SynthesisOsteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA2021
Socio-economic inequalities in fragility fracture incidence: a systematic review and meta-analysis of 61 observational studies.
Synthesis in Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers, 2 of them syntheses that pooled it.
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Who cites it
26 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Social vulnerability indices for proactively identifying at-risk individuals in healthcare: a systematic review.European journal of public health · 2025Pooled it
- Pooled it
- In-hospital hip fracture mortality score: predicting mortality after surgery for proximal femoral fracture in older patients.Annals of medicine · 2026Article
- The role of income and educational level as risk factors for atypical femur fractures: A Nationwide Danish Case-Cohort Study with Blinded Radiographic Review.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026Article
- Early bone health assessment is indicated in Parkinson's: Risk factor analysis in a UK population-based cohort study.Journal of Parkinson's disease · 2026Article
- Spatiotemporal patterns of femoral fractures in older adults: healthcare access and regional inequalities in southern Brazil.BMC geriatrics · 2026Observational
- 30-day readmission risk after hip fracture: a qualitative study in the Midlands, United Kingdom.BMC geriatrics · 2026Observational
- Deprivation indices and their association with fragility fractures and bone density: evidence from a large observational cohort.Rheumatology (Oxford, England) · 2026Observational
- Social determinants of vulnerability to nitrogen oxide- and sulfur dioxide-related bone damage among postmenopausal women in the United States.Frontiers in public health · 2026Article
- Global burden of pediatric orthopaedic fractures: an epidemiological analysis from 1990 to 2021.Archives of orthopaedic and trauma surgery · 2025Article
- Global burden of low bone mineral density related fractures in pre- and post-menopausal women from 1990 to 2021, with projections to 2050.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2025Article
- Article
- Socioeconomic Position and Chronic Opioid Use After Hip Fracture Surgery: A Danish Population-Based Cohort Study.European journal of pain (London, England) · 2025Article
- Impact of social determinants on osteoporosis treatment and secondary fracture risk after primary fragility fractures.Archives of osteoporosis · 2025Article
- Impact of social determinants on osteoporosis treatment and secondary fracture risk after primary fragility fractures.Archives of osteoporosis · 2025Article
- Hospitalisation from fractures in New Zealand octogenarians: LiLACS NZ.Archives of osteoporosis · 2025Article
- Evaluating catastrophic health expenditures among patients with long bone fractures in Ghana's major teaching hospitals: a hospital-based analysis.BMC health services research · 2025Article
- The Association Between Socioeconomic Position and Infection Risk After Hip Fracture Surgery: A Nationwide Cohort Study of 54,853 Patients.Clinical epidemiology · 2025Article
- Educational gradient in hip fracture incidence in Norway. The Norwegian Epidemiologic Osteoporosis Studies (NOREPOS).Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2024Article
- Frailty Status, Sedentary Behaviors, and Risk of Incident Bone Fractures.The journals of gerontology. Series A, Biological sciences and medical sciences · 2024Article
Corrections and comments
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Authors and funding
10 authors.
Funding
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Abstract
Individuals with low socio-economic status (SES) have a more than 25% higher risk of fragility fractures than individuals with high SES. Body mass index and lifestyle appear to mediate the effect of SES on fracture risk. Strategies to prevent fractures should aim to reduce unhealthy behaviours through tackling structural inequalities.
introductionThis systematic review and meta-analysis aimed to evaluate the impact of socio-economic status (SES) on fragility fracture risk.
methodsMedline, Embase, and CINAHL databases were searched from inception to 28 April 2021 for studies reporting an association between SES and fragility fracture risk among individuals aged ≥50 years. Risk ratios (RR) were combined in meta-analyses using random restricted maximum likelihood models, for individual-based (education, income, occupation, cohabitation) and area-based (Index of Multiple Deprivation, area income) SES measures.
resultsA total of 61 studies from 26 different countries including more than 19 million individuals were included. Individual-based low SES was associated with an increased risk of fragility fracture (RR 1.27 [95% CI 1.12, 1.44]), whilst no clear association was seen when area-based measures were used (RR 1.08 [0.91, 1.30]). The strength of associations was influenced by the type and number of covariates included in statistical models: RR 2.69 [1.60, 4.53] for individual-based studies adjusting for age, sex and BMI, compared with RR 1.06 [0.92, 1.22] when also adjusted for health behaviours (smoking, alcohol, and physical activity). Overall, the quality of the evidence was moderate.
conclusionOur results show that low SES, measured at the individual level, is a risk factor for fragility fracture. Low BMI and unhealthy behaviours are important mediators of the effect of SES on fracture risk. Strategies to prevent fractures and reduce unhealthy behaviours should aim to tackle structural inequalities in society thereby reducing health inequalities in fragility fracture incidence.
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Registered trials
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