Osteoporosis International

, Volume 22, Issue 5, pp 1343–1353 | Cite as

Socioeconomic status and bone health in community-dwelling older men: the CHAMP Study

  • I. Nabipour
  • R. Cumming
  • D. J. Handelsman
  • M. Litchfield
  • V. Naganathan
  • L. Waite
  • H. Creasey
  • M. Janu
  • D. Le Couteur
  • P. N. Sambrook
  • M. J. Seibel
Original Article



The association between socioeconomic status (SES) and bone health, specifically in men, is unclear. Based upon data from the large prospective Concord Health in Ageing Men Project (CHAMP) Study of community-dwelling men aged 70 years or over, we found that specific sub-characteristics of SES, namely, marital status, living circumstances, and acculturation, reflected bone health in older Australian men.


Previous studies reported conflicting results regarding the relationship between SES and bone health, specifically in men. The main objective of this study was to investigate associations of SES with bone health in community-dwelling men aged 70 years or over who participated in the baseline phase of the CHAMP Study in Sydney, Australia.


The Australian Socioeconomic Index 2006 (AUSEI06) based on the Australian and New Zealand Standard Classification of Occupations was used to determine SES in 1,705 men. Bone mineral density and bone mineral content (BMC) were determined by dual-energy X-ray absorptiometry. Bone-related biochemical and hormonal parameters, including markers of bone turnover, parathyroid hormone, and vitamin D, were measured in all men.


General linear models adjusted for age, weight, height, and bone area revealed no significant differences across crude AUSEI06 score quintiles for BMC at any skeletal site or for any of the bone-related biochemical measures. However, multivariate regression models revealed that in Australian-born men, marital status was a predictor of higher lumbar BMC (β = 0.07, p = 0.002), higher total body BMC (β = 0.05, p = 0.03), and lower urinary NTX-I levels (β=−0.08, p = 0.03), while living alone was associated with lower BMC at the lumbar spine (β=−0.05, p = 0.04) and higher urinary NTX-I levels (β=0.07, p = 0.04). Marital status was also a predictor of higher total body BMC (β = 0.14, p = 0.003) in immigrants from Eastern and South Eastern Europe. However, in immigrants from Southern Europe, living alone and acculturation were predictors of higher femoral neck BMC (β = 0.11, p = 0.03) and lumbar spine BMC (β = 0.10, p = 0.008), respectively.


Although crude occupation-based SES scores were not significantly associated with bone health in older Australian men, specific sub-characteristics of SES, namely, marital status, living circumstances, and acculturation, were predictors of bone health in both Australia-born men and European immigrants.


Bone health Bone mineral density Bone turnover Complex systems Immigration Socioeconomic status 



This study was supported by the National Health and Medical Research Council (project grants ID 301916, 512364, and 633224) and the Sydney Medical School Foundation. Dr. Nabipour was supported by The Persian Gulf Tropical Medicine Research Center, Bushehr University of Medical Science, Bushehr/Iran. The authors thank Melisa Litchfield, Fiona Stanaway, and James Modzelewski for their expert technical support.

Conflicts of interest



  1. 1.
    Liu J, Dietz T, Carpenter SR, Alberti M, Folke C, Moran E, Pell AN, Deadman P, Kratz T, Lubchenco J, Ostrom E, Ouyang Z, Provencher W, Redman CL, Schneider SH, Taylor WW (2007) Complexity of coupled human and natural systems. Science 317:1513–1516PubMedCrossRefGoogle Scholar
  2. 2.
    Liu J, Dietz T, Carpenter SR, Folke C, Alberti M, Redman CL, Schneider SH, Ostrom E, Pell AN, Lubchenco J, Taylor WW, Ouyang Z, Deadman P, Kratz T, Provencher W (2007) Coupled human and natural systems. Ambio 36:639–649PubMedCrossRefGoogle Scholar
  3. 3.
    Elliot JR, Gilchrist NL, Wells JE (1996) The effect of socioeconomic status on bone density in a male Caucasian population. Bone 18:371–373PubMedCrossRefGoogle Scholar
  4. 4.
    Inanici-Ersoz F, Gokce-Kutsal Y, Oncel S, Eryavuz M, Peker O, Ok S (2002) A multicenter, case control study of risk factors for low tibial speed of sound among residents of urban areas in Turkey. Rheumatol Int 22:20–26PubMedCrossRefGoogle Scholar
  5. 5.
    Shatrugna V, Kulkarni B, Kumar PA, Rani KU, Balakrishna N (2005) Bone status of Indian women from a low-income group and its relationship to the nutritional status. Osteoporos Int 16:1827–1835PubMedCrossRefGoogle Scholar
  6. 6.
    Yankg K, McElmurry BJ, Park CG (2006) Decreased bone mineral density and fractures in low-income Korean women. Health Care Women Int 27:254–267CrossRefGoogle Scholar
  7. 7.
    Pearson D, Taylor R, Masud T (2004) The relationship between social deprivation, osteoporosis, and falls. Osteoporos Int 15:132–138PubMedCrossRefGoogle Scholar
  8. 8.
    Farahmand BY, Persson PG, Michaëlsson K, Baron JA, Parker MG, Ljunghall S, Swedish Hip Fracture Group (2000) Socioeconomic status, marital status and hip fracture risk: a population-based case–control study. Osteoporos Int 11:803–808PubMedCrossRefGoogle Scholar
  9. 9.
    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 9:236–241PubMedCrossRefGoogle Scholar
  10. 10.
    Wang MC, Dixon LB (2006) Socioeconomic influences on bone health in postmenopausal women: findings from NHANES III, 1988–1994. Osteoporos Int 17:91–98PubMedCrossRefGoogle Scholar
  11. 11.
    Navarro MC, Sosa M, Saavedra P, Lainez P, Marrero M, Torres M, Medina CD (2009) Poverty is a risk factor for osteoporotic fractures. Osteoporos Int 20:393–398PubMedCrossRefGoogle Scholar
  12. 12.
    Brennan SL, Henry MJ, Wluka AE, Nicholson GC, Kotowicz MA, Williams JW, Pasco JA (2009) BMD in population-based adult women is associated with socioeconomic status. J Bone Miner Res 24:809–815PubMedCrossRefGoogle Scholar
  13. 13.
    Jones S, Johansen A, Brennan J, Butler J, Lyons RA (2004) The effect of socioeconomic deprivation on fracture incidence in the United Kingdom. Osteoporos Int 15:520–524PubMedCrossRefGoogle Scholar
  14. 14.
    Alver K, Søgaard AJ, Falch JA, Meyer HE (2007) The Oslo Health Study: is bone mineral density higher in affluent areas? Int J Equity Health 23:6–19Google Scholar
  15. 15.
    Zingmond DS, Soohoo NF, Silverman SL (2006) The role of socioeconomic status on hip fracture. Osteoporos Int 17:1562–1568PubMedCrossRefGoogle Scholar
  16. 16.
    Lauderdale DS, Rathouz PJ (2003) Does bone mineralization reflect economic conditions? An examination using a national US sample. Econ Hum Biol 1:91–104PubMedCrossRefGoogle Scholar
  17. 17.
    del Rio Barquero L, Romera Baures M, Pavia Segura J, Setoain Quinquer J, Serra Majem L, Garces Ruiz P, Lafuente Navarro C, Domenech Torné FM (1992) Bone mineral density in two different socio-economic population groups. Bone Miner 18:159–168PubMedCrossRefGoogle Scholar
  18. 18.
    Brennan SL, Henry MJ, Wluka AE, Nicholson GC, Kotowicz MA, Pasco JA (2010) Socioeconomic status and bone mineral density in a population-based sample of men. Bone 46:993–999PubMedCrossRefGoogle Scholar
  19. 19.
    Atalar E, Aydin G, Keles I, Inal E, Zog G, Arslan A, Orkun S (2009) Factors affecting bone mineral density in men. Rheumatol Int 29:1025–1030PubMedCrossRefGoogle Scholar
  20. 20.
    Cauley JA, Fullman RL, Stone KL, Zmuda JM, Bauer DC, Barrett-Connor E, Ensrud K, Lau EM, Orwoll ES, Mr. OS Research Group (2005) Factors associated with the lumbar spine and proximal femur bone mineral density in older men. Osteoporos Int 16:1525–1537PubMedCrossRefGoogle Scholar
  21. 21.
    Cumming RG, Handelsman D, Seibel MJ, Creasey H, Sambrook P, Waite L, Naganathan V, Le Couteur D, Litchfield M (2009) Cohort profile: the Concord Health and Ageing in Men Project (CHAMP). Int J Epidemiol 38:374–378PubMedCrossRefGoogle Scholar
  22. 22.
    Washburn RA, Smith KW, Jette AM, Janney CA (1993) The Physical Activity Scale for the Elderly (PASE): development and evaluation. J Clin Epidemiol 46:153–162PubMedCrossRefGoogle Scholar
  23. 23.
    WHO Study Group on Assessment of Fracture Risk and its Application to Screening for Postmenopausal Osteoporosis (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: Report of a WHO Study Group. WHO Technical Report Series 843Google Scholar
  24. 24.
    McMillan J, Beavis A, Jones FL (2009) The AUSEI06: a new socioeconomic index for Australia. J Sociol 45:123–149CrossRefGoogle Scholar
  25. 25.
    Trewin D, Pink B (2006) ANZSCO Australian and New Zealand standard classification of occupations, 1st edn. Australian Bureau of Statistics Cat No. 1220.0Google Scholar
  26. 26.
    Prentice A, Parsons TJ, Cole TJ (1994) Uncritical use of bone mineral density in absorptiometry may lead to size-related artifacts in the identification of bone mineral determinants. Am J Clin Nutr 60:837–842PubMedGoogle Scholar
  27. 27.
    Australian Bureau of Statistics (2008) Standard Australian Classification of Countries (SACC), 2nd edn. 1269Google Scholar
  28. 28.
    Chiu GR, Araujo AB, Travison TG, Hall SA, McKinlay JB (2009) Relative contributions of multiple determinants to bone mineral density in men. Osteoporos Int 20:2035–2047PubMedCrossRefGoogle Scholar
  29. 29.
    Nabulsi M, Mahfoud Z, Maalouf J, Arabi A, Fuleihan GE (2008) Impact of maternal veiling during pregnancy and socioeconomic status on offspring’s musculoskeletal health. Osteoporos Int 19:295–302PubMedCrossRefGoogle Scholar
  30. 30.
    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 20:2082–2089PubMedCrossRefGoogle Scholar
  31. 31.
    Norris SA, Sheppard ZA, Griffiths PL, Cameron N, Pettifor JM (2008) Current socio-economic measures, and not those measured during infancy, affect bone mass in poor urban South African children. J Bone Miner Res 23:1409–1416PubMedCrossRefGoogle Scholar
  32. 32.
    Marwaha RK, Tandon N, Reddy DH, Mani K, Puri S, Aggarwal N, Grewal K, Singh S (2007) Peripheral bone mineral density and its predictors in healthy school girls from two different socioeconomic groups in Delhi. Osteoporos Int 18:375–383PubMedCrossRefGoogle Scholar
  33. 33.
    Lin SS, Kelsey JL (2000) Use of race and ethnicity in epidemiologic research: concepts, methodological issues, and suggestions for research. Epidemiol Rev 22:187–202PubMedGoogle Scholar
  34. 34.
    Shavers VL, Brown ML, Klabunde C (2004) Race/ethnicity and the receipt of watchful waiting for the initial management of prostate cancer. J Gen Intern Med 19:146–155PubMedCrossRefGoogle Scholar
  35. 35.
    Araujo AB, Travison TG, Harris SS, Holick MF, Turner AK, McKinlay JB (2007) Race/ethnic differences in bone mineral density in men. Osteoporos Int 18:943–953PubMedCrossRefGoogle Scholar
  36. 36.
    Marshall LM, Zmuda JM, Chan BK, Barrett-Connor E, Cauley JA, Ensrud KE, Lang TF, Orwoll ES (2008) Osteoporotic Fractures in Men (MrOS) Research Group 2008 Race and ethnic variation in proximal femur structure and BMD among older men. J Bone Miner Res 23:121–130PubMedCrossRefGoogle Scholar
  37. 37.
    Ho SC, Chen YM, Woo JL (2005) Educational level and osteoporosis risk in postmenopausal Chinese women. Am J Epidemiol 1(16):680–690CrossRefGoogle Scholar
  38. 38.
    Gur A, Sarac AJ, Nas K, Cevik R (2004) The relationship between educational level and bone mineral density in postmenopausal women. BMC Fam Pract 6:5–18Google Scholar
  39. 39.
    Renzaho AM, Oldroyd J, Burns C, Waters E, Riggs E, Renzaho C (2009) Over and undernutrition in the children of Australian immigrants: assessing the influence of birthplace of primary carer and English language use at home on the nutritional status of 4–5-year-olds. Int J Pediatr Obes 4:73–80PubMedCrossRefGoogle Scholar
  40. 40.
    Meyer HE, Tverdal A, Falch JA (1993) Risk factors for hip fracture in middle-aged Norwegian women and men. Am J Epidemiol 1(137):1203–1211Google Scholar
  41. 41.
    Brennan SL, Pasco JA, Urquhart DM, Oldenburg B, Hanna F, Wluka AE (2009) The association between socioeconomic status and osteoporotic fracture in population-based adults: a systematic review. Osteoporos Int 20:1487–1497PubMedCrossRefGoogle Scholar
  42. 42.
    Helbing D (2009) Managing complexity in socioeconomic systems. Eur Rev 17:423–438CrossRefGoogle Scholar
  43. 43.
    Orwoll ES, Bell NH, Nanes MS, Flessland KA, Pettinger MB, Mallinak NJ, Cain DF (1998) Collagen N-telopeptide excretion in men: the effects of age and intrasubject variability. J Clin Endocrinol Metab 83:3930–3935PubMedCrossRefGoogle Scholar
  44. 44.
    Leder BZ, Araujo AB, Travison TG, McKinlay JB (2007) Racial and ethnic differences in bone turnover markers in men. J Clin Endocrinol Metab 92:3453–3457PubMedCrossRefGoogle Scholar
  45. 45.
    Meier C, Nguyen TV, Center JR, Seibel MJ, Eisman JA (2005) Bone resorption and osteoporotic fractures in elderly men: the Dubbo Osteoporosis Epidemiology Study. J Bone Miner Res 20:579–587PubMedCrossRefGoogle Scholar
  46. 46.
    Galea S, Hall C, Kaplan GA (2009) Social epidemiology and complex system dynamic modelling as applied to health behaviour and drug use research. Int J Drug Policy 20:209–216PubMedCrossRefGoogle Scholar
  47. 47.
    Almaas E (2007) Biological impacts and context of network theory. J Exp Biol 210:1548–1558PubMedCrossRefGoogle Scholar
  48. 48.
    Sales-Pardo M, Guimerà R, Moreira AA, Amaral LA (2007) Extracting the hierarchial organization of complex systems. Proc Natl Acad Sci USA 104:15224–15229PubMedCrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2010

Authors and Affiliations

  • I. Nabipour
    • 1
    • 2
  • R. Cumming
    • 3
  • D. J. Handelsman
    • 4
  • M. Litchfield
    • 5
  • V. Naganathan
    • 5
  • L. Waite
    • 5
  • H. Creasey
    • 5
  • M. Janu
    • 6
  • D. Le Couteur
    • 5
  • P. N. Sambrook
    • 7
  • M. J. Seibel
    • 1
  1. 1.Bone Research Program, ANZAC Research InstituteThe University of SydneyConcordAustralia
  2. 2.Department of Endocrine and Metabolic Diseases, The Persian Gulf Tropical Medicine Research CenterBushehr University of Medical SciencesBushehrIran
  3. 3.School of Public HealthThe University of SydneySydneyAustralia
  4. 4.Department of Andrology, ANZAC Research InstituteThe University of SydneySydneyAustralia
  5. 5.Centre for Education and Research on Ageing, Concord HospitalThe University of SydneySydneyAustralia
  6. 6.Sydney South West Pathology Service, Concord HospitalSydneyAustralia
  7. 7.Institute of Bone and Joint Research, Royal North Shore HospitalThe University of SydneySydneyAustralia

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