Skip to main content

Advertisement

SpringerLink
Log in

Socioeconomic status influences on bone mineral density in American men: findings from NHANES 2011–2020

  • Original Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

Summary

The association between socioeconomic status (SES) and bone mineral density (BMD) in men remains controversial. We showed that SES was positively associated with BMD in American men. Confounding factors like race/ethnicity and age could affect the association.

Introduction

Based on the data from the National Health and Nutrition Examination Survey (NHANES), 2011–2020, this article aims to investigate the association of SES (poverty income ratio (PIR) and education level) with the BMD in American men.

Methods

We evaluated the association of SES with BMD in 4446 men aged ≥ 20 years (mean age, 41.0 ± 13.4 years) from the NHANES 2011–2020. BMD was measured by dual-energy X-ray absorptiometry (DXA) at the lumbar spine. We used multivariate linear regression models to examine the relationship between SES and total spine BMD, adjusted for a large range of confounding factors.

Results

Compared with other PIR quarters, individuals in the highest quarter of PIR were more likely to be older and white and had fewer smoking or drinking behaviors. After adjusting for race/ethnicity, age, drinking and smoking behavior, body mass index (BMI), total protein, serum calcium, serum uric acid, cholesterol, serum phosphorus, and blood urea nitrogen, PIR was positively correlated with total spine BMD (β = 0.004 95% CI: 0.001–0.007, P = 0.006). Individuals with the highest degree (college degree or above) had a 0.057 g/cm2 greater BMD than that of the lowest degree (less than 9th grade) (β = 0.057 95% CI: 0.037–0.077, P < 0.001).

Conclusions

Our study indicates that SES was positively associated with the lumbar BMD among American men. Clinicians, healthcare providers, and policymakers should consider the unequal SES of men when implementing osteoporosis prevention and treatment strategies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

The data that support the findings of this study are available in the supplementary material of this article.

Code availability

Not applicable.

References

  1. Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17:1726–1733

    Article  CAS  Google Scholar 

  2. Hernlund E, Svedbom A, Ivergård M, et al. (2013) Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos 8:136

  3. Reginster JY, Burlet N (2006) Osteoporosis: a still increasing prevalence. Bone 38:S4-9

    Article  Google Scholar 

  4. Mustapha A, Ssekasanvu J, Chen I et al (2022) Hypertension and socioeconomic status in south central Uganda: a population-based cohort study. Glob Heart 17:3

    Article  Google Scholar 

  5. Hawkins Carranza F, Corbatón-Anchuelo A, Bermejo Pareja F et al (2022) Incidence of type 2 diabetes in the elderly in Central Spain: association with socioeconomic status, educational level, and other risk factors. Prim Care Diabetes 16(2):279–286

  6. Valentin G, Ravn MB, Jensen EK et al (2021) Socio-economic inequalities in fragility fracture incidence: a systematic review and meta-analysis of 61 observational studies. Osteoporos Int 32:2433–2448

    Article  CAS  Google Scholar 

  7. Valentin G, Pedersen SE, Christensen R et al (2020) Socio-economic inequalities in fragility fracture outcomes: a systematic review and meta-analysis of prognostic observational studies. Osteoporos Int 31:31–42

    Article  CAS  Google Scholar 

  8. Brennan SL, Winzenberg TM, Pasco JA, Wluka AE, Dobbins AG, Jones G (2013) Social disadvantage, bone mineral density and vertebral wedge deformities in the Tasmanian older adult cohort. Osteoporos Int 24:1909–1916

    Article  CAS  Google Scholar 

  9. Hsieh CH, Wang CY, McCubbin M, Zhang S, Inouye J (2008) Factors influencing osteoporosis preventive behaviours: testing a path model. J Adv Nurs 62:336–345

    Article  Google Scholar 

  10. Hernandez-Rauda R, Martinez-Garcia S (2004) Osteoporosis-related life habits and knowledge about osteoporosis among women in El Salvador: a cross-sectional study. BMC Musculoskelet Disord 5:29

    Article  Google Scholar 

  11. Song SY, Kim Y, Park H, Kim YJ, Kang W, Kim EY (2017) Effect of parity on bone mineral density: a systematic review and meta-analysis. Bone 101:70–76

    Article  Google Scholar 

  12. Lins Vieira NF, da Silva Nascimento J, do Nascimento CQ, Barros Neto JA, Oliveira Dos Santo ACS (2021) Association between bone mineral density and nutritional status, body composition and bone metabolism in older adults. J Nutr Health Aging 25:71–76

  13. Wang MC, Dixon LB (2006) Socioeconomic influences on bone health in postmenopausal women: findings from NHANES III, 1988–1994. Osteoporos Int 17:91–98

    Article  Google Scholar 

  14. Du Y, Zhao LJ, Xu Q, Wu KH, Deng HW (2017) Socioeconomic status and bone mineral density in adults by race/ethnicity and gender: the Louisiana osteoporosis study. Osteoporos Int 28:1699–1709

    Article  CAS  Google Scholar 

  15. Elliot JR, Gilchrist NL, Wells JE (1996) The effect of socioeconomic status on bone density in a male Caucasian population. Bone 18:371–373

    Article  CAS  Google Scholar 

  16. Myong JP, Kim HR, Choi SE, Koo JW (2012) The effect of socioeconomic position on bone health among Koreans by gender and menopausal status. Calcif Tissue Int 90:488–495

    Article  CAS  Google Scholar 

  17. Nabipour I, Cumming R, Handelsman DJ et al (2011) Socioeconomic status and bone health in community-dwelling older men: the CHAMP study. Osteoporos Int 22:1343–1353

    Article  CAS  Google Scholar 

  18. Araujo AB, Yang M, Suarez EA et al (2014) Racial/ethnic and socioeconomic differences in bone loss among men. J Bone Miner Res 29:2552–2560

    Article  Google Scholar 

  19. Loucks EB, Rehkopf DH, Thurston RC, Kawachi I (2007) Socioeconomic disparities in metabolic syndrome differ by gender: evidence from NHANES III. Ann Epidemiol 17:19–26

    Article  Google Scholar 

  20. Suresh S, Sabanayagam C, Shankar A (2011) Socioeconomic status, self-rated health, and mortality in a multiethnic sample of US adults. J Epidemiol 21:337–345

    Article  Google Scholar 

  21. Lane NE (2006) Epidemiology, etiology, and diagnosis of osteoporosis. Am J Obstet Gynecol 194:S3-11

    Article  CAS  Google Scholar 

  22. Akkus Z, Camdeviren H, Celik F, Gur A, Nas K (2005) Determination of osteoporosis risk factors using a multiple logistic regression model in postmenopausal Turkish women. Saudi Med J 26:1351–1359

    PubMed  Google Scholar 

  23. Gur A, Sarac AJ, Nas K, Cevik R (2004) The relationship between educational level and bone mineral density in postmenopausal women. BMC Fam Pract 5:18

    Article  Google Scholar 

  24. Guadalupe-Grau A, Fuentes T, Guerra B, Calbet JA (2009) Exercise and bone mass in adults. Sports Med 39:439–468

    Article  Google Scholar 

  25. Brennan SL, Henry MJ, Wluka AE, Nicholson GC, Kotowicz MA, Pasco JA (2010) Socioeconomic status and bone mineral density in a population-based sample of men. Bone 46:993–999

    Article  Google Scholar 

  26. del Rio BL, RomeraBaures M, Pavia Segura J et al (1992) Bone mineral density in two different socio-economic population groups. Bone Miner 18:159–168

    Article  Google Scholar 

  27. Xu X, Liu L, Sharma M, Zhao Y (2015) Smoking-related knowledge, attitudes, behaviors, smoking cessation idea and education level among young adult male smokers in Chongqing, China. Int J Environ Res Public Health 12:2135–2149

    Article  Google Scholar 

  28. Mullen PD, Simons-Morton DG, Ramírez G, Frankowski RF, Green LW, Mains DA (1997) A meta-analysis of trials evaluating patient education and counseling for three groups of preventive health behaviors. Patient Educ Couns 32:157–173

    Article  CAS  Google Scholar 

  29. Macgregor CB, Meerkin JD, Alley SJ, Vandelanotte C, Reaburn PJ (2018) Osteoporosis and low bone mineral density (osteopenia) in rural and remote Queensland. Aust J Rural Health 26:369–374

    Article  Google Scholar 

  30. Wastesson JW, RingbäckWeitoft G, Parker MG, Johnell K (2013) Educational level and use of osteoporosis drugs in elderly men and women: a Swedish nationwide register-based study. Osteoporos Int 24:433–442

    Article  CAS  Google Scholar 

  31. Arabi A, Nabulsi M, Maalouf J et al (2004) Bone mineral density by age, gender, pubertal stages, and socioeconomic status in healthy Lebanese children and adolescents. Bone 35:1169–1179

    Article  Google Scholar 

  32. Crandall CJ, Merkin SS, Seeman TE, Greendale GA, Binkley N, Karlamangla AS (2012) Socioeconomic status over the life-course and adult bone mineral density: the Midlife in the U.S. Study. Bone 51:107–13

  33. Crandall CJ, Miller-Martinez D, Greendale GA, Binkley N, Seeman TE, Karlamangla AS (2012) Socioeconomic status, race, and bone turnover in the Midlife in the US Study. Osteoporos Int 23:1503–1512

    Article  CAS  Google Scholar 

  34. Nam HS, Shin MH, Zmuda JM et al (2010) Race/ethnic differences in bone mineral densities in older men. Osteoporos Int 21:2115–2123

    Article  Google Scholar 

  35. Conradie M, Conradie MM, Kidd M, Hough S (2014) Bone density in black and white South African women: contribution of ethnicity, body weight and lifestyle. Arch Osteoporos 9:193

    Article  Google Scholar 

  36. Ho SC, Chen YM, Woo JL (2005) Educational level and osteoporosis risk in postmenopausal Chinese women. Am J Epidemiol 161:680–690

    Article  Google Scholar 

  37. Allali F, Rostom S, Bennani L, Abouqal R, Hajjaj-Hassouni N (2010) Educational level and osteoporosis risk in postmenopausal Moroccan women: a classification tree analysis. Clin Rheumatol 29:1269–1275

    Article  Google Scholar 

  38. Yu CX, Zhang XZ, Zhang K, Tang Z (2015) A cross-sectional study for estimation of associations between education level and osteoporosis in a Chinese men sample. BMC Musculoskelet Disord 16:382

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We acknowledge the data from the National Health and Nutrition Examination Survey (NHANES).

Author information

Author notes

  1. Pei-Lun Xiao and Cairen·Fuerwa contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopaedics, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, 519000, Guangdong, China

    Pei-Lun Xiao, Cairen Fuerwa, Chi-Jen Hsu, Rong Peng, Ning Jiang, Yong-Guang Ma, Xiang-He Xu & Hua-Ding Lu

  2. Department of Orthopaedics, Honghui Hospital, Xi’an Jiao Tong University, Xi’an, 710000, China

    Ai-Yong Cui

Authors
  1. Pei-Lun Xiao
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cairen Fuerwa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chi-Jen Hsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rong Peng
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ai-Yong Cui
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ning Jiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yong-Guang Ma
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Xiang-He Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Hua-Ding Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hua-Ding Lu.

Ethics declarations

Ethics approval

The study was approved by the ethics review board of the National Center for Health Statistics.

Consent to participate

Written consent was obtained from each participant.

Consent for publication

Not applicable.

Conflict of interest

None.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Xiao, PL., Fuerwa, C., Hsu, CJ. et al. Socioeconomic status influences on bone mineral density in American men: findings from NHANES 2011–2020. Osteoporos Int 33, 2347–2355 (2022). https://doi.org/10.1007/s00198-022-06498-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-022-06498-5

Keywords

Search

Navigation