Osteoporosis International

, Volume 17, Issue 1, pp 91–98 | Cite as

Socioeconomic influences on bone health in postmenopausal women: findings from NHANES III, 1988–1994

  • May-Choo WangEmail author
  • L. Beth Dixon
Original Article


Our objectives were (1) to examine the associations of education and income with bone health in non-Hispanic White, non-Hispanic Black and Mexican-American postmenopausal women, (2) to determine if any observed associations can be explained by behavioral factors such as calcium intake and physical activity and (3) to determine if government food assistance and education are associated with increased calcium intake among low-income women. Cross-sectional data were gathered by the Third National Health and Nutrition Examination Survey, 1988–1994 (NHANES III) using a stratified multistage probability design. Bone health was indicated by total hip bone mineral density (BMD, g/cm2). Multiple linear regression was used to evaluate the associations of education, income and behavioral factors with BMD. There were 2,905 postmenopausal women with acceptable DXA scans and complete relevant data selected from a nationally representative sample of the civilian non-institutionalized population aged 2 months and older. Education and income were positively associated with BMD in Black and White women, respectively, but not in Mexican-American women. When behavioral factors were included in the analyses, associations with education and income were eliminated. Instead, positive associations with estrogen use, calcium intake and physical activity, and a negative association with smoking, were noted in White women. Among low-income women, education was associated with increased calcium intake, while participation in the Food Stamp Program was associated with increased calcium intake in Black women. We conclude that education and/or income are positively associated with BMD among Black and White postmenopausal women, and that efforts to promote bone health among low-income women are warranted.


Bone density Food assistance Postmenopausal women Socioeconomic position White, Black and Mexican-American 



We wish to thank Professor Zak Sabry for his insightful comments on drafts of this manuscript. This study was supported by The United States Department of Agriculture, Economic Research Service, under Agreement no. 43-3AEM-8-80052 with San Jose State University, CA.


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2005

Authors and Affiliations

  1. 1.School of Public HealthUniversity of California at BerkeleyBerkeleyUSA
  2. 2.Center for Weight and HealthUniversity of California at BerkeleyBerkeleyUSA
  3. 3.Department of Nutrition, Food Studies and Public HealthNew York UniversityNew YorkUSA

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