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27-03-2013 | General practice | Article

Wealth wards off fractures


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medwireNews: The highest risk for fractures is concentrated in the most deprived sector of society, report UK researchers.

"A lower bone mineral density may play a role, but it seems likely that the cause is multifactorial and relates to a number of medical and social comorbidities," say Charles Court-Brown (Royal Infirmary of Edinburgh, UK) and colleagues.

They analyzed 6872 fractures in patients over 15 years of age from Edinburgh and the surrounding area (population in this age group about half a million) over a 1-year period. The team found a significant relationship between affluence, based on the Carstairs score, and fracture risk, such that the risk rose with increasing deprivation.

"However, the relationship is not linear, and in our society, it is the most deprived 10% who present with an increased incidence of fractures," Court-Brown et al write in the Journal of Bone & Joint Surgery.

They add: "We accept that other societies may show a different relationship between fracture incidence and deprivation, but there is some evidence that the problem is widespread."

People whose Carstairs scores fell in deciles 9 and 10 (the most deprived 10% of the population) had significant increases in the risk for almost every type of fracture, with risk increases in men ranging from 2.4-fold for metatarsal fractures to 10.5-fold for the proximal part of the tibia.

This increased risk was despite people in these deciles having a younger average age than those categorized as less deprived. The difference in age had other effects, however; the rates of proximal femoral fracture were 15.3% among people in decile 1, compared with 8.6% among those in decile 10, suggesting that people in decile 10 do not live long enough to accumulate many osteoporosis-associated fractures.

There were also gender differences. "It is noticeable that there is a much narrower spread of odds ratios for females than for males, and it seems likely that the wider distribution of odds ratios for males represents behavioral changes in addition to the medical and social comorbidities that affect both sexes," say the researchers.

Indeed, the odds for a fracture resulting from assault were elevated 4.8-fold in men in deciles 9 and 10 versus those in deciles 1-8, whereas the risk was increased just 2.4-fold in women. Conversely, women in deciles 9 and 10 had a 10.7-fold increased risk for spontaneous or pathologic fractures relative to those in deciles 1-8, whereas men had a 4.3-fold increased risk.

Men in deciles 9 and 10 were more likely than women to drink excess alcohol, the researchers note, and to sustain fractures in a car accident.

By Eleanor McDermid, Senior medwireNews Reporter

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