Study Highlights Osteoporosis Risk in Gay Men

Non-heterosexual minority men have a greater risk of poor bone health than heterosexual men, and this risk appears to be independent of lifestyle and psychosocial factors, suggests a study published in the American Journal of Human Biology.

Surprisingly, the study did not find that non-heterosexual minority women were more likely to experience poor bone health.

People belonging to sexual minorities are known to be at greater risk of several adverse health outcomes and this has been attributed to a greater prevalence of unhealthy lifestyle factors, such as smoking, among this population, as well as the significant stresses they have experienced related to the stigma associated with their sexuality. However, there has been little research looking at whether sexuality has any impact on bone health using assessments of bone mineral density measures or fracture risk.

To examine the association between bone health and sexuality, researchers combined data on 3,243 adults from the 2007 to 2008, 2009 to 2010, and 2013 to 2014 cycles of U.S. National Health and Nutrition Examination Survey, which included dual-energy X-ray absorptiometry (DXA) assessments. The participants included 253 sexual minority people (53 lesbian/gay, 97 bisexual, and 103 same-sex experienced) and 2990 heterosexuals. Their average age was 36 years.

Sexual orientation-based comparisons were made for a number of bone health indicators, including z-scored bone mineral density in the lumbar spine (L1-4 vertebrae) and proximal femur (femoral head, greater trochanter, and intertrochanteric line), bone mineral content in the femur and spine, and osteoporosis risk.

James Gibb from the department of anthropology at the University of Toronto in Canada said: “Sexual orientation-based disparities in bone mass were observed across all anatomical sites. This effect was due to differences between heterosexual and gay men and persisted in linear regressions after adjusting for risk factors.”

Specifically, the results showed that gay men, but not bisexual men or sexual minority females, had lower z-scored bone mineral density values in their trochanter, intertrochanter and femoral neck regions. The analysis also showed differences in femoral and femoral neck bone mineral content between heterosexual and gay men (P = 0.02), and in femoral, femoral neck and spinal bone mineral content between heterosexual and bisexual women (P = 0.05).

Minority stress is considered a major contributing factor in health disparities experienced by sexual minority people, and understanding the role of lived experiences and stress physiology in shaping variability in bone health will enable policymakers to design more effective public health policy and interventions, Dr. Gibb said.

In the light of that, he added, the finding that bisexual women had higher bone mineral content than heterosexual and other sexual minority women was “surprising.”

“Although statistically nonsignificant, lesbian and bisexual females in our sample consistently display better indicators of bone mass compared to heterosexual and same sex experienced women,” he said. “Our finding that bisexual women, and to a lesser extent lesbian women, have better bone health than other female participants, warrants further investigations.”

Cannabis consumption was associated with lower femoral bone mineral content suggesting that behavioral factors likely have an impact on bone health outcomes, he said, and moderate depression was significantly associated with bone mineral density independent of sexuality.

“Characterizing the unique socioeconomic, psychosocial, and ecological risk factors that result in an increased vulnerability to poor bone health among sexual minority people is important for designing therapeutic and public health interventions for this community, especially as the population of sexual minority older adults grows,” Dr. Gibb added.

“This research may help identify ways in which public health professionals and government officials can construct health policies and interventions that may reduce the risk for negative health consequences experienced by sexual minorities by identifying critical periods of development early in their life.”

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REFERENCE

Gibb, JK, Shattuck, EC. Sexual orientation‐based disparities in bone health: Evidence of reduced bone mineral density and mineral content among sexual minority men but not women in multiple NHANES waves. Am J Hum Biol. 2020; 1– 21. https://doi.org/10.1002/ajhb.23534