Amin, Hamzah and Khan, Muhammed Aqib and Bukhari, Marwan (2026) Investigating the association between urban rural classification with fragility fractures and bone density in the UK : evidence from a large observational clinical cohort. Rheumatology Advances in Practice. ISSN 2514-1775
Full text not available from this repository.Abstract
Objectives Geographic variation in fracture risk exists across the UK, yet urban-rural differences in fracture risk and bone density have yet to be explored. We aimed to investigate associations between urban-rural classification and bone health outcomes in a UK clinical population. Methods We analysed patients who underwent dual-energy X-ray absorptiometry scanning between June 2004–May 2025 in northwest England. Geographic status was assessed using 2011 UK Census Urban Rural Classification. Multiple imputation with parameter pooling was performed with logistic and linear regression models adjusted for FRAX risk factors to investigate the associations between urban–rural residence and major osteoporotic fractures, hip fractures, bone mineral density, and body composition. Results Of 40,951 eligible patients, 32,324 (79%) were women with mean age 68.2 years, 11,811 major osteoporotic fractures were reported including 2,208 hip fractures. No significant association existed between urban–rural status and odds of having a previous fragility fracture (major osteoporotic fractures: odds ratio (OR) 0.97, 95% CI 0.92–1.02; hip fractures: OR 0.98, 95% CI 0.90–1.07). Rural residence was associated with lower osteoporosis odds: femoral neck OR 0.86 (95% CI 0.80–0.92) and lumbar spine OR 0.85 (95% CI 0.80–0.91). Rural patients had significantly lower regional body fat: femoral fat percentage (β=-0.45, 95% CI -0.55 to -0.34, p < 0.001) and abdominal fat percentage (β=-0.43, 95% CI -0.58 to -0.29, p < 0.001). Conclusions Rural residence was associated with improved bone density and body composition but was not associated with fragility fractures in our referred UK clinical cohort.