Deprivation indices and their association with fragility fractures and bone density : evidence from a large observational cohort

Amin, Hamzah and Khan, Muhammed Aqib and Bukhari, Marwan (2025) Deprivation indices and their association with fragility fractures and bone density : evidence from a large observational cohort. Rheumatology. ISSN 1462-0324

Abstract

Socioeconomic deprivation as a fracture risk factor remains underexplored. We evaluated associations between deprivation indices and bone health outcomes in a UK clinical population. 40,951 patients aged ≥50 years underwent dual-energy X-ray absorptiometry (DXA) scanning between June 2004-May 2025 in northwest England. Socioeconomic status was assessed using the Index of Multiple Deprivation (IMD) and Townsend Deprivation Score (TDS). Generalised additive models examined associations between deprivation and major osteoporotic fractures (MOF), hip fractures (HF), bone density and body composition while adjusting for FRAX risk factors. Of 40,951 patients who underwent DXA scanning, 32,324 (79%) were women with mean age 68.2 years and 11,811 major osteoporotic fractures including 2,208 hip fractures. After excluding patients with missing deprivation data, 29,693 patients were analysed. The most deprived patients (IMD) had higher odds of MOF (OR 1.07, 95% CI 1.02-1.14) and HF (OR 1.28, 95% CI 1.11-1.46). TDS was also associated with MOF (OR 1.10, 95% CI 1.03-1.18). Both indices were linked to higher osteoporosis odds: TDS showed ORs of 1.45 (95% CI 1.33-1.59) for femoral neck and 1.30 (95% CI 1.19-1.29) for lumbar spine, while IMD showed ORs of 1.34 (95% CI 1.24-1.45) and 1.20 (95% CI 1.13-1.29), respectively. Deprived patients had increased regional body fat: TDS had 0.90% higher femoral fat and 0.84% higher abdominal fat, while IMD showed 0.60% and 0.67% higher fat percentages respectively. Socioeconomic deprivation is independently associated with increased fracture odds, osteoporosis, and high fragility fracture risk-related body composition. [Abstract copyright: © The Author(s) 2025. Published by Oxford University Press on behalf of the British Society for Rheumatology.]