Socio-economic Determinants of Bone Health from Past to Present

Abstract

Increasing epidemiology evidence amounts for social determinants of bone health underlying musculo-skeletal conditions such as osteoporosis. Amongst different facets influencing skeletal health, socio-economic status (SES) has been identified as a critical factor determining one’s access to resources, health care, education, nutrition, and physical activity. Recent conceptual and epigenetic studies assessing SES links with DNA methylation offer further support for the adverse effects of social disadvantage in early life on bone quantity and quality in adulthood. However, this evidence for socially patterned risks in bone fragility is not restricted to the contemporary society. Data exist for ancient human skeletal samples deriving from SES stratified cemeteries that also reflect bone changes consistent with lifestyles specific to social standing. Similarly to modern data, the conclusion drawn from the ancient times has been for a negative effect of low SES on bone growth and maintenance. Some contradictory results, mirroring previously reported inconsistencies in epidemiological studies, have also been reported showing that high SES can equally result in poor bone health. It becomes clear that ancient perspectives can offer a further line of support into these ongoing epidemiological and epigenetic research efforts. Taken together, a holistic approach to clinical understanding and practice of bone health is recommended, building upon ancient and modern findings to target living groups who are most at risk of developing low bone mass and compromised bone micro-architecture.