title: Poverty is a risk factor for osteoporotic fractures.
abstract: 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.
  
  
  BACKGROUND
  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/cm(2) vs. 0.867 g/cm(2), 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.
authors.affiliation: Health Education and Promotion Working Group, Canary Islands, Spain. msosa@ono.com
authors.forename: M C
authors.initials: MC
authors.lastname: Navarro
authors.forename: M
authors.initials: M
authors.lastname: Sosa
authors.forename: P
authors.initials: P
authors.lastname: Saavedra
authors.forename: P
authors.initials: P
authors.lastname: Lainez
authors.forename: M
authors.initials: M
authors.lastname: Marrero
authors.forename: M
authors.initials: M
authors.lastname: Torres
authors.forename: C D
authors.initials: CD
authors.lastname: Medina
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D015992:Body Mass Index; D015519:Bone Density / Q000502:physiology; D003430:Cross-Sectional Studies; D005260:Female; D005272:Femur Neck / Q000000981:diagnostic imaging; D050723:Fractures, Bone / Q000453:epidemiology*; D006801:Humans; D008019:Life Style; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000453:epidemiology*; D017698:Postmenopause; D011203:Poverty; D015995:Prevalence; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D016103:Spinal Fractures / Q000453:epidemiology
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