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Associations between adverse social position and bone mineral density in women aged 50 years or older: data from the Manitoba Bone Density Program

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Abstract

Summary

We examined the independent contribution of income to low bone mineral density in women aged 50 years and older. A significant dose–response association was observed between low income and low (bone mineral density) BMD, which was not explained by clinical risk factors or osteoporotic treatment in the year prior.

Introduction

The association between social disadvantage and osteoporosis is attracting increased attention; however, little is known of the role played by income. We examined associations between income and bone mineral density (BMD) in 51,327 women aged ≥50 years from Manitoba, Canada.

Methods

Low BMD was defined as a T-score ≥2.5SD (femoral neck or minimum) measured by dual energy X-ray absorptiometry (DXA) 1996–2001. Mean household income was extracted from Canada Census 2006 public use files and categorized into quintiles. Age, weight and height were recorded at time of DXA. Parental hip fracture was self-reported. Diagnosed comorbidities, including osteoporotic fracture and rheumatoid arthritis, were ascertained from hospital records and physician billing claims. Chronic obstructive pulmonary disease was used as a proxy for smoking and alcohol abuse as a proxy for high alcohol intake. Corticosteroid use was obtained from the comprehensive provincial pharmacy system. Logistic regression was used to assess relationships between income (highest income quintile held as referent) and BMD, accounting for clinical risk factors.

Results

Compared to quintile 5, the adjusted odds ratio (OR) for low BMD at femoral neck for quintiles 1 through 4 were, respectively, OR1.41 (95 %CI 1.29–1.55), OR1.32 (95 %CI 1.20–1.45), OR1.19 (95 %CI 1.08–1.30) and OR1.10 (95 %CI 1.00–1.21). Similar associations were observed when further adjustment was made for osteoporotic drug treatment 12 months prior and when low BMD was defined by minimum T-score.

Conclusions

Lower income was associated with lower BMD, independent of clinical risk factors. Further work should examine whether lower income increases the likelihood of treatment qualification.

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Acknowledgments

The authors are indebted to Manitoba Health for the provision of data (HIPC file number 2012/2013-15). The results and conclusions are those of the authors, and no official endorsement by Manitoba Health is intended or should be inferred. This article has been reviewed and approved by the members of the Manitoba Bone Density Program Committee. SL Brennan is supported by a National Health and Medical Research Council (NHMRC) of Australia Early Career Fellowship (1012472) and a Dyason Fellowship 2012 from The University of Melbourne. LM Lix is supported by a Manitoba Research Chair.

Conflicts of interest

Sharon L Brennan has no disclosures. William D Leslie has served on advisory boards for Novartis, Amgen, Genzyme; received unrestricted research grants from Amgen; received speaker fees from Amgen. Lisa Lix has received an unrestricted research grant from Amgen.

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Authors and Affiliations

  1. NorthWest Academic Centre, The University of Melbourne, Sunshine Hospital, 176 Furlong Road, St Albans, Victoria, 3021, Australia

    S. L. Brennan

  2. Australian Institute for Musculoskeletal Sciences, 176 Furlong Road, St Albans, 3021, Australia

    S. L. Brennan

  3. School of Medicine, Deakin University, Geelong, 3220, Australia

    S. L. Brennan

  4. Department of Medicine, St Boniface Hospital, 409 Tache Avenue, Winnipeg, R2H 2A6, Canada

    W. D. Leslie

  5. Department of Community Health Sciences, University of Manitoba, 750 Bannatyne Avenue, Winnipeg, R3E 0W3, Canada

    L. M. Lix

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  1. S. L. Brennan
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  3. L. M. Lix
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Correspondence to S. L. Brennan.

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Brennan, S.L., Leslie, W.D. & Lix, L.M. Associations between adverse social position and bone mineral density in women aged 50 years or older: data from the Manitoba Bone Density Program. Osteoporos Int 24, 2405–2412 (2013). https://doi.org/10.1007/s00198-013-2311-z

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