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

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. A total of 40 951 patients aged ≥50 years underwent DXA scanning between June 2004 and 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 (MOFs), hip fractures (HFs), bone density and body composition while adjusting for FRAX risk factors. Of the 40 951 patients who underwent DXA scanning, 32 324 (79%) were women with mean age 68.2 years and 11 811 MOFs including 2208 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.