Food Insecurity Is Associated With Lower Bone Mineral Density Among Older Puerto Rican Adults Living in Boston

OBJECTIVES: We aimed to measure associations between food security status and bone mineral density (BMD) among Puerto Rican adults. Osteoporosis, which is characterized by low BMD and reduced bone strength, increases risk of fracture. Food insecurity is associated with poor dietary quality, which may be associated with poorer BMD. However, few studies have examined the relationship between food insecurity and measures of bone health. METHODS: Data were from the Boston Puerto Rican Osteoporosis Study (BPROS), an ancillary study of Boston Puerto Rican Health Study (BPRHS). Participants were aged 45–75 y at baseline. Food security was assessed as a binary predictor (food secure vs. food insecure) based on the USDA's Guide to Measuring Household Food Security at the baseline visit. BMD was measured at the femoral neck, lumbar spine, trochanter, and total hip, using dual energy x-ray absorptiometry (DXA) approximately 2 y after baseline. SAS (version 9.4) was used to conduct statistical analyses including means, frequencies, and multivariable analysis of covariance models. Interactions with sex/menopausal status/estrogen use, diabetes, and plasma vitamin D status were examined; none were significant. RESULTS: 27% of the sample reported food insecurity (n = 258). Those who were food insecure had significantly lower BMD at the total hip than those who were food secure (BMD: 1.05 g/cm(2) ± 0.01 vs. 1.02 g/cm(2) ± 0.01, P = 0.02) after adjusting age, sex/menopause/estrogen, height, BMI, smoking status and alcohol use. Differences in BMD least-squared means between those who experience food insecurity compared to those who are food secure at the femoral neck (BMD: 0.96 g/cm(2) ± 0.01 vs. 0.94 g/cm(2) ± 0.01, P = 0.09) and the trochanter (BMD: 0.85 g/cm(2) ± 0.01 vs. 0.83 g/cm(2) ± 0.01, P = 0.07) approached significance. There was no significant association between food security status and BMD at the lumbar spine. CONCLUSIONS: Food security may contribute to lower BMD measures among older Puerto Rican adults; however, more prospective studies are needed. These findings suggest that programs and policies that address social factors, such as food insecurity, may be important for bone health and prevention of osteoporosis. FUNDING SOURCES: P01 AG023394, P50 HL105185, R01 AG027087, K01 AR067894.