The relationship between social deprivation, osteoporosis, and falls

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.

Improving Osteoporosis Management in Primary Care: An Audit of the Impact of a Community Based Fracture Liaison Nurse

“…However, a previous study has shown lower rates of hip fracture with increased deprivation, with these differences put down to differences in age between groups [ 51 ]. Though a previous study had suggested that people from more deprived groups were more likely to have a lower bone mineral density, with the only clearly difference in risk factors that hey smoked more [ 52 ].…”

The Association between Fracture Rates and Neighborhood Characteristics in Washington, DC, Children

“…[14–18] Lower SES is also associated with lower bone density in adult women [19] and increased adult fracture risk in osteoporosis. [20] On a neighborhood level, Canadian studies have shown that children who live in low-income neighborhoods exercise less and have less healthy diets than those living in more affluent neighborhoods, even after adjusting for family SES. [13] Studies of the effect of such community poverty on childhood fracture risk are limited and have yielded inconsistent results.…”

Anti‐osteoporosis medication dispensing by clinical commissioning groups in England – an ecological study of variability in practice and of the effect of the Covid‐19 pandemic

“…Although, women are more likely to suffer from osteoporosis, 10 those in the least deprived quartile of the population had significantly higher heel Bone Mineral Density (BMD) compared with the rest of the population. 41 Women in this quartile were also significantly less likely to smoke, indicating a relationship between gender, smoking, deprivation and osteoporosis. Socioeconomic deprivation was also found to be a risk factor for osteoporosis in older adults.…”