Abstract
BACKGROUND: Previous epidemiological studies have reported significant regional variations in the global prevalence of osteoporosis. However, these variations cannot be fully explained by known risk factors. AIM: This study aims to explore the regional variations in the global prevalence of low bone mineral density (LBMD) among women aged 55 years or older and its association of socioeconomic factors. METHODS: We used data from the 2019 Global Burden of Disease (GBD 2019) to highlight the regional differences in the prevalence of LBMD among women aged 55 or older worldwide. We then examined the correlations between LBMD in this demographic and four socioeconomic factors: GDP, urbanization ratio, prevalence of undernourishment (sourced from the World Bank), and current health expenditure (CHE) (obtained from the World Health Organization). To investigate the relationships between LBMD in women aged 55 and older and the urbanization ratio, prevalence of undernourishment, and CHE, we utilized linear mixed models. RESULTS: The age-standardized summary exposure value (ASSEV) of LBMD in women aged 55 or older was highest in Western Sub-Saharan Africa (42.88, 95% UI, 33.43-53.04 in 1990 and 39.68, 95% UI, 30.42-49.66 in 2019), followed by Eastern Sub-Saharan Africa, Central Sub-Saharan Africa, and Southeast Asia. The lowest ASSEV was found in Central Asia (20.21, 95% UI, 13.74-27.39 in 1990 and 18.14, 95% UI, 12.03-25.67 in 2019), followed by Western Europe. The ASSEV of LBMD in women aged 55 or older was negatively correlated with CHE (β =-2.39, P < 0.001) and positively correlated with the prevalence of undernourishment (β = 1.76, P < 0.001). No significant correlation was found between the ASSEV of LBMD in women aged 55 or older and the urbanization ratio. CONCLUSIONS: Socioeconomic factors have close relationship with LBMD. The imbalances of socioeconomic development might be the reason for variations of LBMD in women aged 55 or older worldwide. Reduction of undernourishment and enhancement of health expenditure might contribute to preventing LBMD. A limited increase in health investment could greatly decrease the prevalence of LBMD, especially in regions with low health expenditure.