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Widespread pain contributes to fracture risk in older adults
Among older adults, pain at multiple sites was associated with incident fracture risk in a dose-response manner, suggesting that widespread pain is an independent contributor to fracture risk, according to findings published in the Journal of Bone and Mineral Research.
“Pain at multiple sites is an independent marker for future fractures in the elderly,” Feng Pan, MD, PhD, a research fellow with the Menzies Institute for Medical Research at the University of Tasmania, Australia, told Endocrine Today. “Treatment and management of pain at multiple sites may have the potential to reduce fracture risk in [an] older population.”
Pan and colleagues analyzed data from 1,099 adults participating in the Tasmanian Older Adult Cohort Study, a longitudinal, observational, population-based study of adults aged 50 to 80 years (mean baseline age, 63 years). Researchers conducted baseline measurements in 2002, with follow-up at approximately 2.6 years (n = 875), 5.1 years (n = 768) and 10.7 years (n = 563). Fracture events occurring at any site were recorded at each visit and then were categorized into five groups: any fractures, vertebral, nonvertebral, hip and major fractures. Participants also reported the location of sites where they experienced pain at baseline, including whether they had pain (answering yes/no) in the neck, back, hands, shoulders, hips, knees or feet. The total number of painful sites (range, 0-7) was stratified by three groups (0-2 sites, 3-4 sites and 5-7 sites). The short-form Physiological Profile Assessment was used to identify individuals at risk for falling. Researchers used log-binomial regression to examine the associations between number of painful sites and prevalent and incident fractures at different sites.
At baseline, participants reported 450 fractures. During 10.7 years of follow-up, participants reported 154 new fractures, according to researchers. “Those who reported a greater number of painful sites were more likely to be female, heavier and shorter, have a greater BMI, be physically inactive, have more comorbidities, a higher reported use of pain medication, a greater falls risk score, as well as higher prevalent and incident fractures,” the researchers wrote.
Prevalent fractures increased with increasing number of painful sites in a dose-response manner for fractures at any site, nonvertebral sites and hip (P for trend < .05). Results for major and vertebral fractures did not reach significance, according to researchers.
Participants reporting pain at five to seven sites had an increased risk for incident fractures at any site (RR = 1.69; 95% CI, 1.13-2.53), major fracture (RR = 2.17; 95% CI, 1.12-4.22) and vertebral fracture (RR = 6.44; 95% CI, 1.64-25.33) when compared with those reporting pain at two sites or fewer. The associations persisted after adjustment for falls risk and bone mineral density.
Pan said the potential for pain management in fracture prevention warrants further exploration.
“Genetic, inflammatory and neurological studies to further explore the underlying mechanisms of pain at multiple sites are needed, thereby developing a mechanism-based approach to fracture prevention,” Pan said. – by Regina Schaffer
For more information:
Feng Pan, MD, PhD, can be reached at the Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, Tasmania 7000, Australia; email: feng.pan@utas.edu.au.
Disclosures: The authors report no relevant financial disclosures.