Socioeconomic Status Associated With Coexistence of Metabolic Syndrome and Postmenopausal Osteoporosis

Postmenopausal women with low income and less education are more likely to have coexistence of metabolic syndrome (MetS) and osteoporosis compared with women who have middle levels of education and income, according to study results published in Menopause.

MetS and osteoporosis generally increase with age and coexist with menopause, but no studies have considered women’s menopausal status. In addition, there is a lack of data on the association of the coexistence of MetS and osteoporosis with health-related risk factors.

To examine these associations between socioeconomic status, health-related behaviors, and diet-related factors and the coexistence of MetS and osteoporosis in postmenopausal Korean women, data from a total of 1991 women in the 2008 to 2011 Korean National Health and Nutrition Examination Surveys (KNHANES) were evaluated. Postmenopausal women aged 45 to 65 years who had complete and valid data on the risk factors necessary for MetS diagnosis, had never been diagnosed with any form of cancer or thyroid disease, consumed between 500 to 4000 calories per day, and did not consume alcohol on the day of the survey were included.

MetS was defined as having ≥3 of the following: triglyceride levels ≥150 mg/dL or drug treatment for elevated triglycerides; high-density lipoprotein cholesterol (HDL-C) levels ≤50 mg/dL or drug treatment for reduced HDL-C; fasting glucose levels ≥100 mg/dL or drug treatment for elevated glucose; systolic blood pressure (BP) ≥130 mm Hg, diastolic BP ≥85 mm Hg, or antihypertensive medication treatment; or waist circumference ≥80 cm.

Dual-energy x-ray absorptiometry was used to measure bone mineral density at the lumbar spine, femoral neck, and total hip. The BMD values were then converted into T-scores, which were used to categorize patients as having normal BMD (T-score ≥-1.0), osteopenia (T-score >-1.0 to <-2.5), or osteoporosis (T-score ≤-2.5), as defined by the World Health Organization.

The mean age of women in the group with both MetS and osteoporosis (58.0±0.1 years) was highest and significantly different from the mean age of women in the control group (53.2±0.1 years; P <.0001). Women in the MetS (54.9±0.1 years) and osteoporosis (55.8±0.1 years) groups had similar and significantly higher ages than women in the control group (P <.0001). The group with MetS and osteoporosis had the highest proportion of women with the lowest education (62.3%) as well as the highest rates of women in the 2 lowest income quartiles (P <.0001). The proportion of women with low physical activity was highest in the group with both MetS and osteoporosis, and the proportion of women with high physical activity was lowest (P =.04). The group with coexisting MetS and osteoporosis also had the highest proportion of nondrinkers (P =.002).

Women in the MetS/osteoporosis and MetS groups had significantly higher systolic BP (P <.0001), fasting blood glucose (P =.013), and triglycerides (P =.0283) relative to women in the control and osteoporosis groups. Dietary factors also differed between groups: the ratio of protein (P =.0001) and fat (P =.02) to total caloric intake was significantly lower in the group with MetS and osteoporosis relative to the control group, as was daily intake of calcium, phosphorus, potassium, sodium, vitamin A, niacin, and vitamin C. The daily intake of fruits, fish, and dairy was also significantly lower in the group with coexisting MetS and osteoporosis relative to the normal group. Higher levels of alcohol intake were positively associated with MetS and osteoporosis co-occurrence.

Taken together, the study found that postmenopausal women with MetS and osteoporosis had worse metabolic parameters, had lower intake of some key nutrients and food groups, were more likely to be physically inactive, and were more likely to have less education and a lower household income relative to women without either condition. The nutritional deficits may have been attributed to a higher intake of carbohydrates than recommended by the Dietary Reference Intakes for Koreans (70% in this study vs 55%-65% as recommended).

These findings may help guide future screening of high-risk groups and treatment for postmenopausal women with MetS and osteoporosis. The strong association between socioeconomic status and the coexistence of MetS and osteoporosis should be considered in the management of postmenopausal women’s health. Nutritional education may improve adherence to dietary guidelines, particularly dairy foods.

Future studies should explore specific treatments to improve the health of postmenopausal women, such as increasing physical activity and dairy consumption and decreasing alcohol intake.

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Reference

Lee H, Kim J, Lim H. Coexistence of metabolic syndrome and osteopenia associated with social inequalities and unhealthy lifestyle among postmenopausal women in South Korea: The 2008 to 2011 Korea National Health and Nutritional Examination Survey (KNHANES). Menopause. 2020;27(6):000-000