What personal factors are associated with osteoporosis, fragility fracture, and osteopenia? A population-level analysis using the United Kingdom Biobank

Abstract

Purpose: Osteopenia, osteoporosis, and fragility fractures pose a major public health concern. Population-level clinical and biopsychosocial data may uncover modifiable risk factors to target when developing whole person approaches to managing these conditions. The purpose of this study was to identify personal risk factors associated with osteoporosis, fragility fractures, and osteopenia from the United Kingdom Biobank (UKB) - a large population-level database.

Methods: We performed a cross-sectional study using the UKB to evaluate the association between 39 systematically selected explanatory variables with a diagnosis of osteopenia, osteoporosis, or fragility fracture. Bivariate analysis was performed followed by multivariable logistic regression adjusting for multicollinearity using covariance testing.

Results: Of 502,507 patients in the UKB, 40,657 had complete bone mineral density information from DEXA scans, and 32,193 had sustained a fragility fracture in the previous five years. In multivariable regression, increased time spent watching television (OR 1.15), living in an area with a high index of deprivation (OR 1.14), infrequent visits from friends and family (OR 1.09), experiencing symptoms of anxiety (OR 1.09), experiencing symptoms of depression (OR 1.08), and decreased exercise frequency (OR 1.03), were associated with increased risk of osteoporosis. Decreased exercise frequency (OR 1.27), increased BMI (OR 1.2), living in an area with a high index of deprivation (OR 1.11), and decreased salary (OR 1.10) were associated with increased risk of fragility fracture. Symptoms of anxiety (OR 1.15), living in an area with a high index of deprivation (OR 1.13), and increased time spent watching television (OR 1.11), living alone (OR 1.08), and symptoms of depression (OR 1.06), were associated with increased risk of osteopenia (p < 0.05 for all variables).

Conclusion: Analysis of population-level datasets reveal a range of modifiable mental, social, and lifestyle/behavioral health factors that can inform multidisciplinary team-based care, including strategies that respond to psychosocial concerns and sustaining healthy lifestyles and behaviors in patients experiencing osteoporosis, fragility fracture, and osteopenia. Future work should assess the impact of integrated, whole person management programs for these conditions on longitudinal outcomes.

Keywords: Bone health; Whole person care.