Epidemiology of osteoporosis in Germany: Is there a socioeconomic impact on the prevalence?

Osteoporosis and its consequences are a major public health concern. Here we focus on the prevalence of osteoporosis in Germany, stratifying not only for age and gender but also for socioeconomic background. These data are still lacking in Germany but represent an important aspect for implementing effective public health strategies.

This cross-sectional analysis is based on the national telephone health interview survey „German Health Update“ (GEDA2012) performed in 2012/2013. GEDA2012 provides information on osteoporosis and other self-reported diseases along with sociodemographic characteristics for nearly 20,000 adults. Descriptive statistical analysis and multiple logistic regression were used to examine the association between osteoporosis, age, gender and level of education adjusting for BMI, smoking status and alcohol consumption. Analyses were limited to participants aged 50 years or older.

Overall, 8.7% of the 10,660 participants aged 50+ years had osteoporosis with significant differences between men and women (men 4.7%, women 12.2%, p < 0.001). The proportion of female adults with osteoporosis increased substantially with age while prevalence rates for men remained nearly unchanged. The prevalence of osteoporosis was found to be higher for people with a low educational level (13.0%) compared to those with medium (8.3%) or high (5.5%) educational qualification. In multiple regression analysis, the level of education showed no significant association with the odds of having osteoporosis.

Osteoporosis has a major impact on health and patients' quality of life. Our findings showed that osteoporosis is associated with age and gender but there was no clear evidence of socioeconomic differences for German adults. However, prevalence rates may be biased as information on fractures was not available or diagnoses were not clinically verified. Over- or under-diagnosis in different socioeconomic levels has to be discussed.