Prevalence of osteoporosis by educational level in a cohort of postmenopausal women

To evaluate whether the prevalence of osteoporosis and related risk factors might be influenced by the level of education, as has been demonstrated fo r many other chronic diseases, 6160 postmenopausal women at their first den sitometric referral were interviewed about reproductive variables, past and current use of estrogens, prevalence of chronic diseases, and lifestyle fa ctors such as calcium intake, physical activity, smoking and overweight. Th is sample was stratified by years of formal education. Densitometric evalua tion was performed by dual-energy X-ray absorptiometry. Age at menarche, pa st exposure to oral contraceptives, use of hormone replacement therapy, pre valence of chronic diseases, physical activity, overweight and smoking show ed significant trends according to the years of education. The prevalence o f osteoporosis showed an inverse relationship with level of education, rang ing from 18.3% for the most educated to 27.8% for the least educated women. Multiple logistic regression analysis demonstrated a predictive role towar d osteoporosis by age, age at menarche and menopause, hormone replacement t herapy, calcium intake, physical activity and body mass index. Using the lo west educational level as reference category, increases in educational stat us were associated with a significantly reduced risk for osteoporosis (OR = 0.76, 95% CI 0.65-0.90 for 6-8 years of schooling; OR = 0.68, 95% CI 0.57- 0.82 for 9 years or more). This study shows differences in the prevalence o f osteoporosis among educational classes and the protective role played by increases in formal education. If these results are confirmed in other popu lation studies, public health intervention programs will have to consider t he socioeconomic and cultural background of the population strata that run a greater risk of osteoporosis.