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Poverty is a risk factor for osteoporotic fractures

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Abstract

Summary

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.

Introduction

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.

Methods

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.

Results

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).

Conclusions

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.

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Acknowledgments

We would like to thank Professor L.J. Melton III of the Mayo Clinic, Rochester, Minesota, USA, for his constructive comments.

Conflicts of interest

None.

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Authors and Affiliations

  1. Health Education and Promotion Working Group, Canary Islands, Spain

    M. C. Navarro, P. Lainez, M. Marrero, M. Torres & C. D. Medina

  2. Bone Metabolic Unit, Hospital University Insular, Las Palmas de Gran Canaria, Canary Islands, Spain

    M. Sosa

  3. Department of Mathematics, University of Las Palmas de Gran Canaria, Canary Islands, Spain

    P. Saavedra

  4. University of Las Palmas de Gran Canaria, Faculty of Health Sciences, Box 550, 35080, Las Palmas de Gran Canaria, Canary Islands, Spain

    M. Sosa

Authors
  1. M. C. Navarro
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  2. M. Sosa
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  3. P. Saavedra
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  4. P. Lainez
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  5. M. Marrero
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  6. M. Torres
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  7. C. D. Medina
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Corresponding author

Correspondence to M. Sosa.

Additional information

This study was support by an unrestricted grant of the Canarian Society of Osteoporosis (SOCAOS SL).

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Navarro, M.C., Sosa, M., Saavedra, P. et al. Poverty is a risk factor for osteoporotic fractures. Osteoporos Int 20, 393–398 (2009). https://doi.org/10.1007/s00198-008-0697-9

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  • DOI: https://doi.org/10.1007/s00198-008-0697-9

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