Association between socioeconomic status and bone mineral density in adults: a systematic review

Brennan, Sharon L.; Pasco, Julie A.; Urquhart, Donna M.; Oldenburg, Brian; Wang, Yuanyuan; Wluka, Anita E.

doi:10.1007/s00198-010-1261-y

Cited by 66 publications

(60 citation statements)

References 34 publications

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“…Low SES, often associated with sub-optimal nutrition and growth delays, may therefore explain the negative correlation between physical activity and LS BMD, a site made up of predominantly trabecular bone, the turnover of which is influenced by the hormonal and metabolic milieu. Low SES has been shown to be a strong independent predictor of whole body bone mineral content, after adjusting for body size and pubertal development in 9-/10-year-old children [22] and adults [35], and has been associated with an increased risk of fracture [36]. Accordingly, we showed that BMD was associated with a higher level of education in black women, which is similar to other studies in the USA [30] and North Africa [37].…”

Section: Discussionsupporting

confidence: 90%

Site-specific differences in bone mineral density in black and white premenopausal South African women

et al. 2011

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Section: Discussionsupporting

confidence: 90%

Site-specific differences in bone mineral density in black and white premenopausal South African women

et al. 2011

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“…All studies were observational. Grading of the overall evidence based on Brennan et al (2011) confirmed strong evidence for a relationship between HGS and hip fracture incidence ("generally consistent findings in multiple high-quality cohort studies"). It was however not possible to comment on the strength of that relationship, as studies were not comparable with regard to design, analyses, populations, primary objectives and dynamometer brands.…”

Section: Methodological Quality and Strength Of Evidencementioning

confidence: 68%

“…Overall evidence was graded using previously published criteria (Brennan et al, 2011;Lievense et al, 2002) with four levels of evidence (no evidence to strong evidence) based on quality, design and number of included studies (appendix 2). In order to compare HGS measures, values provided in Newton were converted into Kilograms (kg); values provided in Kilopascal (kPa) could not be converted (conversion only possible to Kilogram force per square meter).…”

Section: Critical Appraisal Grading Of Evidence and Data Analysismentioning

confidence: 99%

The association between decreased hand grip strength and hip fracture in older people: A systematic review

Denk

Lennon

Gordon

et al. 2018

Experimental Gerontology

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The association between decreased hand grip strength and hip fracture in older people: a systematic review ABSTRACT Hip fractures are a global concern, resulting in poor outcomes and high health care costs. They mostly affect people >80 years. Hip fractures are influenced by various (modifiable) risk factors. Emerging evidence suggests hand grip strength (HGS) to be one of several useful tools to identify hip fracture risk. This is the first systematic review that aims to assess the evidence underlying the relationship between hip fracture incidence and HGS. Eleven studies were selected for this review (six case-control and five cohort studies), comprising 21197 participants. Where reported, HGS was significantly decreased in individuals with a hip fracture near the time of injury as compared to controls (p<0.001); HGS was associated with increased hip fracture risk in all included studies. Meta-analysis was not possible. All studies included in this systematic review confirmed a relationship between decreased HGS and hip fracture incidence. We were not able to quantify the strength of this relationship, due to the heterogeneity of the included studies. HGS merits further investigation as a useful tool for identifying individuals that might be at elevated risk for sustaining a hip fracture. Key words: Hand grip strength, hip fracture, proximal femur fracture, frailty, risk factor 1. Introduction Low impact fractures of the proximal femur (hip fractures) are a major worldwide public health concern (Hernlund et al., 2013; Kanis et al., 2012; The World Bank, 2015). They mostly occur in people older than 80 years (Kistler et al., 2015). As the population ages, hip fractures are predicted to increase by 35% between 2012 and 2022; the annual cost will rise to $1.27 billion in Australia alone (Watts et al., 2013). The current annual hospital cost of hip fractures in the UK has been estimated at £1.1 billion (Leal et al., 2016). Thus, it is vital to further improve fracture prevention strategies, not only to decrease health care costs, but also to reduce devastating outcomes such as morbidity, disability, dependency, and poor quality of life (Griffin et al., 2015;Parker, 2016). Many, often modifiable, risk factors need to be considered for hip fracture prevention. Osteoporosis (Kanis, 1994) and falls (Jarvinen et al., 2008) are recognized risk factors for sustaining a hip fracture. Other factors include, but are not limited to, sarcopenia (Oliveira and Vaz, 2015), muscle weakness, physical inactivity, impaired cognition, impaired vision, and chronic health conditions (Marks, 2010). The current gold standard screening tool to assist in identifying those most at risk of hip fracture is the Fracture Risk Assessment Tool (FRAX®). FRAX is based on 12 variables: age, sex, weight, height, previous fracture, parent fractured hip, current smoking, glucocorticoids, rheumatoid arthritis, secondary osteoporosis, alcohol (three or more units/day), and femoral neck bone mineral density (BMD) (The University of Sheffield, 2011). Lo...

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“…Recent studies are now targeting SEP as a risk factor for poor bone health, raising public health concerns. In these studies [3][4][5][6][7][8], low SEP is associated with low bone mineral density (BMD) and/or increased risk of osteoporosis (or osteoporotic fractures), which may be explained by less protective behaviors in low-SEP individuals. Low SEP can negatively influence bone health and increase the risks of osteoporotic fractures, which deteriorate quality of life [9].…”

mentioning

confidence: 98%

The Effect of Socioeconomic Position on Bone Health Among Koreans by Gender and Menopausal Status

et al. 2012

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While studies suggest that socioeconomic position (SEP) influences bone health and risk of osteoporotic fracture in postmenopausal women, few studies have simultaneously examined gender and menopause differences as they relate to SEP and bone health. Here, we investigated the relationship between SEP and bone mineral density (BMD) among Korean men, premenopausal women, and postmenopausal women using the BMD data set (n = 9,995) of the Korean National Health and Nutrition Examination Survey IV. The relationship between SEP and BMD was estimated using analysis of covariance (ANCOVA); adjustments were made for age and body mass index (BMI) in the multivariate models. The relationship between SEP and osteoporosis prevalence was estimated using logistic regression. Relative index of inequality (RII) in osteoporosis was estimated using log-binomial regression. ANCOVA (adjusted for age and for age plus BMI) showed a significant positive association between SEP and BMD among men and postmenopausal women. Logistic regression showed a significant negative association between SEP and osteoporosis prevalence among men and postmenopausal women but not in premenopausal women. The RII, estimated by log-binomial regression, showed the impact of SEP on osteoporosis to be significant in men and postmenopausal women (p < 0.05) but not in premenopausal women. Overall, low SEP was associated with both low BMD and high risk of osteoporosis among men and postmenopausal women. Efforts to reduce the economic burden of morbidity and mortality from osteoporosis should target men and postmenopausal women with low SEP.

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Association between socioeconomic status and bone mineral density in adults: a systematic review

Abstract: Limited good quality evidence exists for the role that education level may play in BMD levels. Cohort studies are required to examine the relationship between individual SES parameters and BMD in order to identify potential intervention targets.

Cited by 66 publications

References 34 publications

Site-specific differences in bone mineral density in black and white premenopausal South African women

Site-specific differences in bone mineral density in black and white premenopausal South African women

The association between decreased hand grip strength and hip fracture in older people: A systematic review

The Effect of Socioeconomic Position on Bone Health Among Koreans by Gender and Menopausal Status

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