title: Social inequalities in osteoporosis and fracture among community-dwelling older men and women: findings from the Hertfordshire Cohort Study.
abstract: It is unknown whether osteoporosis is socially patterned. Using data from the Hertfordshire Cohort Study we found no consistent evidence for social inequalities in prevalent or incident fracture, bone mineral density or loss rates, or bone strength. Public health strategies for prevention of osteoporosis should focus on the whole population.
  
  
  BACKGROUND
  Osteoporosis and osteoporotic fracture are major public health issues for society; the burden for the affected individual is also high. It is unclear whether osteoporosis and osteoporotic fracture are socially patterned.
  
  
  OBJECTIVE
  This study aims to analyse social inequalities in osteoporosis and osteoporotic fracture among the 3,225 community-dwelling men and women, aged 59-73 years, who participated in the Hertfordshire Cohort Study (HCS), UK.
  
  
  METHODS
  A panel of markers of bone health (fracture since 45 years of age; DXA bone mineral density and loss rate at the total femur; pQCT strength strain indices for the radius and tibia; and incident fracture) were analysed in relation to the social circumstances of the HCS participants (characterised at the individual level by: age left full time education; current social class; housing tenure and car availability).
  
  
  RESULTS
  We found little strong or consistent evidence among men, or women, for social inequalities in prevalent or incident fracture, DXA bone mineral density, bone loss rates, or pQCT bone strength, with or without adjustment for age, anthropometry, lifestyle and clinical characteristics.                 Reduced car availability at baseline was associated with lower pQCT radius and tibia strength strain indices at follow-up among men only (p = 0.02 radius and p < 0.01 tibia unadjusted; p = 0.05 radius and p = 0.01 tibia, adjusted for age, anthropometry, lifestyle and clinical characteristics).
  
  
  CONCLUSIONS
  Our results suggest that fracture and osteoporosis do not have a strong direct social gradient and that public health strategies for prevention and treatment of osteoporosis should continue to focus on the whole population.
authors.affiliation: MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton SO16 6YD, UK. hes@mrc.soton.ac.uk
authors.forename: Holly E
authors.initials: HE
authors.lastname: Syddall
authors.forename: Maria
authors.initials: M
authors.lastname: Evandrou
authors.forename: Elaine M
authors.initials: EM
authors.lastname: Dennison
authors.forename: Cyrus
authors.initials: C
authors.lastname: Cooper
authors.forename: Avan Aihie
authors.initials: AA
authors.lastname: Sayer
mesh_terms: D000368:Aged; D000375:Aging; D015519:Bone Density; D015331:Cohort Studies; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000453:epidemiology*; D015995:Prevalence; D012111:Residence Characteristics; D012959:Socioeconomic Factors; D006113:United Kingdom / Q000453:epidemiology