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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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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DOI: https://doi.org/10.1007/s00198-013-2311-z