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.
KeywordsBone density Hip Social disadvantage spine Socioeconomic factors Systematic review
This study was funded by the National Health and Medical Research Council (NHMRC) of Australia. Ms. Brennan is supported by NHMRC PhD Scholarship (519404). Associate Professor Pasco and Dr. Wluka are the recipients of NHMRC Project Grant (436665). Dr. Urquhart was supported by a NHMRC Health Capacity Building Grant (546248) and a Monash Senior Research Fellowship. Dr. Wluka and Dr. Wang are the recipients of NHMRC Public Health (Australia) Fellowships (317840 and 465142).
Conflicts of interest
- 1.Wilkinson RG, Marmot M (1998) Social determinants of health: the solid facts. World Health Organisation, European Region, CopenhagenGoogle Scholar
- 4.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.Google Scholar
- 5.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.Google Scholar
- 7.Australian Institute of Health and Welfare (2006) Australia’s Health 2006. AIHW, CanberraGoogle Scholar
- 11.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.Google Scholar
- 16.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 49:165–171Google Scholar
- 24.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)Google Scholar
- 29.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.Google Scholar
- 32.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.Google Scholar
- 34.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, CanberraGoogle Scholar
- 35.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, GenevaGoogle Scholar
- 40.Fehily AM, Coles RJ, Evans WD, Elwood PC (1992) Factors affecting bone density in young adults. Am J Clinical Nut 56:579–586Google Scholar