Disparities in osteoporosis by race/ethnicity, education, work status, immigrant status, and economic status in the United States

Published:April 25, 2019DOI:


      • Disparities in osteoporosis exist in US.
      • Socioeconomic factors were related to the prevalence of osteoporosis.
      • Osteoporosis was more prevalent among who were non-citizens and less educated.
      • Osteoporosis was more prevalent among who were unemployed with a lower income.



      Osteoporosis is one of the most common bone health diseases affecting older adults in US. Addressing disparities in osteoporosis will help to enhance the quality of bone care in the nation's bone health programs.

      Materials & methods

      We used the data of adult participants of the National Health and Nutrition Examination Survey with reported bone mineral density measured during the periods of 2005–2010 and 2013–2014 to examine disparities in osteoporosis based on race/ethnicity, educational attainment, work status, immigrant status, and economic status in US.


      Based on educational attainment, the age- and sex-standardized osteoporosis prevalence (SOP) was highest among those with less than a high school education (HSE) (5.1%, 95% CI (CI): 4.3%–5.9%), whereas it was lowest among those with more than HSE (3.2%, CI: 2.7%–3.6%). Based on work status, SOP was highest among unemployed participants (5.4%, CI: 1.9%–8.9%), whereas it was lowest among working participants (2%, CI: 1.6%–2.4%). Based on immigrant status, SOP was highest among non-citizens (6.4%, CI: 5%–7.8%), whereas it was lowest among those born in US (3.4%, CI: 3.1%–3.7%). Based on economic status, SOP was highest among those with poverty-to-income ratio (PIR) <1 (5.5%, CI: 4.4%–6.5%), whereas it was lowest among those with PIR ≥ 4 (2.4%, CI: 1.9%–2.9%).


      Osteoporosis was more prevalent among US adults who were non-citizens, less educated, unemployed, and had lower income. The observed disparities suggest a need for interventions to promote better quality bone care among the socioeconomically disadvantaged groups.


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