Pain at multiple sites is associated with prevalent and incident fractures in older adults

Musculoskeletal pain is common and typically occurs at multiple sites. Pain has been shown to be associated with falls risk; however, whether increased risk for falls associated with multi-site pain (MSP) translates into an increased risk of fractures has not been investigated. This study aimed to describe the associations of number of painful sites with prevalent and incident fractures. Data from a longitudinal population-based study of older adults (mean age 63 years) were utilised. Follow-up was performed at 2.6, 5.1 and 10.7 years later, respectively. Presence/absence of pain at the neck, back, hands, shoulders, hips, knees and feet was assessed by questionnaire at baseline. Participants were classified into three groups according to the total number of painful sites (0-2, 3-4 and 5-7 painful sites). Fractures were self-reported at each time-point. Bone mineral density (BMD) was measured by Dual-energy X-ray absorptiometry. Falls risk was calculated based on the short form Physiological Profile Assessment. Log-binomial regression was used for the analyses. A total of 450 fractures at baseline and 154 new fractures were reported during a mean follow-up period of 10.7 years (range 9.2-12.5 years). In multivariable analyses, number of painful sites was associated with prevalent fractures at any site and non-vertebral. Furthermore, participants with 5-7 painful sites had an increased risk of incident fractures at any site [relative risk (RR) 1.69, 95%CI 1.13-2.53], major (including the femur, radius, ulnar, vertebral, rib and humerus) (RR 2.17, 95%CI 1.12-4.22) and vertebral (RR 6.44, 95%CI 1.64-25.33) compared to those with pain at 0-2 sites. These associations remained significant after further adjustment for falls risk, BMD and confounders. 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. The potential for pain management in fracture prevention warrants further exploration.