The social gradient of fractures at any skeletal site in men and women: data from the Geelong Osteoporosis Study Fracture Grid

Brennan, Sharon L.; Holloway, Kara L.; Williams, Lana J.; Kotowicz, Mark A.; Bucki-Smith, Gosia; Moloney, David; Dobbins, Amelia G.; Timney, Elizabeth N.; Pasco, JA

doi:10.1007/s00198-014-3004-y

Cited by 33 publications

(21 citation statements)

References 28 publications

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“…The public health importance of the social gradient of osteoporosis is underscored by increased attention in recent years [27][28][29][30]. Yet, the underlying mechanism for that gradient remains uncertain.…”

Section: Introductionmentioning

confidence: 99%

“…The epigenetic signature is influenced by a multitude of environmental factors across the lifespan, and the epigenome appears to function as a vital conduit that transduces exposures into phenotypic expression and disease risk [15,31]. We suggest that understanding this mechanism with respect to specific social determinants may identify various entry points for interventions in order to reduce the prevalence of osteoporosis and, consequently, reduce the social gradient of osteoporotic fracture [27]. This paper proposes a conceptual model, based on the challenge posed by social disadvantage to achieving allostasis (the maintenance of stability, or homeostasis, through change [24]), and the 'threehit theory' of the allostatic load model as identified by McEwen et al [32], and later expanded upon by Daskalakis et al [33], whereby genetic predisposition provides the first 'hit' to allostasis, the early life environment provides the second, and later life environment provides the third.…”

Section: Introductionmentioning

confidence: 99%

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DNA methylation and the social gradient of osteoporotic fracture: A conceptual model

Brennan-Olsen

Page

Berk

et al. 2016

Bone

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

DNA methylation and the social gradient of osteoporotic fracture: A conceptual model

Brennan-Olsen

Page

Berk

et al. 2016

Bone

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“…Lifestyle and risk-taking behaviours known to be associated with increased fracture risk are, in the majority, highly socially patterned (Brennan et al, 2014); these include smoking (Hiscock et al, 2012) and alcohol consumption (Mulia et al, 2008). However, even the prevalence of chronic diseases associated with fracture risk vary according to socioeconomic status, for instance diabetes (Krishnan et al, 2010, Agardh et al, 2007) and fracture history (Brennan et al, 2015). Our review showed substance abuse to be associated with a higher risk of fracture in indigenous populations (Leslie et al, 2006), as were lower income and area of geographic residence (Leslie et al, 2005).…”

Section: Discussionmentioning

confidence: 99%

Fractures in indigenous compared to non-indigenous populations: A systematic review of rates and aetiology

et al. 2017

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BackgroundCompared to non-indigenous populations, indigenous populations experience disproportionately greater morbidity, and a reduced life expectancy; however, conflicting data exist regarding whether a higher risk of fracture is experienced by either population. We systematically evaluate evidence for whether differences in fracture rates at any skeletal site exist between indigenous and non-indigenous populations of any age, and to identify potential risk factors that might explain these differences.MethodsOn 31 August 2016 we conducted a comprehensive computer-aided search of peer-reviewed literature without date limits. We searched PubMed, OVID, MEDLINE, CINAHL, EMBASE, and reference lists of relevant publications. The protocol for this systematic review is registered in PROSPERO, the International Prospective Register of systematic reviews (CRD42016043215). Using the World Health Organization reference population as standard, hip fracture incidence rates were re-standardized for comparability between countries.ResultsOur search yielded 3227 articles; 283 potentially eligible articles were cross-referenced against predetermined criteria, leaving 27 articles for final inclusion. Differences in hip fracture rates appeared as continent-specific, with lower rates observed for indigenous persons in all countries except for Canada and Australia where the opposite was observed. Indigenous persons consistently had higher rates of trauma-related fractures; the highest were observed in Australia where craniofacial fracture rates were 22-times greater for indigenous compared to non-indigenous women. After adjustment for socio-demographic and clinical risk factors, approximately a three-fold greater risk of osteoporotic fracture and five-fold greater risk of craniofacial fractures was observed for indigenous compared to non-indigenous persons; diabetes, substance abuse, comorbidity, lower income, locality, and fracture history were independently associated with an increased risk of fracture.ConclusionsThe observed paucity of data and suggestion of continent-specific differences indicate an urgent need for further research regarding indigenous status and fracture epidemiology and aetiology. Our findings also have implications for communities, governments and healthcare professionals to enhance the prevention of trauma-related fractures in indigenous persons, and an increased focus on modifiable lifestyle behaviours to prevent osteoporotic fractures in all populations.

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“…Risk factors for fracture included as confounders in this study are age and sex (16, 17), and prevalence of fracture may be greater among people of lower socioeconomic status (30). For ALS, risk factors include age and sex (1).…”

Section: Methodsmentioning

confidence: 99%

Association of fractures with the incidence of amyotrophic lateral sclerosis

Peters

Weibull

Fang

et al. 2017

Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration

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Objective Elevated bone turnover observed in ALS patients suggests poor bone health and increased fracture risk. We therefore evaluated the relationship of fracture to subsequent ALS risk. Methods We followed 4,529,460 Swedes from 1987 to 2010 and identified ALS and fractures from the Swedish National Patient Register. We examined associations of ALS risk with all fractures, osteoporotic and non-osteoporotic fractures, and traumatic and non-traumatic fractures among individuals aged 30 to 80 years. We used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). We analyzed the association of ALS with time since fracture using a Poisson regression model. Results All fractures (HR: 1.51, 95% CI: 1.39, 1.65) as well as osteoporotic (HR: 1.59, 95% CI: 1.41, 1.79), non-osteoporotic (HR: 1.46, 95% CI: 1.31, 1.63), traumatic (HR: 1.50, 95% CI: 1.37, 1.63), and non-traumatic fractures (HR: 1.80, 95% CI: 1.35, 2.40) were associated with a higher incidence of ALS. Increased ALS incidence was associated with fractures occurring from one (HR: 2.33, 95% CI: 2.04, 2.66) to 18 years (HR: 1.19, 95% CI: 1.01, 1.43) before ALS diagnosis. Conclusions Poor bone health may be related to ALS. These findings may offer insight into ALS pathophysiology.

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The social gradient of fractures at any skeletal site in men and women: data from the Geelong Osteoporosis Study Fracture Grid

Abstract: Disadvantaged men and women have an increased fracture incidence compared to their less disadvantaged counterparts. The large differences in fracture rates between SES groups warrant further research into designing appropriate, targeted interventions for those demographics at most risk.

Cited by 33 publications

References 28 publications

DNA methylation and the social gradient of osteoporotic fracture: A conceptual model

DNA methylation and the social gradient of osteoporotic fracture: A conceptual model

Fractures in indigenous compared to non-indigenous populations: A systematic review of rates and aetiology

Association of fractures with the incidence of amyotrophic lateral sclerosis

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