Monash Centre for Health Research and Implementation, Monash University, Locked Bag 29, Clayton, Melbourne, Vic, 3168, Australia.
Department of Endocrinology, Monash Health, Melbourne, 3168, Australia.
Arch Osteoporos. 2024 Nov 4;19(1):106. doi: 10.1007/s11657-024-01463-7.
Osteoporosis affects over half of older women, whether urban compared to rural residents have different risk of osteoporosis is unclear. This 23-year longitudinal study of Australian women found lower risk of osteoporosis and fractures among women living in rural compared with urban areas, which may relate to distribution of risk factors and/or screening opportunities.
To determine whether the prevalence of osteoporosis, fractures, and dual-X-ray absorptiometry (DXA) differs between Australian women living in rural compared with urban areas.
The Australian Longitudinal Study on Women's Health, a prospective longitudinal study of Australian women, includes a cohort of women born 1946-1951, surveyed nine times from 1996-2019. Data from administrative health records were linked to survey data. Geographic area was classified as major city, inner regional, outer regional, or remote. Generalised estimating equations (GEE) explored outcomes of osteoporosis, fracture, and DXA rates. Univariable and multivariable regression were performed and bootstrapping with 100 repetitions at 95% sampling of the original dataset to ensure robust results.
A total of 13,712 women were included: 5000 (36.5%) living in major cities, 5214 (38.0%) inner regional, 2798 (20.41%) outer regional, and 700 (5.1%) remote areas. Baseline age, 47.6 (1.46) years (mean (SD)), was similar; but education, marital status, country of birth, smoking, BMI, and comorbidities varied between areas. Over 23 years, 2956 (21.6%) were diagnosed with osteoporosis, 3185 (23.2%) had an incident fracture, and 8151 (59.4%) had a DXA. On univariable analysis, women living outside major cities had lower risk of osteoporosis (inner regional OR 0.92; 95% CI 0.84, 0.99; outer regional 0.70; 0.63, 0.79; remote 0.43; 0.34, 0.53), and lower risk of fractures (inner regional area OR 0.92, 95% CI 0.84, 0.99; outer regional 0.81; 0.73, 0.90; remote 0.54; 0.42, 0.67), than women living in major cities. These differences were no longer significant on multivariable analysis, suggesting differences might be related to the distribution of risk factors. Women living in inner regional and outer regional areas were significantly less likely to have a DXA, than those living in a major city (OR 0.75, 95% CI 0.70, 0.81; OR 0.72; 95% CI 0.64, 0.77, respectively), and this remained significant on multivariable analysis.
CONCLUSION(S): Osteoporosis or fracture affected one-third of older Australian women, and women living outside major cities had lower rates of osteoporosis, fractures, and DXA completion.
确定与城市地区相比，澳大利亚农村地区女性骨质疏松症、骨折和双能 X 线吸收法（DXA）的患病率是否存在差异。
澳大利亚妇女健康纵向研究（Australian Longitudinal Study on Women's Health）是一项对澳大利亚女性的前瞻性纵向研究，包括了出生于 1946 年至 1951 年的女性队列，从 1996 年至 2019 年共进行了 9 次调查。行政健康记录的数据与调查数据相关联。地理区域分为主要城市、内城区、外城区和偏远地区。广义估计方程（GEE）探讨了骨质疏松症、骨折和 DXA 率的结果。进行了单变量和多变量回归，并对原始数据集进行了 100 次重复的自举抽样，以确保结果可靠。
共纳入 13712 名女性：5000 名（36.5%）居住在主要城市，5214 名（38.0%）居住在内城区，2798 名（20.41%）居住在外城区，700 名（5.1%）居住在偏远地区。基线年龄为 47.6（1.46）岁（平均值（SD）），相似；但教育程度、婚姻状况、出生地、吸烟状况、BMI 和合并症在不同地区有所不同。在 23 年的时间里，2956 名（21.6%）被诊断为骨质疏松症，3185 名（23.2%）发生了骨折，8151 名（59.4%）接受了 DXA 检查。单变量分析显示，居住在主要城市以外地区的女性患骨质疏松症的风险较低（内城区 OR 0.92；95%CI 0.84，0.99；外城区 OR 0.70；0.63，0.79；偏远地区 OR 0.43；0.34，0.53），发生骨折的风险也较低（内城区 OR 0.92，95%CI 0.84，0.99；外城区 OR 0.81；0.73，0.90；偏远地区 OR 0.54；0.42，0.67），而居住在主要城市的女性。多变量分析表明，这些差异不再具有统计学意义，表明差异可能与危险因素的分布有关。与居住在主要城市的女性相比，居住在内城区和外城区的女性接受 DXA 的可能性显著降低（OR 0.75，95%CI 0.70，0.81；OR 0.72；95%CI 0.64，0.77），这一结果在多变量分析中仍然显著。
三分之一的老年澳大利亚女性患有骨质疏松症或骨折，居住在主要城市以外地区的女性骨质疏松症、骨折和 DXA 检查的发生率较低。
