Journal of Bone and Mineral Metabolism

, Volume 32, Issue 1, pp 89–95 | Cite as

Influence of education, marital status, occupation, and the place of living on skeletal status, fracture prevalence, and the course and effectiveness of osteoporotic therapy in women in the RAC-OST-POL Study

  • Wojciech Pluskiewicz
  • Piotr Adamczyk
  • Aleksandra Czekajło
  • Władysław Grzeszczak
  • Bogna Drozdzowska
Original Article


The RAC-OST-POL population-based, epidemiological study provided data concerning the influence of education, marital status, occupation, and the place of living (residence) on skeletal status, fracture prevalence, and the course and effectiveness of osteoporotic therapy in 625 women older than 55 years, all of them recruited from the District of Raciborz in Poland. Their mean age was 66.4 ± 7.8 years. All the women completed a specially designed questionnaire. The skeletal status was assessed by femoral neck (FN) and total hip (TH) densitometry, using a Lunar DPX system (USA). In univariate analyses, taking into consideration the age differences, bone mineralization was dependent on marital status (Z score for FN and TH was significantly higher in widows than in divorcees; p < 0.05), place of residence (better results in rural areas; p < 0.05), and occupation (better in standing than sitting jobs; p < 0.05 for FN Z score and p < 0.01 for TH Z score). The multivariate model allowed us to verify that only place of living and type of occupation had a significant influence on densitometry results. In direct comparison, fracture prevalence seemed to be borderline significantly more common in widows (33.5 %) and least common among divorcees (11.8 %) (χ2 = 6.9, df = 3, p = 0.07), but reanalysis performed after age adjustment excluded a true impact of marital status on fracture occurrence. Other factors did not affect fracture occurrence. Some factors influenced the use of medications for osteoporosis: higher level of education was associated with a more frequent use of vitamin D (χ2 = 8.49, df = 3, p < 0.05) and of hormone replacement therapy (HRT) (χ2 = 35.7, df = 3, p < 0.00001). HRT was most commonly used by unmarried women (30 %) and least commonly by divorcees (11.8 %) (χ2 = 11.7, df = 3, p = 0.01). Vitamin D was more often used among women from the urban area of Raciborz than by those from surrounding rural areas (χ2 = 9.2, df = 1, p < 0.01). The frequency of use of the three aforementioned medications was associated with the character of occupation. Women with sedentary jobs demonstrated the highest frequency of intake for vitamin D (χ2 = 9.92, df = 3, p < 0.05) and HRT (χ2 = 19.48, df = 3, p < 0.001) as well as for other antiresorptive medications (χ2 = 8.18, df = 3, p < 0.05). We concluded that the results of the epidemiological study demonstrate that both skeletal status and use of antiosteoporotic medications were partially modified by analyzed social factors, whereas fracture prevalence was generally independent from those factors. These data suggest that education, marital status, place of living, and type of occupation may have impacts on implementation of osteoporosis-preventing health programs.


Bone mineral density Education Marital status Rural Urban 


  1. 1.
    Gur A, Sarac AJ, Nas K, Cevik R (2004) The relationship between educational level and bone mineral density in postmenopausal women. BMC Fam Pract 5:18PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    Brennan RM, Wactawski-Wende J, Crespo CJ, Dmochowski J (2004) Factors associated with treatment initiation after osteoporosis screening. Am J Epidemiol 160:475–483PubMedCrossRefGoogle Scholar
  3. 3.
    Ho SC, Chen YM, Woo JL (2005) Educational level and osteoporosis risk in postmenopausal Chinese women. Am J Epidemiol 161:680–690PubMedCrossRefGoogle Scholar
  4. 4.
    Varenna M, Binelli L, Zucchi F, Rossi V, Sinigaglia L (1999) Prevalence of osteoporosis by educational level in a cohort of postmenopausal women. Osteoporos Int 9:236–241PubMedCrossRefGoogle Scholar
  5. 5.
    Vestergaard P, Rejnmark L, Mosekilde L (2006) Socioeconomic aspects of fractures within universal public healthcare: a nationwide case-control study from Denmark. Scand J Public Health 34:371–377PubMedCrossRefGoogle Scholar
  6. 6.
    Hamdi Kara I, Aydin S, Gemalmaz A, Aktürk Z, Yaman H, Bozdemir N, Kurdak H, Sitmapinar K, Devran Sencar I, Başak O, Akdeniz M, Işildar H, Burgut E, Ozcan S, Akça U, Dağdeviren N, Ungan M (2007) Habitual tea drinking and bone mineral density in postmenopausal Turkish women: investigation of prevalence of postmenopausal osteoporosis in Turkey (IPPOT Study). Int J Vitam Nutr Res 77:389–397PubMedCrossRefGoogle Scholar
  7. 7.
    Kumar A, Mittal S, Orito S, Ishitani K, Ohta H (2010) Impact of dietary intake, education, and physical activity on bone mineral density among North Indian women. J Bone Miner Metab 28:192–201PubMedCrossRefGoogle Scholar
  8. 8.
    Lucas R, Rocha O, Bastos J, Costa L, Barros H, Lunet N (2009) Pharmacological management of osteoporosis and concomitant calcium supplementation in a Portuguese urban population: the EpiPorto study (2005–2007). Clin Exp Rheumatol 27:47–53PubMedGoogle Scholar
  9. 9.
    Briot K, Ravaud P, Dargent-Molina P, Zylberman M, Liu-Leage S, Roux C (2009) Persistence with teriparatide in postmenopausal osteoporosis. Impact of a patient education and follow-up program: the French experience. Osteoporos Int 20:625–630PubMedCrossRefGoogle Scholar
  10. 10.
    Karunanayake AL, Pinidiyapathirage MJ, Wickremasinghe AR (2010) Prevalence and predictors of osteoporosis in an urban Sri Lankan population. Int J Rheum Dis 13:385–390PubMedCrossRefGoogle Scholar
  11. 11.
    Allali F, Rostom S, Bennani L, Abouqal R, Hajjaj-Hassouni N (2010) Educational level and osteoporosis risk in postmenopausal Moroccan women: a classification tree analysis. Clin Rheumatol 29:1269–1275PubMedCrossRefGoogle Scholar
  12. 12.
    Alisa EM, Quadi SG, Alhujaili NA, Alshehri AM, Ferns GA (2011) Effect of diet and lifestyle factors on bone health in postmenopausal women. J Bone Miner Metab 29:725–735CrossRefGoogle Scholar
  13. 13.
    Meyers OL, Jessop S, Klemp P (1982) The epidemiology of rheumatic disease in a rural and an urban population over the age of 65 years. S Afr Med J 62:403–405PubMedGoogle Scholar
  14. 14.
    Cadarette SM, Jaglal SB, Hawker GA (2005) Fracture prevalence and treatment with bone-sparing agents: are there urban–rural differences? A population-based study in Ontario, Canada. J Rheumatol 32:550–558PubMedGoogle Scholar
  15. 15.
    Rosengren BE, Ahlborg HG, Gärdsell P, Sernbo I, Daly RM, Nilsson JA, Karlsson MK (2010) Bone mineral density and incidence of hip fracture in Swedish urban and rural women 1987–2002. Acta Orthop 81:453–459PubMedCrossRefGoogle Scholar
  16. 16.
    Vavken P, Dorotka R (2011) Burden of musculoskeletal disease and its determination by urbanicity, socioeconomic status, age, and sex: results from 14,507 subjects. Arthritis Care Res (Hoboken) 63:1558–1564CrossRefGoogle Scholar
  17. 17.
    Jaglal SB, Kreiger N, Darlington GA (1995) Lifetime occupational physical activity and risk of hip fracture in women. Ann Epidemiol 5:321–324PubMedCrossRefGoogle Scholar
  18. 18.
    Sinaki M, Fitzpatrick LA, Ritchie CK, Montesano A, Wahner HW (1998) Site-specificity of bone mineral density and muscle strength in women: job-related physical activity. Am J Phys Med Rehabil 77:470–476PubMedCrossRefGoogle Scholar
  19. 19.
    Coupland CA, Grainge MJ, Cliffe SJ, Hosking DJ, Chilvers CE (2000) Occupational activity and bone mineral density in postmenopausal women in England. Osteoporos Int 11:310–315PubMedCrossRefGoogle Scholar
  20. 20.
    Sun Y, Sun D, Zhou Z, Zhu G, Zhang H, Chang X, Lei L, Jin T (2008) Osteoporosis in a Chinese population due to occupational exposure to lead. Am J Ind Med 51:436–442PubMedCrossRefGoogle Scholar
  21. 21.
    Nawrot T, Geusens P, Nulens TS, Nemery B (2010) Occupational cadmium exposure and calcium excretion, bone density, and osteoporosis in men. J Bone Miner Res 25:1441–1445PubMedCrossRefGoogle Scholar
  22. 22.
    Shin M, Paek D, Yoon C (2011) The relationship between the bone mineral density and urinary cadmium concentration of residents in an industrial complex. Environ Res 111:101–109PubMedCrossRefGoogle Scholar
  23. 23.
    Nabipour I, Cumming R, Handelsman DJ, Litchfield M, Naganathan V, Waite L, Creasey H, Janu M, Le Couteur D, Sambrook PN, Seibel MJ (2011) Socioeconomic status and bone health in community-dwelling older men: the CHAMP Study. Osteoporos Int 22:1343–1353PubMedCrossRefGoogle Scholar
  24. 24.
    Pluskiewicz W, Adamczyk P, Czekajło A, Grzeszczak W, Burak W, Drozdzowska B (2012) Epidemiological data on osteoporosis in women from the RAC-OST-POL study. J Clin Densitom 15:308–314PubMedCrossRefGoogle Scholar

Copyright information

© The Japanese Society for Bone and Mineral Research and Springer Japan 2013

Authors and Affiliations

  • Wojciech Pluskiewicz
    • 1
  • Piotr Adamczyk
    • 2
  • Aleksandra Czekajło
    • 3
  • Władysław Grzeszczak
    • 4
  • Bogna Drozdzowska
    • 5
  1. 1.Metabolic Bone Diseases Unit, Department and Clinic of Internal Diseases, Diabetology and NephrologyMedical University of SilesiaKatowicePoland
  2. 2.Department and Clinic of PediatricsMedical University of SilesiaKatowicePoland
  3. 3.Department of NephrologyRaciborzPoland
  4. 4.Department and Clinic of Internal Diseases, Diabetology and NephrologyMedical University of SilesiaKatowicePoland
  5. 5.Department of PathomorphologyMedical University of SilesiaKatowicePoland

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