathod et al. states that Indian studies show the risk of skeletomuscular disorders in post-menopausal women while vasomotor complications are evident in peri-menopausal women.36

Parathyroid disorders usually occur secondary to the discrepancies occuring in thyroid glands resulting in removal of parathyroids during thyroidectomy. Neer et al.37 and Hodsman et al.38 demonstrated the positive correlation between parathormone levels and BMD. Parathormone replacement therapy has proven highly efficient in improvising bone quality.

Thyroid disorders have been rising over the current age due to stress levels and dietary habits. Not many studies have been done to clearly elicit the effect of thyroid dysfunction on BMD, and there are various schools of thought regarding the correlation of serum thyroxine levels on bone quality. Tuchendler et al.39 illustrated a decrease in BMD level among those with hyperthyroidism compared with the hypothyroid group and control group. Jodar et al.40 demonstrated a mild deleterious effect of endogenous and exogenous thyroid hormone excess in the axial bone mass with an evident decrease in BMD in male subjects. Further Vestergaard et al.41 studied a rise in fracture risk hyperthyroidism and hypothyroidism and also thyroid surgery in hyperthyroid patients revealed a decreased fracture risk.

Various states of hormonal imbalance have led to impediment of regular activities among adults. Endocrine disorders that are acquired with age are a global concern and require constant monitoring of health status that are often neglected until impairments set in. A nation’s progress hugely depends on the accessibility and affordability of health care services to its people. Bone health apart from general health has a greater impact on the quality of living, which needs to be assessed and kept track of. This narrative review asserts the effects of endocrinology on bone health therefore, any disturbance in the hormonal levels requires serious attention. Further studies with wider perspectives are required to determine the exact mechanism of action of each hormone on bone health. 

CONCLUSION

Apart from their roles in growth and development, hormones play an undoubtedly important role in maintaining the homeostasis of the body vis-à-vis bone health. The bone health in turn is determined by means of measuring the bone mineral density. Endocrine disorders that were once considered as the diseases of old have now become prevalent among the younger generations due to nutritional deficiency, dietary changes, comfortable standards of living as well as increased levels of stress due to work, education and in sustaining a good living. The focus has diverted from a healthy life to a wealthy life, leaving behind ailments among all age groups. A constant record of bone health is important to avoid bone fragility resulting in morbidities among the population, especially in post-menopausal women. 

 Acknowledgement:

Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.

Conflict of Interest: Nil

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  41. Vestergaard P, Mosekilde L. Fractures in patients with hyperthyroidism and hypothyroidism: a nationwide follow-up study in 16,249 patients. Thyroid. 2002 May 1;12(5):411-9.

Announcements

Dr. Pramod Kumar Manjhi joined Editor-in-Chief since July 2021 onwards

COPE guidelines for Reviewers

SCOPUS indexing: 2014, 2019 to 2021


Awards, Research and Publication incentive Schemes by IJCRR

Best Article Award: 

One article from every issue is selected for the ‘Best Article Award’. Authors of selected ‘Best Article’ are rewarded with a certificate. IJCRR Editorial Board members select one ‘Best Article’ from the published issue based on originality, novelty, social usefulness of the work. The corresponding author of selected ‘Best Article Award’ is communicated and information of award is displayed on IJCRR’s website. Drop a mail to editor@ijcrr.com for more details.

Women Researcher Award:

This award is instituted to encourage women researchers to publish her work in IJCRR. Women researcher, who intends to publish her research work in IJCRR as the first author is eligible to apply for this award. Editorial Board members decide on the selection of women researchers based on the originality, novelty, and social contribution of the research work. The corresponding author of the selected manuscript is communicated and information is displayed on IJCRR’s website. Under this award selected women, the author is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.

Emerging Researcher Award:

‘Emerging Researcher Award’ is instituted to encourage student researchers to publish their work in IJCRR. Student researchers, who intend to publish their research or review work in IJCRR as the first author are eligible to apply for this award. Editorial Board members decide on the selection of student researchers for the said award based on originality, novelty, and social applicability of the research work. Under this award selected student researcher is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.


Best Article Award

A Study by Humaira Tahir et al. entitled "Comparison of First Analgesic Demand after Major Surgeries of Obstetrics and Gynecology between Pre-Emptive Versus Intra-Operative Groups by Using Intravenous Paracetamol: A Cross-Sectional Study" is awarded Best Article for Vol 14 issue 14
A Study by Monica K. entitled "Risk Predictors for Lymphoma Development in Sjogren Syndrome - A Systematic Review" is awarded Best Article for Vol 14 issue 13
A Study by Mokhtar M Sh et al. entitled "Prevalence of Hospital Mortality of Critically Ill Elderly Patients" is awarded Best Article for Vol 14 issue 12
A Study by Vidya S. Bhat et al. entitled "Effect of an Indigenous Cleanser on the Microbial Biofilm on Acrylic Denture Base - A Pilot Study" is awarded Best Article for Vol 14 issue 11
A Study by Pandya S. et al. entitled "Acute and 28-Day Repeated Dose Subacute Toxicological Evaluation of Coroprotect Tablet in Rodents" is awarded Best Article for Vol 14 issue 10
A Study by Muhammad Zaki et al. entitled "Effect of Hemoglobin Level on the Severity of Acute Bronchiolitis in Children: A Case-Control Study" is awarded Best Article for Vol 14 issue 09
A Study by Vinita S & Ayushi S entitled "Role of Colour Doppler and Transvaginal Sonography for diagnosis of endometrial pathology in women presenting with Abnormal Uterine Bleeding" is awarded Best Article for Vol 14 issue 08
A Study by Prabhu A et al. entitled "Awareness of Common Eye Conditions among the ASHA (Accredited Social Health Activist) Workers in the Rural Communities of Udupi District- A Pilot Study" is awarded Best Article for Vol 14 issue 07
A Study by Divya MP et al. entitled "Non-Echoplanar Diffusion-Weighted Imaging and 3D Fiesta Magnetic Resonance Imaging Sequences with High Resolution Computed Tomography Temporal Bone in Assessment and Predicting the Outcome of Chronic Suppurative Otitis Media with Cholesteatoma" is awarded Best Article for Vol 14 issue 06
A Study by Zahoor Illahi Soomro et al. entitled "Functional Outcomes of Fracture Distal Radius after Fixation with Two Different Plates: A Retrospective Comparative Study" is awarded Best Article for Vol 14 issue 05
A Study by Ajai KG & Athira KN entitled "Patients’ Gratification Towards Service Delivery Among Government Hospitals with Particular Orientation Towards Primary Health Centres" is awarded Best Article for Vol 14 issue 04
A Study by Mbungu Mulaila AP et al. entitled "Ovarian Pregnancy in Kindu City, D.R. Congo - A Case Report" is awarded Best Article for Vol 14 issue 03
A Study by Maryam MJ et al. entitled "Evaluation Serum Chemerin and Visfatin Levels with Rheumatoid Arthritis: Possible Diagnostic Biomarkers" is awarded Best Article for Vol 14 issue 02
A Study by Shanthan KR et al. entitled "Comparison of Ultrasound Guided Versus Nerve Stimulator Guided Technique of Supraclavicular Brachial Plexus Block in Patients Undergoing Upper Limb Surgeries" is awarded Best Article for Vol 14 issue 01
A Study by Amol Sanap et al. entitled "The Outcome of Coxofemoral Bypass Using Cemented Bipolar Hemiarthroplasty in the Treatment of Unstable Intertrochanteric Fracture of Femur in a Rural Setup" is awarded Best Article Award of Vol 13 issue 24
A Study by Manoj KP et al. entitled "A Randomized Comparative Clinical Trial to Know the Efficacy of Ultrasound-Guided Transversus Abdominis Plane Block Against Multimodal Analgesia for Postoperative Analgesia Following Caesarean Section" is awarded Best Article Award of Vol 13 issue 23
A Study by Karimova II et al. entitled "Changes in the Activity of Intestinal Carbohydrases in Alloxan-Induced Diabetic Rats and Their Correction with Prenalon" is awarded Best Article of Vol 13 issue 22
A Study by Ashish B Roge et al. entitled "Development, Validation of RP-HPLC Method and GC MS Analysis of Desloratadine HCL and It’s Degradation Products" is awarded Best Article of Vol 13 issue 21
A Study by Isha Gaurav et al. entitled "Association of ABO Blood Group with Oral Cancer and Precancer – A Case-control Study" is awarded Best Article for Vol 13 issue 20
A Study by Amr Y. Zakaria et al. entitled "Single Nucleotide Polymorphisms of ATP-Binding Cassette Gene(ABCC3 rs4793665) affect High Dose Methotrexate-Induced Nephrotoxicity in Children with Osteosarcoma" is awarded Best Article for Vol 13 issue 19
A Study by Kholis Ernawati et al. entitled "The Utilization of Mobile-Based Information Technology in the Management of Dengue Fever in the Community Year 2019-2020: Systematic Review" is awarded Best Article for Vol 13 issue 18
A Study by Bhat Asifa et al. entitled "Efficacy of Modified Carbapenem Inactivation Method for Carbapenemase Detection and Comparative Evaluation with Polymerase Chain Reaction for the Identification of Carbapenemase Producing Klebsiella pneumonia Isolates" is awarded Best Article for Vol 13 issue 17
A Study by Gupta R. et al. entitled "A Clinical Study of Paediatric Tracheostomy: Our Experience in a Tertiary Care Hospital in North India" is awarded Best Article for Vol 13 issue 16
A Study by Chandran Anand et al. entitled "A Prospective Study on Assessment of Quality of Life of Patients Receiving Sorafenib for Hepatocellular Carcinoma" is awarded Best article for Vol 13 issue 15
A Study by Rosa PS et al. entitled "Emotional State Due to the Covid – 19 Pandemic in People Residing in a Vulnerable Area in North Lima" is awarded Best Article for Vol 13 issue 14
A Study by Suvarna Sunder J et al. entitled "Endodontic Revascularization of Necrotic Permanent Anterior Tooth with Platelet Rich Fibrin, Platelet Rich Plasma, and Blood Clot - A Comparative Study" is awarded Best Article for Vol 13 issue 13
A Study by Mona Isam Eldin Osman et al. entitled "Psychological Impact and Risk Factors of Sexual Abuse on Sudanese Children in Khartoum State" is awarded Best Article for Vol 13 issue 12
A Study by Khaw Ming Sheng & Sathiapriya Ramiah entitled "Web Based Suicide Prevention Application for Patients Suffering from Depression" is awarded Best Article for Vol 13 issue 11
A Study by Purushottam S. G. et al. entitled "Development of Fenofibrate Solid Dispersions for the Plausible Aqueous Solubility Augmentation of this BCS Class-II Drug" is awarded Best article for Vol 13 issue 10
A Study by Kumar S. et al. entitled "A Study on Clinical Spectrum, Laboratory Profile, Complications and Outcome of Pediatric Scrub Typhus Patients Admitted to an Intensive Care Unit from a Tertiary Care Hospital from Eastern India" is awarded Best Article for Vol 13 issue 09
A Study by Mardhiah Kamaruddin et al. entitled "The Pattern of Creatinine Clearance in Gestational and Chronic Hypertension Women from the Third Trimester to 12 Weeks Postpartum" is awarded Best Article for Vol 13 issue 08
A Study by Sarmila G. B. et al. entitled "Study to Compare the Efficacy of Orally Administered Melatonin and Clonidine for Attenuation of Hemodynamic Response During Laryngoscopy and Endotracheal Intubation in Gastrointestinal Surgeries" is awarded Best Article for Vol 13 issue 07
A Study by M. Muthu Uma Maheswari et al. entitled "A Study on C-reactive Protein and Liver Function Tests in Laboratory RT-PCR Positive Covid-19 Patients in a Tertiary Care Centre – A Retrospective Study" is awarded Best Article of Vol 13 issue 06 Special issue Modern approaches for diagnosis of COVID-19 and current status of awareness
A Study by Gainneos PD et al. entitled "A Comparative Evaluation of the Levels of Salivary IgA in HIV Affected Children and the Children of the General Population within the Age Group of 9 – 12 Years – A Cross-Sectional Study" is awarded Best Article of Vol 13 issue 05 Special issue on Recent Advances in Dentistry for better Oral Health
A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" is awarded Best Article of Vol 13 issue 06
A Study by Chen YY and Ghazali SRB entitled "Lifetime Trauma, posttraumatic stress disorder Symptoms and Early Adolescence Risk Factors for Poor Physical Health Outcome Among Malaysian Adolescents" is awarded Best Article of Vol 13 issue 04 Special issue on Current Updates in Plant Biology to Medicine to Healthcare Awareness in Malaysia
A Study by Kumari PM et al. entitled "Study to Evaluate the Adverse Drug Reactions in a Tertiary Care Teaching Hospital in Tamilnadu - A Cross-Sectional Study" is awarded Best Article for Vol 13 issue 05
A Study by Anu et al. entitled "Effectiveness of Cytological Scoring Systems for Evaluation of Breast Lesion Cytology with its Histopathological Correlation" is awarded Best Article of Vol 13 issue 04
A Study by Sharipov R. Kh. et al. entitled "Interaction of Correction of Lipid Peroxidation Disorders with Oxibral" is awarded Best Article of Vol 13 issue 03
A Study by Tarek Elwakil et al. entitled "Led Light Photobiomodulation Effect on Wound Healing Combined with Phenytoin in Mice Model" is awarded Best Article of Vol 13 issue 02
A Study by Mohita Ray et al. entitled "Accuracy of Intra-Operative Frozen Section Consultation of Gastrointestinal Biopsy Samples in Correlation with the Final Histopathological Diagnosis" is awarded Best Article for Vol 13 issue 01
A Study by Badritdinova MN et al. entitled "Peculiarities of a Pain in Patients with Ischemic Heart Disease in the Presence of Individual Combines of the Metabolic Syndrome" is awarded Best Article for Vol 12 issue 24
A Study by Sindhu Priya E S et al. entitled "Neuroprotective activity of Pyrazolone Derivatives Against Paraquat-induced Oxidative Stress and Locomotor Impairment in Drosophila melanogaster" is awarded Best Article for Vol 12 issue 23
A Study by Habiba Suhail et al. entitled "Effect of Majoon Murmakki in Dysmenorrhoea (Usre Tams): A Standard Controlled Clinical Study" is awarded Best Article for Vol 12 issue 22
A Study by Ghaffar UB et al. entitled "Correlation between Height and Foot Length in Saudi Population in Majmaah, Saudi Arabia" is awarded Best Article for Vol 12 issue 21
A Study by Siti Sarah Binti Maidin entitled "Sleep Well: Mobile Application to Address Sleeping Problems" is awarded Best Article for Vol 12 issue 20
A Study by Avijit Singh"Comparison of Post Operative Clinical Outcomes Between “Made in India” TTK Chitra Mechanical Heart Valve Versus St Jude Mechanical Heart Valve in Valve Replacement Surgery" is awarded Best Article for Vol 12 issue 19
A Study by Sonali Banerjee and Mary Mathews N. entitled "Exploring Quality of Life and Perceived Experiences Among Couples Undergoing Fertility Treatment in Western India: A Mixed Methodology" is awarded Best Article for Vol 12 issue 18
A Study by Jabbar Desai et al. entitled "Prevalence of Obstructive Airway Disease in Patients with Ischemic Heart Disease and Hypertension" is awarded Best Article for Vol 12 issue 17
A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09

List of Awardees

A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award


A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award


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IJCRR Code of Conduct: To achieve a high standard of publication, we adopt Good Publishing Practices (updated in 2022) which are inspired by guidelines provided by Committee on Publication Ethics (COPE), Open Access Scholarly Publishers Association (OASPA) and International Committee of Medical Journal Editors (ICMJE)

Disclaimer: International Journal of Current Research and Review (IJCRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal.



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International Journal of Current Research and Review (IJCRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal

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