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Association of pain phenotypes with risk of falls and incident fractures

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posted on 2023-05-21, 14:54 authored by Maxim Devine, Canchen Ma, Jing TianJing Tian, Benny Eathakkattu AntonyBenny Eathakkattu Antony, Cicuttini, F, Graeme JonesGraeme Jones, Feng PanFeng Pan
Objectives:To compare whether falls risk score and incident fracture over 10.7 years were different among three previously identified pain phenotypes.

Methods:Data on 915 participants (mean age 63 years) from a population-based cohort study were studied at baseline and follow-ups at 2.6, 5.1 and 10.7 years. Three pain phenotypes were previously identified using the latent class analysis: Class 1: high prevalence of emotional problems and low prevalence of structural damage; Class 2: high prevalence of structural damage and low prevalence of emotional problems; Class 3: low prevalence of emotional problems and low prevalence of structural damage. Fractures were self-reported and falls risk score was measured using the Physiological Profile Assessment. Generalized estimating equations model and linear mixed-effects model were used to compare differences in incident fractures and falls risk score over 10.7 years between pain phenotypes, respectively.

Results:There were 3 new hip, 19 vertebral, and 121 non-vertebral fractures, and 138 any site fractures during 10.7-year follow-up. Compared with Class 3, Class 1 had a higher risk of vertebral (relative risk (RR) = 2.44, 95%CI: 1.22–4.91), non-vertebral fractures (RR = 1.20, 95%CI: 1.01–1.42), and any site fractures (RR = 1.24, 95%CI: 1.04–1.46) after controlling for covariates, bone mineral density and falls risk score. Class 2 had a higher risk of non-vertebral and any site fracture relative to those in Class 3 (non-vertebral: RR = 1.41, 95%CI: 1.17–1.71; any site: RR = 1.44, 95%CI: 1.20–1.73), but not vertebral fracture. Compared with Class 3, Class 1 had a higher falls risk score at baseline (β = 0.16, 95%CI: 0.09–0.23) and over 10.7-year (β = 0.03, 95%CI: 0.01–0.04).

Conclusions: Class 1 and/or Class 2 had a higher risk of incident fractures and falls risk score than Class 3, highlighting that targeted preventive strategies for fractures and falls are needed in pain population.


National Health & Medical Research Council


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Menzies Institute for Medical Research



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© 2022. The Authors. Licensee MDPI, Basel, Switzerland. This article is licensed under a Creative Commons Attribution 4.0 International (CC BY 4.0) License (, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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Prevention of human diseases and conditions; Clinical health not elsewhere classified; Determinants of health

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