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The relationship between social deprivation, osteoporosis, and falls

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Abstract

The aim of this study was to assess the relationship between heel BMD, risk factors for osteoporosis, falls history, and the Jarman Underprivileged Area Score in an older community population. From the general practice register, 1,187 women (mean age 70, range 60 to 94) were recruited. BMD of the heel was measured using the GE Lunar PIXI densitometer. A T-score cutoff for predicted osteoporosis at the spine or hip of −1.7 was used. A risk factor questionnaire was completed that included fracture history and falls history. The odds ratio (OR) with a 95% confidence interval (CI) was calculated for each risk factor for each quartile of Jarman score and for the diagnosis of osteoporosis. Logistic regression was used to identify the risk factors that predict lone bone mass in the heel. There were no significant differences between women in different quartiles of Jarman score in terms of age and body mass index (BMI). Women in the highest two quartiles of Jarman score (i.e., most deprived) had a significantly higher likelihood of osteoporosis (OR=1.82; 95% CI, 1.03 to 1.63; and OR=1.85; 95% CI, 1.04 to 1.64, respectively) and significantly lower BMD (p=0.008). Women in these two quartiles were significantly more likely to have had a history of previous fracture (OR=1.66; 95% CI, 1.01 to 1.53), but there was no difference in falls history. Women in the lowest quartile (least deprived) were also significantly less likely to smoke (p=0.011) but were not significantly different in terms of other risk factors (e.g., dietary calcium and activity). BMI, age, kyphosis, significant visual problems, and quartile of Jarman score were significant risk factors for low bone mass. Risk factors identified those with low bone mass at the heel with a sensitivity and specificity of 72%. In conclusion, women in the lowest quartile of Jarman score (i.e., least deprived) have significantly higher heel BMD compared with the rest of the population.

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References

  1. Townsend P (1974) Inequality and the health service. Lancet 1(7868):1179–1190

    Article  CAS  PubMed  Google Scholar 

  2. Johansen A, Jones S, Saunders J, Lyons R (2001) Socioeconomic deprivation and the risk of fracture in older people. First joint meeting of the International Bone and Mineral Society and the European Calcified Tissue Society, Madrid, Spain. June 5–10, 2001

  3. la Vecchia C, Negri E, Levi F, Baron JA (1991) Cigarette smoking, body mass and other risk factors for fractures of the hip in women. Int J Epidemiol 20(3):671–677

    PubMed  Google Scholar 

  4. Farahmand BY, Persson PG, Michaelsson K et al (2000) Socioeconomic status, marital status and hip fracture risk: a population-based case-control study. Osteoporos Int 11(9):803–808

    Article  CAS  PubMed  Google Scholar 

  5. Bacon WE, Hadden WC (2000) Occurrence of hip fractures and socioeconomic position. J Aging Health 12(2):193–203

    CAS  PubMed  Google Scholar 

  6. Fitzpatrick P, Kirke PN, Daly L et al (2001) Predictors of first hip fracture and mortality post fracture in older women. Ir J Med Sci 170(1):49–53

    CAS  PubMed  Google Scholar 

  7. del Rio Barquero L, Romera Baures M, Pavia Segura J et al (1992) Bone mineral density in two different socio-economic population groups. Bone Miner 18(2):159–168

    PubMed  Google Scholar 

  8. 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(1):20–26

    Article  PubMed  Google Scholar 

  9. Ribot C, Tremollieres F, Pouilles JM (1995) Can we detect women with low bone mass using clinical risk factors? Am J Med 98(2A):52S–55S

    Article  CAS  Google Scholar 

  10. Ribot C, Pouilles JM, Bonneu M, Tremollieres F (1992) Assessment of the risk of post-menopausal osteoporosis using clinical factors. Clin Endocrinol (Oxf) 36:225–228

    Google Scholar 

  11. Bauer DC, Browner WS, Cauley JA et al (1993) Factors associated with appendicular bone mass in older women. The Study of Osteoporotic Fractures Research Group. Ann Intern Med 118:657–665

    CAS  PubMed  Google Scholar 

  12. Kim CH, Kim YI, Choi CS, Park JY, Lee MS, Lee SI, Kim GS (2000) Prevalence and risk factors of low quantitative ultrasound values of calcaneus in Korean elderly women. Ultrasound Med Biol 26:35–40

    Article  CAS  PubMed  Google Scholar 

  13. Dargent-Molina P, Poitiers F, Breart G (2000) In elderly women weight is the best predictor of a very low bone mineral density: evidence from the EPIDOS study. Osteoporos Int 11:881–888

    Article  CAS  PubMed  Google Scholar 

  14. Stewart A, Reid DM (2000) Quantitative ultrasound or clinical risk factors--which best identifies women at risk of osteoporosis? Br J Radiol 73:165–171

    CAS  PubMed  Google Scholar 

  15. Lin JD, Chen JF, Chang HY, Ho C (2001) Evaluation of bone mineral density by quantitative ultrasound of bone in 16,862 subjects during routine health examination. Br J Radiol 74:602–606

    CAS  PubMed  Google Scholar 

  16. Frost ML, Blake GM, Fogelman I (2001) Quantitative ultrasound and bone mineral density are equally strongly associated with risk factors for osteoporosis. J Bone Miner Res 16:406–416

    CAS  PubMed  Google Scholar 

  17. Royal College of Physicians (1999) Osteoporosis: clinical guidelines for prevention and treatment. Royal College of Physicians, London

  18. National Osteoporosis Foundation (2000) Physician’s guide to the prevention and treatment of osteoporosis. National Osteoporosis Foundation, Washington, DC

  19. Nelson HD, Helfand M, Woolf SH, Allan JD (2002) Screening for postmenopausal osteoporosis: a review of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 137(6):529–541

    PubMed  Google Scholar 

  20. Lee SH, Dargent-Molina P, Breart G (2002) Risk factors for fractures of the proximal humerus: results from the EPIDOS prospective study. J Bone Miner Res 17(5):817–825

    PubMed  Google Scholar 

  21. Jarman B (1983) Identification of underprivileged areas. BMJ 286:1705–1709

    CAS  PubMed  Google Scholar 

  22. Taylor R, Pearson D, Masud T (2001) Long term in vivo and in vitro precision of the GE Lunar PIXI heel densitometer. Osteoporos Int 12[Suppl 2]:S25

  23. Faulkner KG, von Stetten E, Miller P (1999) Discordance in patient classification using T-scores. J Clin Densitom 2:343–350

    CAS  PubMed  Google Scholar 

  24. Pearson D, Masud T, Sahota O, Cawte S, Hosking DJ (2003) A comparison of calcaneal dual energy X-ray absorptiometry and calcaneal ultrasound for predicting the diagnosis of osteoporosis from hip and spine bone densitometry. J Clin Densitom (in press)

  25. Fordham JN, Chinn DJ, Kumar N (2000) Identification of women with reduced bone density at the spine and femoral neck using BMD at the os calcis. Osteoporos Int 11:797–802

    Article  CAS  PubMed  Google Scholar 

  26. Dargent-Molina P, Douchin MN, Cormier C, Meunier PJ, Breart G and the EPIDOS Study Group (2002) Use of clinical risk factors in elderly women with low bone mineral density to identify women at higher risk of hip fracture: the EPIDOS prospective study. Osteoporos Int 13:593–599

    Article  Google Scholar 

  27. Schacke H, Docke WD, Asadullah K (2002) Mechanisms involved in the side effects of glucocorticoids. Pharmacol Ther 96:23–43 (Review)

    Article  CAS  PubMed  Google Scholar 

  28. Cadarette SM, Jaglal SB, Kreiger N, McIsaac WJ, Darlington GA, Tu JV (2000) Development and validation of the Osteoporosis Risk Assessment Instrument to facilitate selection of women for bone densitometry. CMAJ 162:1289–1294

    CAS  PubMed  Google Scholar 

  29. Ben Sedrine W, Devogelaer JP, Kaufman JM et al (2001) Evaluation of the simple calculated osteoporosis risk estimation (SCORE) in a sample of white women from Belgium. Bone 29:374–380

    Article  PubMed  Google Scholar 

  30. Sedrine WB, Chevallier T, Zegels B et al (2002) Development and assessment of the Osteoporosis Index of Risk (OSIRIS) to facilitate selection of women for bone densitometry. Gynecol Endocrinol 16:245–250

    CAS  PubMed  Google Scholar 

  31. Hawker GA, Jamal SA, Ridout R, Chase C (2002) A clinical prediction rule to identify premenopausal women with low bone mass. Osteoporos Int 13:400–406

    Article  Google Scholar 

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Authors and Affiliations

  1. Medical Physics, Nottingham City Hospital NHS Trust, Hucknall Road, Nottingham, NG5 1PB, UK

    Derek Pearson

  2. Clinical Gerentology Research Unit, Nottingham City Hospital NHS Trust, Nottingham, NG5 1PB, UK

    Rachel Taylor

  3. Nottingham City Hospital NHS Trust, Nottingham, NG5 1PB, UK

    Tahir Masud

Authors
  1. Derek Pearson
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  2. Rachel Taylor
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  3. Tahir Masud
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Corresponding author

Correspondence to Derek Pearson.

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Pearson, D., Taylor, R. & Masud, T. The relationship between social deprivation, osteoporosis, and falls. Osteoporos Int 15, 132–138 (2004). https://doi.org/10.1007/s00198-003-1499-8

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  • DOI: https://doi.org/10.1007/s00198-003-1499-8

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