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Comparison of Bone Mineral Density between Urban and Rural Areas: Systematic Review and Meta-Analysis

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  • Mika Matsuzaki
  • Rashmi Pant
  • Bharati Kulkarni
  • Sanjay Kinra

Abstract

Background: Studies from high income countries (HIC) have generally shown higher osteoporotic fracture rates in urban areas than rural areas. Low bone mineral density (BMD) increases susceptibility to fractures. This review aimed to assess whether urbanicity is consistently associated with lower BMD globally. Method: Ovid MEDLINE, EMBASE, and Global Health (-April 2013) were searched for articles investigating differences in bone mineral content (BMC) or BMD between urban and rural areas. Ratio of means (RoM) of BMD were used to estimate effect sizes in meta-analysis, with an exception for one study that only presented BMC data. Results: Fifteen articles from eleven distinct populations were included in the review; seven populations from four high income countries and four from three low and middle income countries (LMIC). Meta-analysis showed conflicting evidence for urban-rural difference in BMD; studies from high income countries generally showed higher BMD in rural areas while the results were more mixed in studies from low and middle income countries (HIC RoM = 0.05; 95% CI: 0.03 to 0.06; LMIC RoM = -0.04: 95% CI: -0.1 to 0.01). Conclusions: Urban-rural differences of bone mineral density may be context-specific. BMD may be higher in urban areas in some lower income countries. More studies with robust designs and analytical techniques are needed to understand mechanisms underlying the effects of urbanization on bone mass accrual and loss.

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  • Mika Matsuzaki & Rashmi Pant & Bharati Kulkarni & Sanjay Kinra, 2015. "Comparison of Bone Mineral Density between Urban and Rural Areas: Systematic Review and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 10(7), pages 1-11, July.
    • Handle: RePEc:plo:pone00:0132239
    DOI: 10.1371/journal.pone.0132239
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    References listed on IDEAS

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    1. David Moher & Alessandro Liberati & Jennifer Tetzlaff & Douglas G Altman & The PRISMA Group, 2009. "Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement," PLOS Medicine, Public Library of Science, vol. 6(7), pages 1-6, July.
    2. Cohen, Barney, 2006. "Urbanization in developing countries: Current trends, future projections, and key challenges for sustainability," Technology in Society, Elsevier, vol. 28(1), pages 63-80.
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