Poverty is a risk factor for osteoporotic fractures
- 317 Downloads
This study assesses the possible association between poverty and osteoporosis and/or fragility fractures in a population of postmenopausal women. We found that postmenopausal women with low socioeconomic status had lower values of BMD at the lumbar spine, a higher prevalence of densitometric osteoporosis, and a higher prevalence of total and vertebral fractures.
Some lifestyles are related to the presence of osteoporosis and/or fragility fractures, whereas poverty is related to some lifestyles. Because of this, we studied the possible association of poverty with osteoporosis and fractures.
This was an observational, cross-sectional study performed in the Canary Islands, Spain. Participants consisted of a total of 1,139 ambulatory postmenopausal women aged 50 years or older with no previous osteoporosis diagnosis and who were enrolled in some epidemiological studies. The prevalence of fractures (vertebral and non-vertebral) and the prevalence of osteoporosis (T-score <–2.5 either at the lumbar spine or the femoral neck). A previously validated questionnaire elicited the most important risk factors for osteoporosis: socioeconomic status, defined by the annual income was also assessed by a personal interview. A dorso-lateral X-ray of the spine was performed, and bone mineral density (BMD) was measured by DXA in the lumbar spine (L2–L4) and proximal femur.
Compared to women with a medium and high socioeconomic status (n = 665), those who were classified into poverty (annual family income lower than 6,346.80 Euros, in a one-member family, n = 474), were older and heavier and had lower height, lower prevalence of tobacco and alcohol consumption, lower use of HRT and higher use of thiazides.
After correcting for age and body mass index (BMI), women in poverty had lower spine BMD values than women with a medium and high socioeconomic status (0.840 g/cm2 vs. 0.867 g/cm2, p = 0.005), but there were no statistical differences in femoral neck BMD between groups. The prevalence of osteoporosis was also higher in women in poverty [40.6% vs. 35.6%, (OR 1.35, CI 95%: 1.03; 1.76)] after adjusting by age and BMI. Moreover, 37.8% of women in poverty had a history of at least one fragility fracture compared to 27.7% of women not in poverty (OR: 1.45, CI 95%: 1.11; 1.90). The prevalence of vertebral fractures was also higher in women in poverty 24.7% vs. 13.4%, (OR 2.01, CI 95%: 1.44; 2.81).
Postmenopausal women with low socioeconomic status had lower values of BMD at the lumbar spine, and a higher prevalence of densitometric osteoporosis, and a higher prevalence of total and vertebral fractures. Because of this, apart from the well known risk factors for osteoporosis, poverty should be taken into account as a possible risk factor for both osteoporosis and fragility fractures, in order to establish sanitary strategies to protect unfavoured postmenopausal women.
KeywordsAlcohol Densitometry Fractures Life styles Menopause Obesity Osteoporosis Poverty Tobacco Vertebral Women
We would like to thank Professor L.J. Melton III of the Mayo Clinic, Rochester, Minesota, USA, for his constructive comments.
Conflicts of interest
- 2.Pachucki-Hyde L (2001) Assessment of risk factors for osteoporosis and fracture. Nurs Clinics N Am 36:401–408 viiGoogle Scholar
- 17.Sosa M, Saavedra P, Munoz-Torres M, Alegre J, Gomez C, Gonzalez-Macias J, Guanabens N, Hawkins F, Lozano C, Martinez M, Mosquera J, Perez-Cano R, Quesada M, Salas E (2002) Quantitative ultrasound calcaneus measurements: normative data and precision in the Spanish population. Osteoporos Int 13:487–492PubMedCrossRefGoogle Scholar
- 18.World Health Organization Scientific Group (1981) Research on the Menopause, WHO Technical Services Report Series 670. Geneva: World Health OrganizationGoogle Scholar
- 19.Working Group on Protocols (2000) Basic data on osteoporosis. Rev Esp Enf Metab Óseas 9:84–85Google Scholar
- 20.Spanish National Institute of Statistics (2004) Life conditions questionnaire. Main results. INE. Avaiable at http://www.ine.es/prensa/np394pdf
- 26.NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis and Therapy (2001). JAMA 285:785–795Google Scholar
- 30.Navarro MC, Saavedra P, Limiñana JM, Calvo JR, Betancor P, Sosa M (1997) Dietary calcium intake, bone mass and life-styles in postmenopausal women with and without osteoporosis. Rev Esp Nutr Comunit 3:15–24Google Scholar
- 34.Giskes K, Kunst AE, Benach J, Borrell C, Costa G, Dahl E, Dalstra JA, Federico B, Helmert U, Judge K, Lahelma E, Moussa K, Ostergren PO, Platt S, Prattala R, Rasmussen NK, Mackenbach JP (2005) Trends in smoking behaviour between 1985 and 2000 in nine European countries by education. J Epidemiol Commun Health 59:395–401CrossRefGoogle Scholar
- 35.Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, Jackson RD, Beresford SA, Howard BV, Johnson KC, Kotchen JM, Ockene J (2002) Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women’s Health Initiative randomized controlled trial. JAMA 288:321–333PubMedCrossRefGoogle Scholar
- 36.Wassertheil-Smoller S, Hendrix SL, Limacher M, Heiss G, Kooperberg C, Baird A, Kotchen T, Curb JD, Black H, Rossouw JE, Aragaki A, Safford M, Stein E, Laowattana S, Mysiw WJ (2003) Effect of estrogen plus progestin on stroke in postmenopausal women: the Women’s Health Initiative: a randomized trial. JAMA 289:2673–2684PubMedCrossRefGoogle Scholar