Relationship between social determinants of health and hip fracture in the American population: a cross-sectional NHANES study.

BackgroundThe risk of hip fractures is closely intertwined with social determinants of health (SDHs), metabolic factors, and circadian rhythm-related variables. Understanding the combined effects of these factors, particularly in the elderly population of China, has substantial public health implications.MethodsThis study utilized data from the China Health and Retirement Longitudinal Study (CHARLS, 2011–2020), which included 11,928 individuals aged 45 years and older, all free from a history of hip fractures. Kaplan-Meier survival curves, multivariable Cox proportional hazards models, and restricted cubic spline (RCS) analysis were applied to explore the associations between SDHs and hip fracture risk, stratified by metabolic syndrome (MetS) and circadian rhythm syndrome (CircS). Sensitivity analyses and receiver operating characteristic (ROC) curves were conducted to validate the findings and assess the predictive performance.ResultsHigher SDHs scores were consistently associated with a reduced risk of hip fractures, particularly among individuals with MetS and CircS. For each unit increase in SDHs, the risk of first hip fracture was reduced by 14% (HR = 0.86; 95%CI, 0.77–0.95; P < 0.003). RCS analysis revealed a significant relationship between SDHs and the incidence of hip fractures across various metabolic and circadian rhythm subgroups (all P-values < 0.05, non-linear P > 0.05). Kaplan-Meier analysis demonstrated statistically significant differences in hip fracture incidence between SDHs groups (log-rank P < 0.001). ROC curve analysis demonstrated superior predictive accuracy for SDHs, with an AUC of 0.723 and 0.731, particularly among individuals with MetS and CircS.ConclusionsSDHs are independently associated with a decreased risk of hip fractures, with a particularly pronounced effect observed in individuals with MetS and CircS. These findings underscore the critical importance of addressing both social and metabolic factors in the prevention of hip fractures, especially within aging populations.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12889-025-25126-5.

Addressing Social Determinants of Mental Health in Pediatrics During the Coronavirus Disease 2019 Pandemic.

BackgroundVitamin D is important for the maintenance of the musculoskeletal system, is positively associated with muscle strength and physical performance, and is inversely associated with fall and fracture risk. The...

Uric acid may be linked to bone health through its antioxidant or prooxidant effects, thereby affecting bone resorption and formation, or through its dual inhibition of vitamin D activation and parathyroid hormone production. Results of prior studies on the relationship between uric acid and bone mineral density have been conflicting. This prospective study was undertaken to examine the relationship between gout, a disease characterized by hyperuricemia and inflammation, and risk of hip or wrist fracture in women. We conducted a prospective observational study of gout and risk of incident wrist and hip fracture in women participating in the Nurses' Health Study (n = 103,799 at baseline, with 14 years of follow-up for the wrist fracture analysis and 22 years of follow-up for the hip fracture analysis). Gout history and incident cases of wrist and hip fracture were assessed by biennial questionnaire. Cox proportional hazards models were used to simultaneously adjust for potential confounders. In this cohort, there were 3,769 incident wrist fractures (1990-2004) and 2,147 incident hip fractures (1990-2012), with 107 wrist fractures and 117 hip fractures occurring in participants with gout. In those women with a history of gout compared with women without gout, the multivariable-adjusted relative risk of wrist fracture was 1.12 (95% confidence interval [95% CI] 0.92-1.36) and the multivariable-adjusted relative risk of hip fracture was 1.38 (95% CI 1.14-1.68). In women, a history of gout is associated with a modestly increased risk of hip fracture, but not significantly associated with a risk of wrist fracture.

THU0004 The C677T Polymorphism in the Mthfr Gene Contributes to an Increased Risk of HIP Fracture in Japanese Patients with Rheumatoid Arthritis

11183 Background: Social determinants of health (SDoH) encompass the various environmental conditions that influence health, well-being, outcomes, and potential risks. Adverse SDoH can exacerbate health disparities and result in a reduced health-related quality of life (HRQoL). We conducted an investigation into the impact of SDoH on the HRQoL of cancer survivors. Methods: The study population was a nationally representative cohort of individuals aged 20-80 years who took part in the United States National Health and Nutrition Examination Survey (NHANES) 2001 to 2018 cycles. We evaluated HRQoL by measuring the number of physically unhealthy days, mentally unhealthy days, inactive days, as well as assessing social support and emotional well-being. We used logistic regression models to investigate the impact of each SDoH on the HRQoL of cancer survivors. Results: We included 4,780 participants in our analyses, comprising 2,533 women and 2,247 men. The participants mean age was 66 (±14) years at the time of enrollment, and 55 (±17) years at the time of cancer diagnosis. Among the total study population, non-melanoma skin cancer (16%) was the most prevalent cancer type. After adjusting for age, age at cancer diagnosis and gender, people who had the lowest self-reported health were more likely to have completed fewer years of education (OR 0.380 [95% CI: 0.32 - 0.45], p &lt; 0.0001), be unemployed (OR 2.30 [1.91 - 2.77], p &lt; 0.0001), have lower family income (OR 0.36 [0.28 - 0.45], p &lt; 0.0001), be food insecure (OR 3.90 [2.80 - 5.44], p &lt; 0.0001), not have private health insurance (OR 1.68 [1.37 - 2.07], p &lt; 0.0001), and have been hospitalized overnight in the last year (OR 5.23 [3.49 - 7.83], p &lt; 0.001) compared to those with the highest self-reported health. SDoH including employment status, family income, food security status, health insurance type, and overnight hospital patient status, were significantly associated with physical and mental health, and physically active days. Level of education and food security were significantly associated with social support and emotional well-being. Conclusions: Adverse SDoH were associated with the reduced HRQoL of cancer survivors in the United States. These findings underscore the importance of addressing and mitigating these social determinants in order to alleviate health disparities and improve the overall well-being and quality of life for cancer survivors.

In a prospective study of 5384 older men, hip BMD was a very strong predictor of hip fracture, much stronger than spine BMD. The relationship between hip BMD and hip fracture risk seemed to be stronger than observed in a large prospective study of women. Hip BMD is an excellent test for predicting fracture risk in men. There have been few studies of the relationship between BMD and risk of fractures in men and none for the association between lumbar spine BMD and risk of hip and nonvertebral fractures. There is also controversy about whether the associations between BMD and risk of fracture are the same in men and women. We measured proximal femur and lumbar spine BMD in 5384 men, 5384 men, >or= 65 years of age. We compared the results to the very similar cohort of 7871 women >or=65 of age. During 4.4 years of 99% complete follow-up, we validated 317 nonvertebral (59 hip) fractures in men and 1169 nonvertebral (208 hip) fractures in women. Total hip BMD was very strongly associated with risk hip fracture in men (3.2-fold increased risk per sex-specific SD decrease in BMD; 95% CI, 2.4-4.1). The association was stronger than observed in SOF (2.1; 95% CI, 1.8, 2.4; p < 0.001 for interaction). Among the men, lumbar spine BMD was weakly associated with risk of hip fracture (relative risk [RR] per sex-specific SD decrease in BMD: 1.5; 95% CI, 1.2, 2.0). The association between total hip BMD and risk of nonvertebral fractures was somewhat stronger for men (RR = 1.6; 95% CI, 1.5, 1.8) than found for women (p = 0.01 for interaction). The risk of nonvertebral fracture was substantially higher in women than in men for all T scores of hip BMD, regardless of whether sex-specific or female reference values were used. Hip BMD is strongly associated with risk of nonvertebral, and especially hip fracture, in older men. These associations are at least as strong as in women. As in women, lumbar spine BMD in men is only weakly associated with risk of hip fracture. Regardless of whether sex-specific or female reference values were used, T scores indicated different risks of fractures in men than in women.

Estradiol, Testosterone, and the Risk for Hip Fractures in Elderly Men from the Framingham Study

BackgroundHip fracture in the elderly is a health burden worldwide due to its high mortality rate. This study was conducted to determine the possible mechanisms of osteopontin (OPN) and β‐carboxy‐terminal cross‐linking telopeptide of type I collagen (β‐CTX) in hip fracture in the elderly.Materials and MethodsIn the study, we recruited 108 elderly patients with hip fracture diagnosed from May 2012 to May 2015 at the Third Hospital of Xiamen and 86 healthy individuals without a history of hip fracture were taken as controls. Serum levels of OPN and β‐CTX were then determined. The T and Z values for bone mineral density (BMD) were also measured. Moreover, logistic regression analysis was performed to assess the risk and protective factors for hip fracture in the elderly.ResultsSerum levels of both OPN and β‐CTX were increased in elderly patients with hip fracture. OPN was positively correlated with β‐CTX. In addition, the levels of OPN and β‐CTX shared a positive association with the age, and a negative association with the BMD, in terms of T and Z values of the hip. In addition, increased BMD and outdoor sports might be protective factors for hip fracture, and an increase in levels of OPN and β‐CTX might be associated with a higher risk of hip fracture in the elderly population.DiscussionCollectively, increased serum levels of OPN and β‐CTX might be correlated with a higher risk of a hip fracture and have predictive values in the occurrence of hip fracture in the elderly.

Propoxyphene use and risk for hip fractures in older adults

Magnesium is an essential mineral for bone metabolism. However, little is known about the relationship between magnesium and the risk of fractures. In this cohort study, we elucidated the association between serum magnesium level and the risk of incident hip fracture among patients undergoing hemodialysis. We identified 113,683 patients undergoing hemodialysis with no history of hip fracture from a nation-wide database of patients undergoing dialysis in Japan. During a 2-year follow-up, a total of 2305 (2%) new hip fractures occurred. The crude incidence rate was significantly higher among patients in the lower quartiles of serum magnesium levels (2.63%, 2.08%, 1.76%, and 1.49% in Q1-Q4, respectively; P<0.001 for trend). The range of serum magnesium levels (in milligrams per deciliter) in each quartile was as follows: Q1, <2.3; Q2, 2.4-2.6; Q3, 2.7-2.8, and Q4, >2.9. After adjustment for demographic and clinical factors, patients in Q1 had a 1.23-fold higher risk for hip fracture than those in Q4 (95% confidence interval, 1.06 to 1.44; P<0.01). Similarly, an inverse probability weighting analysis showed an increased risk of hip fracture among patients in the lower magnesium quartiles. We did not observe significant effect modifications in subgroup analyses. The population-attributable fraction of serum magnesium level for incident hip fractures was 13.7% (95% confidence interval, 3.7% to 22.7%), which was much higher than that of serum calcium, serum phosphate, and parathyroid hormone levels. Thus, mild hypermagnesemia is associated with a lower risk of hip fracture among patients undergoing hemodialysis.

Smoking, smoking cessation, and risk of hip fracture in women

Background To inform recommendations by the Canadian Task Force on Preventive Health Care, we reviewed evidence on the benefits, harms, and acceptability of screening and treatment, and on the accuracy of risk prediction tools for the primary prevention of fragility fractures among adults aged 40 years and older in primary care. Methods For screening effectiveness, accuracy of risk prediction tools, and treatment benefits, our search methods involved integrating studies published up to 2016 from an existing systematic review. Then, to locate more recent studies and any evidence relating to acceptability and treatment harms, we searched online databases

Adverse social determinants of health (SDoH) have been associated with cardiometabolic disease; however, disparities in cardiometabolic outcomes are rarely the result of a single risk factor. This study aimed to identify and characterize SDoH phenotypes based on patient-reported and neighborhood-level data from the institutional electronic medical record and evaluate the prevalence of diabetes, obesity, and other cardiometabolic diseases by phenotype status. Patient-reported SDoH were collected (January to December 2020) and neighborhood-level social vulnerability, neighborhood socioeconomic status, and rurality were linked via census tract to geocoded patient addresses. Diabetes status was coded in the electronic medical record using International Classification of Diseases codes; obesity was defined using measured BMI ≥30 kg/m2. Latent class analysis was used to identify clusters of SDoH (eg, phenotypes); we then examined differences in the prevalence of cardiometabolic conditions based on phenotype status using prevalence ratios (PRs). Complete data were available for analysis for 2380 patients (mean age 53, SD 16 years; n=1405, 59% female; n=1198, 50% non-White). Roughly 8% (n=179) reported housing insecurity, 30% (n=710) reported resource needs (food, health care, or utilities), and 49% (n=1158) lived in a high-vulnerability census tract. We identified 3 patient SDoH phenotypes: (1) high social risk, defined largely by self-reported SDoH (n=217, 9%); (2) adverse neighborhood SDoH (n=1353, 56%), defined largely by adverse neighborhood-level measures; and (3) low social risk (n=810, 34%), defined as low individual- and neighborhood-level risks. Patients with an adverse neighborhood SDoH phenotype had higher prevalence of diagnosed type 2 diabetes (PR 1.19, 95% CI 1.06-1.33), hypertension (PR 1.14, 95% CI 1.02-1.27), peripheral vascular disease (PR 1.46, 95% CI 1.09-1.97), and heart failure (PR 1.46, 95% CI 1.20-1.79). Patients with the adverse neighborhood SDoH phenotype had higher prevalence of poor cardiometabolic conditions compared to phenotypes determined by individual-level characteristics, suggesting that neighborhood environment plays a role, even if individual measures of socioeconomic status are not suboptimal.

Background Previous meta-analyses have reported an increase in the risk of hip fractures in diabetes, but the risk of non-vertebral fractures has not been investigated. In addition, it is not known how the risk of fractures is affected by age, body mass index, diabetes duration and insulin use. To investigate these features, we conducted a meta-analysis on the risk of hip and non-vertebral fractures in diabetes. MethodsWe selected a previously published review to be updated. Medline, Embase and Cochrane databases were searched in March 2018 and an update conducted in March 2019 (Pubmed) using relevant MeSH and free text terms such as “diabetes”, “hyperglycaemia” and “fracture”. We selected observational studies with data on the risk of fractures in adults ολδερ τηαν 18 years old with diabetes compared to people without diabetes. Study quality was assessed using the Newcastle Ottawa Scale. We used the random-effects model to calculate the risk estimates and 95% confidence intervals.Results Forty-nine studies were included. Forty-three studies were included in the hip fracture analysis, 40 cohorts and 3 case-control studies, reporting data from 17,575,873 participants, 2,387,899 with diabetes and 321,720 fractures. Eighteen studies reported the risk of fractures in two or more sites and were included in the non-vertebral fracture risk analysis. All but one study were cohorts. These studies reported data from 2,982,622 participants, 414,195 with diabetes and 185,363 fractures. In both analyses, age varies from 20 to 100 years old, including both type 1 and type 2 diabetes. Overall, the study quality was judged to be moderate to good.We found a significant increase in the risk of fracture in diabetes both for hip (RR 1.52, 95% CI 1.42-1.63) and for non-vertebral fracture (RR 1.20, 1.14-1.27). The increase in the risk was greater for insulin users and longer duration of diabetes, at both sites. At the hip, the risk was higher in the younger population, women, and those with T1D. ConclusionThere was an increase in the risk of hip and non-vertebral fractures in diabetes. Although the mechanisms are not established, patients with type 1 diabetes were the population at higher relative risk. The evidence suggest that the skeleton should be considered a site for diabetic complications.