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Socioeconomics, metabolic syndrome, and osteopenia in postmenopausal women

The increased prevalence of metabolic syndrome and osteoporosis in postmenopausal women has prompted multiple research studies to understand why. A new study from South Korea examined the association of socioeconomic status-related factors, unhealthy lifestyles, and diet-related factors with the coexistence of metabolic syndrome and osteoporosis. Study results are published online today in Menopause, the journal of The North American Menopause Society (NAMS).

Metabolic syndrome and osteoporosis not only adversely affect a woman's quality of life, but they also create significant financial burden. Previous studies have suggested that these health problems are affected by lifestyle, genetic, metabolic, nutrition, and hormone factors. In particular, smoking has been shown to impair calcium absorption. In addition, an inverse relationship has been identified between metabolic syndrome and the intake of carbohydrates, vitamins (A, C, and D), calcium, fruits, and dairy products. Similarly, osteoporosis has an inverse association with higher intakes of vitamin D, fish, and dairy products.

Although these relationships have been the focus of other studies, this study involving nearly 2,000 postmenopausal women between the ages of 45 and 65 is the first known to consider a woman's menopause status. Researchers found that 32.5% of study participants experienced both metabolic syndrome and osteoporosis. Health-related behavior (including physical activity, alcohol consumption, and smoking) and diet-related-factors (such as intake of nutrients, eating habits, and food insecurity) were evaluated to determine their effect on the prevalence of both metabolic syndrome and osteoporosis.

Researchers concluded that the coexistence of metabolic syndrome and osteoporosis was positively associated with insufficient dairy intake, lack of physical activity, and higher alcohol consumption. However, the effect was significantly dependent on socioeconomic factors such as education, household income, place of residence, and employment status. Women with low income and low education were more likely to have metabolic syndrome and osteoporosis. Conversely, women with high income and high education were 70% less likely to have these two health problems compared with a middle-income group. Additional research is suggested to identify controllable factors that could enhance the health of postmenopausal women.



The prevalence of metabolic syndrome (MetS) and osteoporosis (OP) among postmenopausal women has been rapidly increasing. We examined the associations between socioeconomic status-related factors, unhealthy lifestyle, and the coexistence of MetS and osteopenia or OP.


One thousand nine hundred ninety-one postmenopausal women aged 45 to 65 years were used to select a representative sample of the civilian, noninstitutionalized South Korean population from the 2008 to 2011 Korea National Health and Nutrition Examination Survey data. Women were grouped as neither MetS nor OP (normal), MetS, OP, and both MetS and OP (MetS + OP). Socioeconomic status (education, household income, place of residence, employment status), health-related behaviors (physical activity, alcohol consumption, smoking), and diet-related factors (intake of nutrients and food groups, eating habits, food insecurity) were obtained. Logistic regression models were used to examine the odds ratio (OR) and 95% confidence interval (CI).


The prevalence of MetS + OP was 32.5%. The average number of MetS risk factors in MetS + OP was 3.5, higher than that of normal and OP groups (P < 0.001). Bone mineral density at all sites was significantly lower in MetS + OP than normal and MetS groups (P < 0.001). Also, calcium, phosphorus, vitamin A, riboflavin, and niacin levels were lowest in the MetS + OP group compared with the three other groups (P < 0.05). After controlling for covariates, low-income and low-education women were more likely to have MetS + OP (OR 1.97, 95% CI 1.04-3.72); high-income and high-education group was 70% less likely to have MetS + OP (OR 0.30, 95% CI 0.10-0.86) compared with the middle-income and middle-education group.


Social inequalities might be powerful contributors in Korean postmenopausal women with coexistence of MetS and OP. Therefore, social and political perspective approaches are required in this population for prevention and treatment of MetS and OP. Future studies should explore to find controllable factors and thereby improve health status in postmenopausal women


Lee, Hansongyi PhD; Kim, Jieun PhD; Lim, Hyunjung PhD. 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: April 20, 2020 - Volume Publish Ahead of Print - Issue - doi: 10.1097/GME.0000000000001518

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