Advertisement

Archives of Osteoporosis

, Volume 7, Issue 1–2, pp 37–48 | Cite as

Social inequalities in osteoporosis and fracture among community-dwelling older men and women: findings from the Hertfordshire cohort study

  • Holly E. SyddallEmail author
  • Maria Evandrou
  • Elaine M. Dennison
  • Cyrus Cooper
  • Avan Aihie Sayer
Original Article

Abstract

Summary

It is unknown whether osteoporosis is socially patterned. Using data from the Hertfordshire Cohort Study we found no consistent evidence for social inequalities in prevalent or incident fracture, bone mineral density or loss rates, or bone strength. Public health strategies for prevention of osteoporosis should focus on the whole population.

Introduction

Osteoporosis and osteoporotic fracture are major public health issues for society; the burden for the affected individual is also high. It is unclear whether osteoporosis and osteoporotic fracture are socially patterned.

Objective

This study aims to analyse social inequalities in osteoporosis and osteoporotic fracture among the 3,225 community-dwelling men and women, aged 59–73 years, who participated in the Hertfordshire Cohort Study (HCS), UK.

Methods

A panel of markers of bone health (fracture since 45 years of age; DXA bone mineral density and loss rate at the total femur; pQCT strength strain indices for the radius and tibia; and incident fracture) were analysed in relation to the social circumstances of the HCS participants (characterised at the individual level by: age left full time education; current social class; housing tenure and car availability).

Results

We found little strong or consistent evidence among men, or women, for social inequalities in prevalent or incident fracture, DXA bone mineral density, bone loss rates, or pQCT bone strength, with or without adjustment for age, anthropometry, lifestyle and clinical characteristics.

Reduced car availability at baseline was associated with lower pQCT radius and tibia strength strain indices at follow-up among men only (p = 0.02 radius and p < 0.01 tibia unadjusted; p = 0.05 radius and p = 0.01 tibia, adjusted for age, anthropometry, lifestyle and clinical characteristics).

Conclusions

Our results suggest that fracture and osteoporosis do not have a strong direct social gradient and that public health strategies for prevention and treatment of osteoporosis should continue to focus on the whole population.

Keywords

Osteoporosis Osteoporotic fracture Socio-economic position Material deprivation Social inequalities 

Notes

Funding

This work was supported by the Medical Research Council & University of Southampton UK.

References

  1. 1.
    Harvey N, Cooper C (2003) Determinants of fracture risk in osteoporosis. Curr Rheumatol Rep 5:75–81PubMedCrossRefGoogle Scholar
  2. 2.
    Sambrook P, Cooper C (2006) Seminar on osteoporosis. Osteoporosis: trends in epidemiology, pathogenesis and treatment. Lancet 367:2010–8PubMedCrossRefGoogle Scholar
  3. 3.
    Melton LJ, III, Chrischilles EA, Cooper C, Lane AW, Riggs BL. How many women have osteoporosis? JBMR Anniversary Classic. JBMR, Volume 7, Number 9, 1992. J Bone Miner Res 2005 May;20:886-92.Google Scholar
  4. 4.
    Kanis JA, Adams J, Borgstrom F, Cooper C, Jonsson B, Preedy D et al (2008) Modelling cost-effectiveness in osteoporosis. Bone 43:215–6CrossRefGoogle Scholar
  5. 5.
    Walker-Bone K, Dennison E, Cooper C (2001) Osteoporosis. In: Silman AJ, Hochberg M (eds) Epidemiology of the rheumatic diseases, 2nd edn. Oxford University Press, Oxford, pp 259–92Google Scholar
  6. 6.
    Kanis JA, McCloskey EV, Johansson H, Strom O, Borgstrom F, Oden A (2009) How to decide who to treat. Best Pract Res Clin Rheumatol 23(6):711–26PubMedCrossRefGoogle Scholar
  7. 7.
    Marmot M (2001) From Black to Acheson: two decades of concern with inequalities in health. A celebration of the 90th birthday of Professor Jerry Morris. Int J Epidemiol 30(5):1165–71PubMedCrossRefGoogle Scholar
  8. 8.
    Groffen DA, Bosma H, van den AM, Kempen GI, van Eijk JT (2008) Material deprivation and health-related dysfunction in older Dutch people: findings from the SMILE study. Eur J Public Health 18(3):258–63PubMedCrossRefGoogle Scholar
  9. 9.
    Wilkinson RG (1997) Socioeconomic determinants of health. Health inequalities: relative or absolute material standards? BMJ 314(7080):591–5PubMedCrossRefGoogle Scholar
  10. 10.
    Brennan SL, Pasco JA, Urquhart DM, Oldenburg B, Wang Y, Wluka AE (2011) Association between socioeconomic status and bone mineral density in adults: a systematic review. Osteoporos Int 22(2):517–527, Date of Publication: February 2011(2):FebruaryPubMedCrossRefGoogle Scholar
  11. 11.
    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(9):1487–1497, Date of Publication: September 2009(9):SeptemberPubMedCrossRefGoogle Scholar
  12. 12.
    Syddall HE, Aihie SA, Dennison EM, Martin HJ, Barker DJ, Cooper C (2005) Cohort profile: the Hertfordshire cohort study. Int J Epidemiol 34(6):1234–42PubMedCrossRefGoogle Scholar
  13. 13.
    Arber S, Ginn J (1993) Gender and inequalities in health in later life. Soc Sci Med 36(1):33–46PubMedCrossRefGoogle Scholar
  14. 14.
    Wiggins RD, Joshi H, Bartley M, Gleave S, Lynch K, Cullis A (2002) Place and personal circumstances in a multilevel account of women's long-term illness. Soc Sci Med 54(5):827–38PubMedCrossRefGoogle Scholar
  15. 15.
    Dallosso HM, Morgan K, Bassey EJ, Ebrahim SB, Fentem PH, Arie TH (1988) Levels of customary physical activity among the old and the very old living at home. J Epidemiol Community Health 42(2):121–7PubMedCrossRefGoogle Scholar
  16. 16.
    Lohman TG, Roche AF, Martorell R (1988) Anthropometric standardization reference manual. Human Kinetic Books, ChampaignGoogle Scholar
  17. 17.
    Dennison EM, Syddall HE, Sayer AA, Gilbody HJ, Cooper C (2005) Birth weight and weight at 1 year are independent determinants of bone mass in the seventh decade: the Hertfordshire cohort study. Pediatr Res 57(4):582–6PubMedCrossRefGoogle Scholar
  18. 18.
    Dennison EM, Jameson KA, Syddall HE, Martin HJ, Cushnaghan J, Aihie SA et al (2010) Bone health and deterioration in quality of life among participants from the Hertfordshire cohort study. Osteoporos Int 21(11):1817–24PubMedCrossRefGoogle Scholar
  19. 19.
    Oliver H, Jameson KA, Sayer AA, Cooper C, Dennison EM (2007) Growth in early life predicts bone strength in late adulthood: the Hertfordshire cohort study. Bone 41(3):400–5PubMedCrossRefGoogle Scholar
  20. 20.
    Louis O, Soykens S, Willnecker J, Van den Winkel P, Osteaux M (1996) Cortical and total bone mineral content of the radius: accuracy of peripheral computed tomography. Bone 18(5):467–72PubMedCrossRefGoogle Scholar
  21. 21.
    Sievanen H, Koskue V, Rauhio A, Kannus P, Heinonen A, Vuori I (1998) Peripheral quantitative computed tomography in human long bones: evaluation of in vitro and in vivo precision. J Bone Miner Res 13(5):871–82PubMedCrossRefGoogle Scholar
  22. 22.
    Office of Population Censuses and Surveys (1990) Standard occupational classification, Vol 1 Structure and definition of major, minor and unit groups. HMSO, LondonGoogle Scholar
  23. 23.
    Elias P, Halstead K, Prandy K (1993) Computer assisted standard occupational coding. HMSO, LondonGoogle Scholar
  24. 24.
    West J, Hippisley-Cox J, Coupland CAC, Price GM, Groom LM, Kendrick D et al (2004) Do rates of hospital admission for falls and hip fracture in elderly people vary by socio-economic status? Public Health 118(8):576–581, Date of Publication: Dec 2004(8):DecPubMedCrossRefGoogle Scholar
  25. 25.
    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(7):520–524, Date of Publication: Jul 2004(7):JulPubMedCrossRefGoogle Scholar
  26. 26.
    Quah C, Boulton C, Moran C (2011) The influence of socioeconomic status on the incidence, outcome and mortality of fractures of the hip. Journal of Bone and Joint Surgery—Series B 93 B(6):801–805, Date of Publication: June 2011(6):JuneCrossRefGoogle Scholar
  27. 27.
    Hamilton T, Lambert S, Willett K. Proximal femoral fracture and socioeconomic status. Osteoporosis International Conference: Osteoporosis Conference 2010 Liverpool United Kingdom Conference Start: 20101128 Conference End: 20101201 Conference Publication: (var pagings) 21 (pp S515-S516), 2010 Date of Publication: November 2010(var.pagings):November.Google Scholar
  28. 28.
    Dugue A, Greenbank C, Evans B, Diggle P, Goodson N, Halsey J, et al. Increasing deprivation and osteoporosis: Further analysis adjusting for geographical and physical variables. Rheumatology Conference: Rheumatology 2010—British Society for Rheumatology, BSR and British Health Professionals in Rheumatology, BHPR Annual Meeting 2010 Birmingham United Kingdom Conference Start: 20100420 Conference End: 20100423 Conference Publi(var.pagings):AprilGoogle Scholar
  29. 29.
    Court-Brown, Aitken SA, Ralston SH, McQueen MM (2011) The relationship of fall-related fractures to social deprivation. Osteoporos Int 22(4):1211–1218, Date of Publication: April 2011(4):ApriPubMedCrossRefGoogle Scholar
  30. 30.
    Clark E, Cuming M, Gould V, Morrison L, Tobias J. Risk factors for fractures over aged 50 in a population-based cohort of older women. Osteoporosis International Conference: Osteoporosis Conference 2010 Liverpool United Kingdom Conference Start: 20101128 Conference End: 20101201 Conference Publication: (var pagings) 21 (pp S446-S447), 2010 Date of Publication: November 2010(var.pagings):NovemberGoogle Scholar
  31. 31.
    Zingmond DS, Soohoo NF, Silverman SL (2006) The role of socioeconomic status on hip fracture. Osteoporos Int 17(10):1562–1568, Date of Publication: Oct 2006(10):OctPubMedCrossRefGoogle Scholar
  32. 32.
    Farahmand BY, Persson P-G, Michaelsson K, Baron JA, Parker MG, Ljunghall S (2000) Socioeconomic status, marital status and hip fracture risk: a population-based case–control study. Osteoporos Int 11(9):803–808, Date of Publication: 2000(9):2000PubMedCrossRefGoogle Scholar
  33. 33.
    Johnell O, Borgstrom F, Jonsson B, Kanis J (2007) Latitude, socioeconomic prosperity, mobile phones and hip fracture risk. Osteoporos Int 18(3):333–7PubMedCrossRefGoogle Scholar
  34. 34.
    Hokby A, Reimers A, Laflamme L (2003) Hip fractures among older people: do marital status and type of residence matter? Public Health 117(3):196–201PubMedCrossRefGoogle Scholar
  35. 35.
    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(4):371–377, Date of Publication: Aug 2006(4):AugPubMedCrossRefGoogle Scholar
  36. 36.
    Wang M-C, Dixon LB (2006) Socioeconomic influences on bone health in postmenopausal women: findings from NHANES III, 1988–1994. Osteoporos Int 17(1):91–98, Date of Publication: Jan 2006(1):JanPubMedCrossRefGoogle Scholar
  37. 37.
    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(3):236–241, Date of Publication: 1999(3):1999PubMedCrossRefGoogle Scholar
  38. 38.
    Wilson RT, Chase GA, Chrischilles EA, Wallace RB (2006) Hip fracture risk among community-dwelling elderly people in the United States: a prospective study of physical, cognitive, and socioeconomic indicators. Am J Public Health 96(7):1210–1218, Date of Publication: Jul 2006(7):JulPubMedCrossRefGoogle Scholar
  39. 39.
    Benzeval M, Judge K, Smaje C (1995) Beyond class, race, and ethnicity: deprivation and health in Britain. Health Serv Res 30(1 Pt 2):163–77PubMedGoogle Scholar
  40. 40.
    Clark EM, Ness A, Tobias JH (2005) Social position affects bone mass in childhood through opposing actions on height and weight. J Bone Miner Res 20(12):2082–2089, Date of Publication: Dec 2005(12):DecPubMedCrossRefGoogle Scholar
  41. 41.
    Bartley M, Blane D (1994) Socioeconomic deprivation in Britain. Appropriateness of deprivation indices must be ensured. BMJ 309(6967):1479PubMedCrossRefGoogle Scholar
  42. 42.
    APHO and Department of Health. Health Profile 2008—Hertfordshire. http://www apho org uk/resource/item aspx?RID = 52400 2008
  43. 43.
    Ismail AA, O'Neill TW, Cockerill W, Finn JD, Cannata JB, Hoszowski K et al (2000) Validity of self-report of fractures: results from a prospective study in men and women across Europe. EPOS study group. European prospective osteoporosis study group. Osteoporos Int 11(3):248–54PubMedCrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2012

Authors and Affiliations

  • Holly E. Syddall
    • 1
    Email author
  • Maria Evandrou
    • 2
  • Elaine M. Dennison
    • 1
    • 3
  • Cyrus Cooper
    • 1
  • Avan Aihie Sayer
    • 1
    • 4
  1. 1.MRC Lifecourse Epidemiology Unit, Southampton General HospitalUniversity of SouthamptonSouthamptonUK
  2. 2.Centre for Research on AgeingUniversity of SouthamptonSouthamptonUK
  3. 3.Victoria UniversityWellingtonNew Zealand
  4. 4.Academic Geriatric MedicineUniversity of SouthamptonSouthamptonUK

Personalised recommendations