title: The relationship between socioeconomic status and fracture in a fracture clinic setting: data from the Nottingham Fracture Liaison Service.
abstract: BACKGROUND
  This study aims to better understand the relationship between socioeconomic status (SES), fractures in those that attend an outpatient fracture clinic and a diagnosis of osteoporosis. This will further aid our ability to risk stratify patients' with fractures for further investigation and secondary management of their bone health.
  
  
  METHODS
  This is a cross sectional analysis using data from the Nottingham Fracture Liaison Service of patients attending the outpatient fracture clinic from 1/01/08 to 31/12/11. Logistic regression adjusted for age and gender were used to investigate SES, fractures and a diagnosis of osteoporosis. Fisher's exact test was used to compare DXA attendance in those living in most deprived and least deprived area. A cut off of 65 years was used to conduct subset analysis of a younger and an older group.
  
  
  RESULTS
  6362 patients (1346 male, 5016 female; mean (SD) age, 69 (12)) were included in the study. There was no relationship between SES, proportion of fracture types and having a diagnosis of osteoporosis. Prevalence of osteoporosis in each SES quintile from 1 (most deprived) to 5 (least deprived) was 26.68%, 29.04%, 24.83%, 25.67% and 26.68% respectively. The least deprived quintile compared with the most deprived was not associated with a diagnosis of osteoporosis (OR 0.97; 95% CI 0.76-1.25, p=0.837). Those living in the most deprived area were less likely to attend their bone density scan appointment compared to those living in the least deprived area (OR 0.56; 95% CI 0.44-0.7, p<0.0001).
  
  
  CONCLUSIONS
  This study has shown that there is no relationship between SES, fracture types and a diagnosis of osteoporosis in those that present to the fracture clinic. SES should not be used to risk stratify patients for further bone health management after fractures. Those living in the most deprived areas are less likely to attend their bone density scan and efforts need to be made to improve attendance in this group.
authors.affiliation: Department of Healthcare of Older Person, Queens Medical Centre, Nottingham, United Kingdom. Electronic address: terenceong@doctors.org.uk.
authors.forename: Terence
authors.initials: T
authors.lastname: Ong
authors.affiliation: Nottingham Clinical Trials Unit, University of Nottingham, United Kingdom.
authors.forename: Wei
authors.initials: W
authors.lastname: Tan
authors.affiliation: Department of Trauma and Orthopaedics, Queens Medical Centre, Nottingham, United Kingdom.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Marshall
authors.affiliation: Department of Healthcare of Older Person, Queens Medical Centre, Nottingham, United Kingdom.
authors.forename: Opinder
authors.initials: O
authors.lastname: Sahota
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D010024:Osteoporosis / Q000453:epidemiology*; D015995:Prevalence; D011379:Prognosis; D012307:Risk Factors; D063127:Secondary Health Care; D012923:Social Class; D006113:United Kingdom / Q000453:epidemiology
keywords: Bone density; Fractures; Indices of multiple deprivation; Osteoporosis; Socioeconomic status