title: Chronic widespread bodily pain is increased among individuals with history of fracture: findings from UK Biobank.
abstract: CONCLUSIONS
  In this cross-sectional analysis of the UK Biobank cohort, a history of fracture was associated with increased risk of current widespread chronic pain.
  
  
  OBJECTIVE
  We aimed to test the hypothesis that a history of fracture is associated with reporting chronic widespread bodily pain (CWBP), using baseline data from the UK Biobank cohort, comprising 502,656 people aged 40-69 years.
  
  
  METHODS
  The case definition of current chronic widespread bodily pain was based on a response of 'yes' to the question 'do you have pain all over the body?' and 'yes' to 'and have you experienced pain all over the body for more than 3 months?' Multivariable Poisson regression with robust standard errors was used to test the relationship between fracture (occurring within 5 years prior to the baseline interview, and recorded by self-report) at the spine, hip, upper limb or lower limb and CWBP, adjusting for confounders.
  
  
  RESULTS
  Of 501,733 participants (mean age 56.5 years), 7130 individuals reported CWBP and 23,177 had a history of fracture affecting the upper limb, lower limb, spine and/or hip. Individuals with prior fracture were significantly more likely to report CWBP than those without. After adjustment for potential risk factors (age, gender, demographic, lifestyle and socioeconomic, and psychological), risk ratios were attenuated but remained statistically significant with a more than doubling of risk for CWBP with spine fractures in men (risk ratio (RR) 2.67, 95% confidence interval (CI) 1.66-4.31; p < 0.001) and women (RR 2.13, 95% CI 1.35-3.37, p = 0.001) and with hip fractures in women (RR 2.19, 95% CI 1.33-3.59; p = 0.002).
  
  
  CONCLUSIONS
  In this cross-sectional analysis, previous fracture is associated with an increased likelihood of chronic widespread bodily pain, particularly with hip fractures in women, and spine fractures in both sexes. If replicated, these findings may help inform the identification of those most at risk of chronic widespread pain post-fracture, allowing preventative measures to be targeted.
authors.affiliation: MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD, UK.
authors.forename: Karen
authors.initials: K
authors.lastname: Walker-Bone
authors.affiliation: MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD, UK.|NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
authors.forename: Nicholas C
authors.initials: NC
authors.lastname: Harvey
authors.affiliation: MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD, UK.
authors.forename: Georgia
authors.initials: G
authors.lastname: Ntani
authors.affiliation: MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD, UK.
authors.forename: Tannaze
authors.initials: T
authors.lastname: Tinati
authors.affiliation: Musculoskeletal Research Collaboration (Epidemiology Group), University of Aberdeen, Aberdeen, UK.
authors.forename: Gareth T
authors.initials: GT
authors.lastname: Jones
authors.affiliation: Division of Population Health Sciences, University of Dundee, Dundee, UK.
authors.forename: Blair H
authors.initials: BH
authors.lastname: Smith
authors.affiliation: Musculoskeletal Research Collaboration (Epidemiology Group), University of Aberdeen, Aberdeen, UK.
authors.forename: Gary J
authors.initials: GJ
authors.lastname: Macfarlane
authors.affiliation: MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD, UK. cc@mrc.soton.ac.uk.|NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK. cc@mrc.soton.ac.uk.|NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK. cc@mrc.soton.ac.uk.
authors.forename: Cyrus
authors.initials: C
authors.lastname: Cooper
mesh_terms: D018070:Biological Specimen Banks; D015992:Body Mass Index; D059350:Chronic Pain / Q000453:epidemiology* / Q000209:etiology; D003430:Cross-Sectional Studies; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology*; D006620:Hip Fractures / Q000453:epidemiology; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000453:epidemiology* / Q000209:etiology; D012307:Risk Factors; D017678:Sex Distribution; D016103:Spinal Fractures / Q000453:epidemiology; D006113:United Kingdom / Q000453:epidemiology
keywords: Chronic widespread pain; Epidemiology; Fracture; Stressors; UK Biobank