Top

14-05-2018 | Osteoporosis | Article

Prevalence and comorbidity of osteoporosis– a cross-sectional analysis on 10,660 adults aged 50 years and older in Germany

Journal: BMC Musculoskeletal Disorders

Authors: Marie-Therese Puth, Manuela Klaschik, Matthias Schmid, Klaus Weckbecker, Eva Münster

Publisher: BioMed Central

Abstract

Background

Knowledge on prevalence of osteoporosis stratifying for socioeconomic background is insufficient in Germany. Little is known in Europe about other diseases that go along with it although these aspects are important for implementing effective public health strategies.

Methods

This cross-sectional analysis was based on the national telephone survey “German Health Update” (GEDA 2012) performed in 2012/2013. GEDA 2012 provides information on self-reported diseases and sociodemographic characteristics for nearly 20,000 adults. Descriptive statistical analysis and multiple logistic regression were used to examine the association between osteoporosis and age, sex, other diseases and education defined by ISCED. Analyses were limited to participants aged 50 years and older.

Results

Overall, 8.7% of the 10,660 participants aged 50+ years had osteoporosis (men 4.7%, women 12.2%). More than 95% of the adults with osteoporosis had at least one coexisting disease. The odds for arthrosis (OR 3.3, 95% CI 2.6-4.1), arthritis (OR 3.0, 95% CI 2.2-4.2), chronic low back pain (OR 2.8, 95% CI 2.3-3.5), depression (OR 2.3, 95% CI 1.7-3.1) and chronic heart failure (OR 2.3, 95% CI 1.6-3.1), respectively, were greater for adults with osteoporosis. Education showed no significant association with osteoporosis.

Conclusions

There was no clear evidence of socioeconomic differences regarding osteoporosis for adults in Germany. However, clinicians need to be aware that multimorbidity is very common in adults with osteoporosis. Health care interventions for osteoporosis could be improved by offering preventive care for other diseases that go along with it. Over- or under-diagnosis in different socioeconomic levels has to be further explored.

Reginster J-Y, Burlet N. Osteoporosis: a still increasing prevalence. Bone. 2006;38:S4–9. https://doi.org/10.1016/j.bone.2005.11.024.CrossRefPubMed

Svedbom A, Hernlund E, Ivergård M, Compston J, Cooper C, Stenmark J, et al. Osteoporosis in the European Union: a compendium of country-specific reports. Arch Osteoporos. 2013;8:137. https://doi.org/10.1007/s11657-013-0137-0.CrossRefPubMedPubMedCentral

World Health Organization. WHO SCIENTIFIC GROUP ON THE ASSESSMENT OF OSTEOPOROSIS AT PRIMARY HEALTH CARE LEVEL: Summary Meeting Report, Brussels, Belgium, 5-7 May 2004. 2004. http://www.who.int/chp/topics/Osteoporosis.pdf. Accessed 03 Apr 2017.

Felsenberg D, Silman AJ, Lunt M, Armbrecht G, Ismail AA, Finn JD, et al. Incidence of vertebral fracture in europe: results from the European prospective osteoporosis study (EPOS). J Bone Miner Res. 2002;17:716–24. https://doi.org/10.1359/jbmr.2002.17.4.716.CrossRefPubMed

de Gelder R, Koster EM, van Buren LP, van Ameijden EJC, Harrison A, Birt CA, Verma A. Differences in adults' health and health behaviour between 16 European urban areas and the associations with socio-economic status and physical and social environment. Eur J Pub Health. 2016; https://doi.org/10.1093/eurpub/ckv141.

Robert Koch-Institut. Gesundheitliche Ungleichheit in verschiedenen Lebensphasen. Gesundheitsberichterstattung des Bundes. Gemeinsam getragen von RKI und Destatis. 2017. http://www.rki.de/DE/Content/Gesundheitsmonitoring/Gesundheitsberichterstattung/GBEDownloadsB/gesundheitliche_ungleichheit_lebensphasen. Accessed 24 May 2017.

Mackenbach JP, Kunst AE, Cavelaars AE, Groenhof F, Geurts JJM. Socioeconomic inequalities in morbidity and mortality in western Europe. Lancet. 1997;349:1655–9. https://doi.org/10.1016/S0140-6736(96)07226-1.CrossRefPubMed

Mackenbach JP, Stirbu I, Roskam A-JR, Schaap MM, Menvielle G, Leinsalu M, Kunst AE. Socioeconomic inequalities in health in 22 European countries. N Engl J Med. 2008;358:2468–81. https://doi.org/10.1056/NEJMsa0707519.CrossRefPubMed

Brennan SL, Pasco JA, Urquhart DM, Oldenburg B, Hanna F, Wluka AE. The association between socioeconomic status and osteoporotic fracture in population-based adults: a systematic review. Osteoporos Int. 2009;20:1487–97. https://doi.org/10.1007/s00198-008-0822-9.CrossRefPubMed

10.

Brennan SL, Pasco JA, Urquhart DM, Oldenburg B, Wang Y, Wluka AE. Association between socioeconomic status and bone mineral density in adults: a systematic review. Osteoporos Int. 2011;22:517–27. https://doi.org/10.1007/s00198-010-1261-y.CrossRefPubMed

11.

Kanis JA, McCloskey EV. Risk factors in osteoporosis. Maturitas. 1998:229–33.

12.

de Laet C, Kanis JA, Oden A, Johanson H, Johnell O, Delmas P, et al. Body mass index as a predictor of fracture risk: a meta-analysis. Osteoporos Int. 2005;16:1330–8. https://doi.org/10.1007/s00198-005-1863-y.CrossRefPubMed

13.

Kanis JA, Borgstrom F, de Laet C, Johansson H, Johnell O, Jonsson B, et al. Assessment of fracture risk. Osteoporos Int. 2005;16:581–9. https://doi.org/10.1007/s00198-004-1780-5.CrossRefPubMed

14.

Robert Koch Institute, Department of Epidemiology and Health Monitoring. German Health Update 2012 (GEDA 2012). Public Use File first Version. 2014. https://doi.org/10.7797/29-201213-1-1-1.

15.

Kurth B-M, Lange C, Kamtsiuris P, Holling H. Gesundheitsmonitoring am Robert Koch-Institut. Sachstand und Perspektiven Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2009;52:557–70. https://doi.org/10.1007/s00103-009-0843-3.CrossRef

16.

Lange C, Jentsch F, Allen J, Hoebel J, Kratz AL, von der Lippe E, et al. Data resource profile: German health update (GEDA)--the health interview survey for adults in Germany. Int J Epidemiol. 2015;44:442–50. https://doi.org/10.1093/ije/dyv067.CrossRefPubMed

17.

ADM Arbeitskreis Deutscher Markt- und Sozialforschungsinstitute e.V. The ADM-Sampling-System for Telephone Surveys. http://www.adm-ev.de/fileadmin/user_upload/PDFS/Description-ADM-Stichproben-Telefon_EN.pdf. Accessed 02 May 2017.

18.

Häder S, Gabler S. Ein neues Stichprobendesign für telefonische Umfragen in Deutschland. In: Gabler S, editor. Telefonstichproben in Deutschland. Opladen u.a.: Westdt. Verl.; 1998. p. 69–88. doi:https://doi.org/10.1007/978-3-322-83334-1_6.

19.

Kish L. A procedure for objective respondent selection within the household. J Am Stat Assoc. 1949;44:380–7. https://doi.org/10.1080/01621459.1949.10483314.CrossRef

20.

Robert-Koch-Institut. Daten und Fakten: Ergebnisse der Studie "Gesundheit in Deutschland aktuell 2012": Beiträge zur Gesundheitsberichterstattung des Bundes. RKI, Berlin. 2014. http://www.rki.de/DE/Content/Gesundheitsmonitoring/Gesundheitsberichterstattung/GBEDownloadsB/GEDA12.pdf?__blob=publicationFile. Accessed 31 Jan 2017.

21.

The American Association for Public Opinion Research. Standard Definitions: Final Disposition of Case Codes and Outcome Rates for Surveys. 7th edition. 2011. https://www.esomar.org/uploads/public/knowledge-and-standards/codes-and-guidelines/ESOMAR_Standard-Definitions-Final-Dispositions-of-Case-Codes-and-Outcome-Rates-for-Surveys.pdf. Accessed 04 Oct 2017.

22.

Swart E, Gothe H, Geyer S, Jaunzeme J, Maier B, Grobe TG, Ihle P. Gute Praxis Sekundärdatenanalyse (GPS): Leitlinien und Empfehlungen. Gesundheitswesen. 2015;77:120–6. https://doi.org/10.1055/s-0034-1396815.CrossRefPubMed

23.

World Health Organization. Obesity - preventing and managing the global epidemic: report on a WHO consultation. Geneva: World Health Organization; 2000.

24.

Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA. The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory care quality improvement project (ACQUIP). Alcohol use disorders identification test. Arch Intern Med. 1998;158:1789–95.CrossRefPubMed

25.

IBM Corp. IBM SPSS statistics for windows. Armonk, NY: IBM Corp; 2016. Released

26.

R Core Team. R: a language and environment for statistical computing. Vienna: R Foundation for Statistical Computing; 2016.

27.

Wright NC, Looker AC, Saag KG, Curtis JR, Delzell ES, Randall S, Dawson-Hughes B. The recent prevalence of osteoporosis and low bone mass in the United States based on bone mineral density at the femoral neck or lumbar spine. J Bone Miner Res. 2014;29:2520–6. https://doi.org/10.1002/jbmr.2269.CrossRefPubMedPubMedCentral

28.

Wade SW, Strader C, Fitzpatrick LA, Anthony MS, O'Malley CD. Estimating prevalence of osteoporosis: examples from industrialized countries. Arch Osteoporos. 2014;9:182. https://doi.org/10.1007/s11657-014-0182-3.CrossRefPubMed

29.

Fuchs J, Rabenberg M, Scheidt-Nave C. Pravalenz ausgewahlter muskuloskelettaler Erkrankungen: Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2013;56:678–86. https://doi.org/10.1007/s00103-013-1687-4.CrossRefPubMed

30.

Hadji P, Klein S, Gothe H, Haussler B, Kless T, Schmidt T, et al. The epidemiology of osteoporosis--bone evaluation study (BEST): an analysis of routine health insurance data. Dtsch Arztebl Int. 2013;110:52–7. https://doi.org/10.3238/arztebl.2013.0052.PubMedPubMedCentralCrossRef

31.

Haussler B, Gothe H, Gol D, Glaeske G, Pientka L, Felsenberg D. Epidemiology, treatment and costs of osteoporosis in Germany--the BoneEVA study. Osteoporos Int. 2007;18:77–84. https://doi.org/10.1007/s00198-006-0206-y.CrossRefPubMed

32.

Scheidt-Nave C, Starker A. Osteoporosepravalenz und assoziierte Versorgungsmuster bei Frauen im Alter ab 45 Jahren in Deutschland. Ergebnisse des ersten telefonischen Gesundheitssurveys 2003. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2005;48:1338–47. https://doi.org/10.1007/s00103-005-1166-7.CrossRefPubMed

33.

Berg KM, Kunins HV, Jackson JL, Nahvi S, Chaudhry A, Harris KA, et al. Association between alcohol consumption and both osteoporotic fracture and bone density. Am J Med. 2008;121:406–18. https://doi.org/10.1016/j.amjmed.2007.12.012.CrossRefPubMedPubMedCentral

34.

Gaddini GW, Turner RT, Grant KA, Iwaniec UT. Alcohol: a simple nutrient with complex actions on bone in the adult skeleton. Alcohol Clin Exp Res. 2016;40:657–71. https://doi.org/10.1111/acer.13000.CrossRefPubMedPubMedCentral

35.

Zhang X, Yu Z, Yu M, Qu X. Alcohol consumption and hip fracture risk. Osteoporos Int. 2015;26:531–42. https://doi.org/10.1007/s00198-014-2879-y.CrossRefPubMed

36.

Tucker KL, Jugdaohsingh R, Powell JJ, Qiao N, Hannan MT, Sripanyakorn S, et al. Effects of beer, wine, and liquor intakes on bone mineral density in older men and women. Am J Clin Nutr. 2009;89:1188–96. https://doi.org/10.3945/ajcn.2008.26765.CrossRefPubMedPubMedCentral

37.

Waugh EJ, Lam M-A, Hawker GA, McGowan J, Papaioannou A, Cheung AM, et al. Risk factors for low bone mass in healthy 40-60 year old women: a systematic review of the literature. Osteoporos Int. 2009;20:1–21. https://doi.org/10.1007/s00198-008-0643-x.CrossRefPubMed

38.

Du Y, Zhao L-J, Xu Q, Wu K-H, Deng H-W. Socioeconomic status and bone mineral density in adults by race/ethnicity and gender: the Louisiana osteoporosis study. Osteoporos Int. 2017;28:1699–709. https://doi.org/10.1007/s00198-017-3951-1.CrossRefPubMed

39.

Westhoff G, Schneider M, Raspe H, Zeidler H, Runge C, Volmer T, Zink A. Advance and unmet need of health care for patients with rheumatoid arthritis in the German population--results from the German rheumatoid arthritis population survey (GRAPS). Rheumatology (Oxford). 2009;48:650–7. https://doi.org/10.1093/rheumatology/kep045.CrossRef

40.

Cauley JA. Public health impact of osteoporosis. J Gerontol A Biol Sci Med Sci. 2013;68:1243–51. https://doi.org/10.1093/gerona/glt093.CrossRefPubMedPubMedCentral

41.

Cummings SR, Melton LJ. Epidemiology and outcomes of osteoporotic fractures. Lancet. 2002;359:1761–7. https://doi.org/10.1016/S0140-6736(02)08657-9.CrossRefPubMed

42.

Drosselmeyer J, Rapp MA, Hadji P, Kostev K. Depression risk in female patients with osteoporosis in primary care practices in Germany. Osteoporos Int. 2016;27:2739–44. https://doi.org/10.1007/s00198-016-3584-9.CrossRefPubMed

43.

Im G-I, Kim M-K. The relationship between osteoarthritis and osteoporosis. J Bone Miner Metab. 2014;32:101–9. https://doi.org/10.1007/s00774-013-0531-0.CrossRefPubMed