Association between socioeconomic status and bone mineral density in adults: a systematic review
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For most causes of mortality and morbidity, a socioeconomic gradient exists; however, this systematic review identified limited evidence for the role of education on bone mineral density (BMD). Further research is required to build upon the current paucity of data examining influences of socioeconomic status (SES) on BMD, especially in men.
For most causes of mortality and morbidity, a socioeconomic gradient exists, although little is understood of the relationship between BMD and SES. We systematically evaluated evidence of SES as a risk factor for low BMD at the clinically relevant sites of hip and spine in adults.
We conducted a computer-aided search of Medline, EMBASE, CINAHL, and PsychINFO from January 1, 1966 until December 31, 2008. Reviewed studies investigated the relationship between SES parameters of income, education, and occupation, and the level of BMD. Studies were rated based on their methodological quality, and a best-evidence synthesis was used to summarise the results.
One case-control and seven cross-sectional studies were identified for inclusion, of which four cross-sectional studies were high-quality. Best-evidence analysis identified consistent, yet limited, evidence for a positive association between educational attainment and BMD in women. No evidence was available regarding an association between income or occupation and BMD in either gender, or education and BMD in men.
Limited good quality evidence exists for the role that education level may play in BMD levels. Cohort studies are required to examine the relationship between individual SES parameters and BMD in order to identify potential intervention targets.
- Wilkinson RG, Marmot M (1998) Social determinants of health: the solid facts. World Health Organisation, European Region, Copenhagen
- Pincus T, Callahan LF, Burkhauser RV (1987) Most chronic diseases are reported more frequently by individuals with fewer than 12 years of formal education in the age 18–64 United States population. J Chronic Dis 40:865–874 CrossRef
- Mol GD, van de Lisdonk EH, Smits JPJM, van den Hoogen JMP, Bor JHJ, Westert GP (2005) A widening health gap in general practice? Socio-economic differences in morbidity between 1975 and 2000 in The Netherlands. Public Health 119:616–625 CrossRef
- World Health Organisation (2006) Summary of Proceedings. In Commission on the Social Determinants of Health: Fifth Meeting of the Commission on the Social Determinants of Health. Geneva: WHO, Nairobi Kenya.
- Turrell G, L Stanley, M de Looper, B Oldenburg (2006) Health Inequalities in Australia: Morbidity, health behaviours, risk factors and health service use. In Canberra, Queensland University of Technology and the Australian Institute of Health and Welfare.
- la Vecchia C, Negri E, Pagano R, Decarli A (1987) Education, prevalence of disease, and frequency of health care utilisation. The 1983 Italian National Health Survey. J Epidemiol Comm Health 41:161–165 CrossRef
- Australian Institute of Health and Welfare (2006) Australia’s Health 2006. AIHW, Canberra
- Begg S, Vos T, Barker B, Stanley L, Lopez AD (2008) Burden of disease and injury in Australia in the new millennium: measuring health loss from diseases, injuries and risk factors. Med J Aust 188:36–40
- Cummings S, Kelsey JL, Nevitt MC, O’Dowd KJ (1985) Epidemiology of osteoporosis and osteoporotic fractures. Epidemiol Rev 7:178–208
- Pasco JA, Seeman E, Henry MJ, Merriman EN, Nicholson GC, Kotowicz MA (2006) The population burden of fractures originates in women with osteopenia, not osteoporosis. Osteoporos Int 17:1404–1409 CrossRef
- World Health Organisation (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. In WHO Tech Rep Series. WHO Study Group, pp 1–129.
- Pasco JA, Sanders KM, Hoekstra FM, Henry MJ, Nicholson GC, Kotowicz MA (2005) The human cost of fracture. Osteoporos Int 16:2046–2052 CrossRef
- Cooper C (1997) The crippling consequences of fractures and their impact on quality of life. Am J Med 103:12S–17S CrossRef
- Keene GS, Parker MJ, Pryor GA (1993) Mortality and morbidity after hip fractures. BMJ 307:1248–1250 CrossRef
- Galindo-Ciocon D, Ciocon JO, Galindo D (1995) Functional impairment among elderly women with osteoporotic vertebral fractures. Rehabil Nurs 20:79–83
- Brennan SL, Pasco JA, Urquhart DM, Oldenburg B, Hanna FS, Wluka AE (2009) The association between socioeconomic status and osteoporotic fracture in population-based adults: a systematic review. Osteoporos Int 49:165–171
- Demeter S, Leslie WD, Lix L, MacWilliam L, Finlayson GS, Reed M (2007) The effect of socioeconomic status on bone density testing in a public health-care system. Osteoporos Int 18:153–158 CrossRef
- Neuner J, Zhang X, Sparapani R, Laud PW, Nattinger AB (2007) Racial and socioeconomic disparities in bone density testing before and after hip fracture. J General Int Med 22:1239–1245 CrossRef
- Anastasopoulou C, Rude RK (2002) Bone mineral density screening: assessment of influence on prevention and treatment of osteoporosis. Endocrine Practice 8:199–201
- Wang M, Dixon LB (2006) Socioeconomic influences on bone health in postmenopausal women: findings from NHANES III, 1988–1994. Osteoporos Int 17:91–98 CrossRef
- Brennan SL, Henry MJ, Wluka AE, Nicholson GC, Kotowicz MA, Williams JW, Pasco JA (2009) Bone mineral density in population-based adult women is associated with socioeconomic status. J Bone Miner Res 24:809–815 CrossRef
- Lievense A, Bierma-Zeinstra SMA, Vergahen AP, van Baar ME, Verhaar JAN, Koes BW (2002) Influence of obesity on the development of osteoarthritis of the hip: a systematic review. Rheumatol 41:1155–1162 CrossRef
- Lievense A, Bierma-Zeinstra SMA, Verhagen AP, Verhaar JAN, Koes BW (2001) Influence of work on the development of osteoarthritis of the hip: a systematic review. J Rheumatol 28:2520–2528
- Brennan SL, Pasco JA, Urquhart DM, Oldenburg B, Hanna F, Wluka AE (2009) The association between urban or rural locality and hip fracture: a systematic review. J Epidemiol Comm Health Published Online First: 19 August 2009 (in press)
- Akkus Z, Camdeviren H, Celik F, Gur A, Nas K (2005) Determination of osteoporosis risk factors using a mutiple logistic regression model in postmenopausal Turkish women. Saudi Med J 26:1351–1359
- Varenna M, Binelli L, Zucchi F, Ghiringhelli D, Gallazzi M, Sinigaglia L (1999) Prevalence of osteoporosis by educational level in a cohort of postmenopausal women. Osteoporos Int 9:236–241 CrossRef
- Ho SC, Chen YM, Woo JLF (2005) Educational level and osteoporosis risk in postmenopausal Chinese women. Am J Epidemiol 161:680–690 CrossRef
- Bener A, Hammoudeh M, Zirie M (2007) Prevalence and predictors of osteoporosis and the impact of life style factors on bone mineral density. APLAR J Rheumatol 10:227–233 CrossRef
- Gur A, Sarac AJ, Nas K, Cevik R (2004) The relationship between educational level and bone mineral density in postmenopausal women. BMC family practice [electronic resource] 5:18%N 11.
- Elliot JR, Gilchrist NL, Wells JE (1996) The effect of socioeconomic status on bone density in a male Caucasian population. Bone 18:371–373 CrossRef
- Del Rio BL, Romera Baures M, Pavia Segura J, Setoain Quinquer J, Serra Majem L, Garces Ruiz P, Lafuente Navarro C, Domenech Torne FM (1992) Bone mineral density in two different socio-economic population groups. Bone Miner 18:159–168 CrossRef
- Kondo T, Sakakibara H, Miyao M, Yamada S, Shirota T, Izuhara Y, Kumagai K (1995) Relationship of bone density with lifestyle and labor factors among middle-aged and elderly women in a rural community. Bulletin of the Physical Fitness Research Institute: 88:98–103.
- Murillo-Uribe A, Carranza-Lira S, Martínez-Trejo NA, Santos-González JE (1999) Epidemiologic variables in postmenopausal women. Ginecol Obstet Mex 67:478–483
- Australian Institute of Health and Welfare (2000) Australia’s Health 2000: the Seventh Biennial Health Report of the Australian Institute of Health and Welfare. AIHW, Canberra
- WHO Commission on Social Determinants of Health (2008) Closing the gap in a generation: health equity through action on the social determinants of health. Final report of the CSDH. World Health Organization, Geneva
- Clark EM, Ness A, Tobias JH, ALSPAC Study Team (2005) Social position affects bone mass in childhood through opposing actions on height and weight. J Bone Miner Res 20:2082–2089 CrossRef
- Vidulich L, Norris SA, Cameron N, Pettifor JM (2007) Infant programming of bone size and bone mass in 10-year-old Black and White South African children. Paediatric Perinatal Epidemiol 21:354–362 CrossRef
- Nabulsi M, Mahfoud Z, Maalouf J, Arabi A, Fuleihan GEH (2008) Impact of maternal veiling during pregnancy and socioeconomic status on offspring’s musculoskeletal health. Osteoporos Int 19:295–302 CrossRef
- Jones G, Riley M, Dwyer T (2000) Breastfeeding in early life and bone mass in prepubertal children: a longitudinal study. Osteoporos Int 11:146–152 CrossRef
- Fehily AM, Coles RJ, Evans WD, Elwood PC (1992) Factors affecting bone density in young adults. Am J Clinical Nut 56:579–586
- Bailey DA (1997) The Saskatchewan Pediatric Bone Mineral Accrual Study: bone mineral acquisition during the growing years. Int J Sports Med, Supplement 18:S191–S194 CrossRef
- Micklesfield LK, Levitt NS, Carstens MT, Dhansay MA, Norris SA, Lambert EV (2007) Early life and current determinants of bone in South African children of mixed ancestral origin. Ann Human Biol 34:647–655 CrossRef
- Moreno Villares JM, Galiano Segovia MJ (2007) Influence of nutrition and the social environment in the bone maturation of children . Nutricion Hospitalaria 22:726–727
- Oliver H, Jameson KA, Sayer AA, Cooper C, Dennison EM (2007) Growth in early life predicts bone strength in late adulthood: the Hertfordshire Cohort Study. Bone 41:400–405 CrossRef
- Pasco JA, Wark JD, Carlin JB, Ponsonby A-L, Vuillermin PJ, Morley R (2008) Maternal vitamin D in pregnancy may influence not only offspring bone mass but other aspects of musculoskeletal health and adiposity. Med Hypoth 71:266–269 CrossRef
- Morley R, Carlin JB, Pasco JA, Wark JD (2006) Maternal 25-hydroxyvitamin D and parathyroid hormone concentrations and offspring birth size. J Clin Endocrinol Metab 91:906–912 CrossRef
- Association between socioeconomic status and bone mineral density in adults: a systematic review
Volume 22, Issue 2 , pp 517-527
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- Bone density
- Social disadvantage spine
- Socioeconomic factors
- Systematic review
- Industry Sectors
- Author Affiliations
- 1. Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, The Alfred Hospital, Monash University, Commercial Road, Melbourne, 3004, Victoria, Australia
- 2. Department of Clinical and Biomedical Sciences: Barwon Health, The University of Melbourne, Geelong, Australia