Osteoporosis International

, Volume 25, Issue 4, pp 1327–1335 | Cite as

Marital histories, marital support, and bone density: findings from the Midlife in the United States Study

  • D. Miller-Martinez
  • T. Seeman
  • A. S. Karlamangla
  • G. A. Greendale
  • N. Binkley
  • C. J. CrandallEmail author
Original Article



We examined the association between marital life history and bone mineral density (BMD) in a national sample from the US. In men, being stably married was independently associated with better lumbar spine BMD, and in women, more spousal support was associated with better lumbar spine BMD.


Adult bone mass may be influenced by stressors over the life course. We examined the association between marital life history and bone mineral density (BMD) net socioeconomic and behavioral factors known to influence bone mass. We sought evidence for a gender difference in the association between marital history and adult BMD.


We used data from 632 adult participants in the Midlife in the United States Study to examine associations between marital history and BMD, stratified by gender, and adjusted for age, weight, menopausal stage, medication use, childhood socioeconomic advantage, adult financial status, education, physical activity, smoking, and alcohol consumption.


Compared to stably married men, men who were currently divorced, widowed, or separated, men who were currently married but previously divorced, widowed, or separated, and never married men had 0.33 (95 % CI: 0.01, 0.65), 0.36 (95 % CI: 0.10, 0.83), and 0.53 (95 % CI: 0.23, 0.83) standard deviations lower lumbar spine BMD, respectively. Among men married at least once, every year decrement in age at first marriage (under age 25) was associated with 0.07 SD decrement in lumbar spine BMD (95 % CI: 0.002, 0.13). In women, greater support from the spouse was associated with higher lumbar spine BMD.


Our findings suggest that marriage before age 25 and marital disruptions are deleterious to bone health in men, and that marital quality is associated with better bone health in women.


Bone density Marital history Marital quality Marital status Osteoporosis 



This research was supported by National Institutes of Health grant numbers 1R01AG033067, R01-AG-032271, and P01-AG-020166. The research was further supported by the following grants M01-RR023942 (Georgetown), M01-RR00865 (UCLA), from the General Clinical Research Centers Program and 1UL1RR020511 (UW) from the Clinical and Translational Science Award (CTSA) program of the National Center for Research Resources, National Institutes of Health. Dr. Crandall received support from the Jonsson Comprehensive Cancer Center at the University of California, Los Angeles.

Conflicts of interest



  1. 1.
    USPSTF (2011) Screening for osteoporosis: U.S. preventive services task force recommendation statement. Ann Intern Med 154:356–364Google Scholar
  2. 2.
    Gruenewald TL, Karlamangla AS, Hu P, Stein-Merkin S, Crandall C, Koretz B, Seeman TE (2012) History of socioeconomic disadvantage and allostatic load in later life. Soc Sci Med 74:75–83PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Seeman TE, McEwen BS, Rowe JW, Singer BH (2001) Allostatic load as a marker of cumulative biological risk: MacArthur studies of successful aging. Proc Natl Acad Sci U S A 98:4770–4775PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Seeman TE, Singer BH, Rowe JW, Horwitz RI, McEwen BS (1997) Price of adaptation–allostatic load and its health consequences. MacArthur studies of successful aging. Arch Int Med 157:2259–2268CrossRefGoogle Scholar
  5. 5.
    Foundation NO (2013) Clinician’s guide to prevention and treatment of osteoporosis. National Osteoporosis Foundation, Washington, DCGoogle Scholar
  6. 6.
    Heaney RP, Abrams S, Dawson-Hughes B, Looker A, Marcus R, Matkovic V, Weaver C (2000) Peak bone mass. Osteoporos Int 11:985–1009PubMedCrossRefGoogle Scholar
  7. 7.
    Crandall CJ, Merkin SS, Seeman TE, Greendale GA, Binkley N, Karlamangla AS (2012) Socioeconomic status over the life-course and adult bone mineral density: the Midlife in the U.S. Study. Bone 51:107–113PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Dupre M, Meadow SO (2007) Disaggregating the effects of marital trajectories on health. Journal of Family Issues 28:623–652CrossRefGoogle Scholar
  9. 9.
    Lillard W (1995) Til death do us part: marital disruption and mortality. Am J Sociol 100:1131–1156CrossRefGoogle Scholar
  10. 10.
    Hope S, Rodgers B, Power C (1999) Marital status transitions and psychological distress: longitudinal evidence from a national population sample. Psychol Med 29:381–389PubMedCrossRefGoogle Scholar
  11. 11.
    Uecker JE, Stokes CE (2008) Early marriage in the United States. J Marriage Fam 70:835–846PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Karlamangla AS, Mori T, Merkin SS, Seeman TE, Greendale GA, Binkley N, Crandall CJ (2013) Childhood Socioeconomic Status and Adult Femoral Neck Bone Strength: Findings from The Midlife in the United States Study. BoneGoogle Scholar
  13. 13.
    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 22:517–527PubMedCrossRefGoogle Scholar
  14. 14.
    Farahmand BY, Persson PG, 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 11:803–808PubMedCrossRefGoogle Scholar
  15. 15.
    Meyer HE, Tverdal A, Falch JA (1993) Risk factors for hip fracture in middle-aged Norwegian women and men. Am J Epidemiol 137:1203–1211PubMedGoogle Scholar
  16. 16.
    Nabipour I, Cumming R, Handelsman DJ et al (2011) Socioeconomic status and bone health in community-dwelling older men: the CHAMP Study. Osteoporos Int 22:1343–1353PubMedCrossRefGoogle Scholar
  17. 17.
    Gove WR (1984) Gender differences in mental and physical illness: the effects of fixed roles and nurturant roles. Soc Sci Med 19:77–91PubMedCrossRefGoogle Scholar
  18. 18.
    Ross M, Goldsteen (1990) The Impact of the Fam on Health: The Decade in Rev J Fam and the Fam 52:1059–1078Google Scholar
  19. 19.
    Dienberg Love G, Seeman TE, Weinstein M, Ryff CD (2010) Bioindicators in the MIDUS national study: protocol, measures, sample, and comparative context. J Aging Health 22:1059–1080PubMedCrossRefGoogle Scholar
  20. 20.
    Brim OG, Ryff CD, Kessler RC (2004) How healthy are we? A national study of well-being at midlife. University of Chicago Press, ChicagoGoogle Scholar
  21. 21.
    Radler BT, Ryff CD (2010) Who participates? Accounting for longitudinal retention in the MIDUS national study of health and well-being. J Aging Health 22:307–331PubMedCentralPubMedCrossRefGoogle Scholar
  22. 22.
    Schuster TL, Kessler RC, Aseltine RH Jr (1990) Supportive interactions, negative interactions, and depressed mood. Am J Community Psychol 18:423–438PubMedCrossRefGoogle Scholar
  23. 23.
    Riggs BL, Wahner HW, Dunn WL, Mazess RB, Offord KP, Melton LJ 3rd (1981) Differential changes in bone mineral density of the appendicular and axial skeleton with aging: relationship to spinal osteoporosis. J Clin Invest 67:328–335PubMedCentralPubMedCrossRefGoogle Scholar
  24. 24.
    Treloar AE (1981) Menstrual cyclicity and the pre-menopause. Maturitas 3:249–264PubMedCrossRefGoogle Scholar
  25. 25.
    Campbell TL (1993) Research reports: marriage and health. Fam Syst Med 11:303–309CrossRefGoogle Scholar
  26. 26.
    Williams K, Umberson D (2004) Marital status, marital transitions, and health: a gendered life course perspective. J Health Soc Behav 45:81–98PubMedCrossRefGoogle Scholar
  27. 27.
    Booth A, Amato P (1991) Divorce and psychological stress. J Health Soc Behav 32:396–407PubMedCrossRefGoogle Scholar
  28. 28.
    Gerstel NRC, Rosenfield S (1985) Explaining the sumptomatology of separated and divorced men and women: the role of material conditions and social networks. Oxford J 64:84–101Google Scholar
  29. 29.
    Rosen CJ, American Society for Bone and Mineral Research. (2009) Primer on the metabolic bone diseases and disorders of mineral metabolism. American Society for Bone and Mineral Research, Washington, D.C.Google Scholar
  30. 30.
    Mora S, Goodman WG, Loro ML, Roe TF, Sayre J, Gilsanz V (1994) Age-related changes in cortical and cancellous vertebral bone density in girls: assessment with quantitative CT. AJR Am J Roentgenol 162:405–409PubMedCrossRefGoogle Scholar
  31. 31.
    Nilsson M, Ohlsson C, Mellstrom D, Lorentzon M (2009) Previous sport activity during childhood and adolescence is associated with increased cortical bone size in young adult men. J Bone Miner Res 24:125–133PubMedCrossRefGoogle Scholar
  32. 32.
    Ott SM (1991) Bone density in adolescents. N Engl J Med 325:1646–1647PubMedCrossRefGoogle Scholar
  33. 33.
    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
  34. 34.
    Adler NE, Ostrove JM (1999) Socioeconomic status and health: what we know and what we don’t. Ann N Y Acad Sci 896:3–15PubMedCrossRefGoogle Scholar
  35. 35.
    American Psychological Association (2000) Resolution on poverty and socioeconomic status. American Psychological Association, Washington, DCGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2013

Authors and Affiliations

  • D. Miller-Martinez
    • 1
  • T. Seeman
    • 1
  • A. S. Karlamangla
    • 1
  • G. A. Greendale
    • 1
  • N. Binkley
    • 2
  • C. J. Crandall
    • 3
    Email author
  1. 1.Division of GeriatricsDavid Geffen School of Medicine at University of California, Los AngelesLos AngelesUSA
  2. 2.University of Wisconsin-Madison Osteoporosis Clinical Center and Research ProgramMadisonUSA
  3. 3.Division of General Internal Medicine and Health Services ResearchDavid Geffen School of Medicine at University of California, Los AngelesLos AngelesUSA

Personalised recommendations