[Show abstract][Hide abstract] ABSTRACT: Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed treatments for depression and, as a class of drugs, are among the most used medications in the world. Concern regarding possible effects of SSRI treatment on fetal development has arisen recently as studies have suggested a link between maternal SSRI use and an increase in birth defects such as persistent pulmonary hypertension, seizures and craniosynostosis. Furthermore, SSRI exposure in adults is associated with decreased bone mineral density and increased fracture risk, and serotonin receptors are expressed in human osteoblasts and osteoclasts. To determine possible effects of SSRI exposure on developing bone, we treated both zebrafish, during embryonic development, and human mesenchymal stem cells (MSCs), during differentiation into osteoblasts, with the two most prescribed SSRIs, citalopram and sertraline. SSRI treatment in zebrafish decreased bone mineralization, visualized by alizarin red staining and decreased the expression of mature osteoblast-specific markers during embryogenesis. Furthermore, we showed that this inhibition was not associated with increased apoptosis. In differentiating human MSCs, we observed a decrease in osteoblast activity that was associated with a decrease in expression of the osteoblast-specific genes Runx2, Sparc and Spp1, measured with quantitative real-time PCR (qRT-PCR). Similar to the developing zebrafish, no increase in expression of the apoptotic marker Caspase 3 was observed. Therefore, we propose that SSRIs inhibit bone development by affecting osteoblast maturation during embryonic development and MSC differentiation. These results highlight the need to further investigate the risks of SSRI use during pregnancy in exposing unborn babies to potential skeletal abnormalities.Molecular Psychiatry advance online publication, 8 September 2015; doi:10.1038/mp.2015.135.
[Show abstract][Hide abstract] ABSTRACT: We investigated change in health-related quality of life due to fracture in Australian adults aged over 50 years. Fractures reduce quality of life with the loss sustained at least over 12 months. At a population level, the loss was equivalent to 65 days in full health per fracture.
We aimed to quantify the change in health-related quality of life (HRQoL) that occurred as a consequence of a fracture using the EQ-5D-3 L questionnaire.
Adults aged ≥50 years with a low to moderate energy fracture were recruited from eight study centres across Australia. This prospective study included an 18-month follow-up of participants recruited within 2 weeks of a fracture (hip, wrist, humerus, vertebral and ankle). Information collected at baseline and 4, 12 and 18 months included characteristics of participants such as income level, education and prior fracture status. At 12 months post-fracture, the cumulative loss of quality of life was estimated using multivariate regression analysis to identify the predictors of HRQoL loss.
Mean HRQoL for all participants before fracture was 0.86, with wrist fracture having the highest pre-fracture HRQoL (0.90), while vertebral fracture had the lowest (0.80). HRQoL declined to 0.42 in the immediate post-fracture period. Only participants with a wrist, humerus or ankle fracture returned to their pre-fracture HRQoL after 18 months. An increased loss of HRQoL over 12 months was associated with HRQoL prior to the fracture, hospitalisation, education and fracture site. The multiple regression explained 30 % of the variation in the cumulative HRQoL loss at 12 months post-fracture for all fractures.
Low to moderate energy fractures reduce HRQoL, and this loss is sustained for at least 12 months or, in the case of hip and spine fractures, at least 18 months. At a population level, this represents an average loss of 65 days in full health per fragility fracture. This significant burden reinforces the need for cost-effective fracture prevention strategies.
Full-text · Article · Mar 2015 · Osteoporosis International
[Show abstract][Hide abstract] ABSTRACT: Obesity is heritable and predisposes to many diseases. To understand the genetic basis of obesity better, here we conduct a genome-wide association study and Metabochip meta-analysis of body mass index (BMI), a measure commonly used to define obesity and assess adiposity, in up to 339,224 individuals. This analysis identifies 97 BMI-associated loci (P < 5 x 10(-8)), 56 of which are novel. Five loci demonstrate clear evidence of several independent association signals, and many loci have significant effects on other metabolic phenotypes. The 97 loci account for approximately 2.7% of BMI variation, and genome-wide estimates suggest that common variation accounts for >20% of BMI variation. Pathway analyses provide strong support for a role of the central nervous system in obesity susceptibility and implicate new genes and pathways, including those related to synaptic function, glutamate signalling, insulin secretion/action, energy metabolism, lipid biology and adipogenesis
[Show abstract][Hide abstract] ABSTRACT: Aim
The risk profiles and considerable morbidity associated with hip (HF) and vertebral fracture (VF) are well documented and this contrasts with descriptions of non-hip, non-vertebral fracture (NHNVF). The aim of this study was to assess risk factors for NHNVF and compared them with HF and VF.
As part of the Geelong Osteoporosis Study, incident fractures during 2005-2007 for men and 1994-1996 for women were identified using a computerised keyword search of all radiological reports from medical imaging centres serving the Barwon Statistical Division (south-eastern Australia). Fracture cases were invited to complete questionnaire and clinical measurement. Risk factors for 213 men and 424 women were collected including spine, proximal femur, whole body and forearm bone mineral density (BMD, adjusted for age, sex and height), age, height, weight, mobility (limited or not), falls (never/rarely, occasionally or regularly), alcohol consumption, smoking and the number of adult (20yr) fractures after a minimal trauma event.
The numbers of clinical VF, HF and NHNVF were 57, 41 and 115 for men and 116, 65 and 243 for women, respectively. The NHNVF contributed 54.0% of all fractures for men and 57.3% for women. Compared with the HF group, individuals sustaining a NHNVF were younger, heavier, had lower BMD and a higher proportion of fallers had reduced BMD. For both sexes, the HF group had comparable mean BMD to the NHNVF group across all sites except for lower mid forearm in NHNVF women (0.574 0.006 gm/cm2 vs 0.605 0.013 gm/cm2). The clinical VF group had lower weight and were shorter in both sexes than the other two groups. In women, the clinical VF group had lower spinal and total body BMD than the HF and NHNVF groups (BMD spine: VF 0.9170.017 gm/cm2 vs HF 1.0340.023 gm/cm2 vs NHNVF 1.0080.012 gm/cm2).
Although HF and VF receive the most attention in the literature and are the targeted sites for fracture prevention, it is the NHNVF sites that are responsible for the largest absolute number of fractures. The high proportion of NHNVF sustained by men and women of all ages in this study is a concern if fracture preventions are focussed only on those with a lower body weight and those sustaining fractures of the hip or vertebrae.
[Show abstract][Hide abstract] ABSTRACT: Background
The GIANT consortium identified 14 loci in European Ancestry (EA) individuals associated with waist-to-hip ratio adjusted for BMI (WHR). These loci are wide and narrowing the signals remains necessary.ResultsTwelve of 14 loci identified in GIANT EA samples retained strong associations with WHR in our joint EA/AA analysis (log-Bayes factor>6.1). Trans-ethnic analyses at five loci (TBX15-WARS2, LYPLAL1, ADAMTS9, LY86 and ITPR2-SSPN) substantially narrowed the signals to smaller sets of variants, some of which are in regions that have evidence of regulatory activity.Conclusion
By leveraging varying linkage disequilibrium structures across different populations, SNPs with strong signals and narrower credible sets from trans-ethnic meta-analysis of central obesity provide more precise localizations of potential functional variants and suggest a possible regulatory role.Methods
Meta-analysis results for WHR were obtained from 77,167 EA participants from GIANT and 23,564 African Ancestry (AA) participants from the African Ancestry Anthropometry Genetics Consortium. For fine mapping we interrogated SNPs within ±250 kb flanking regions of 14 previously reported index SNPs from loci discovered in EA populations by performing trans-ethnic meta-analysis of results from the EA and AA meta-analyses. We applied a Bayesian approach that leverages allelic heterogeneity across populations to combine meta-analysis results and aids in fine-mapping shared variants at these locations. We annotated variants using information from the ENCODE Consortium and Roadmap Epigenomics Project to prioritize variants for possible functionality.
Full-text · Article · Apr 2014 · Human Molecular Genetics
[Show abstract][Hide abstract] ABSTRACT: We explored the effect of using male and female reference data in a male sample to categorise areal bone mineral density (BMD). Using male reference data, a large proportion of fractures arose from osteopenia, whereas using female reference data shifted the fracture burden into normal BMD.
The purpose of this study was to describe fracture risk associated with osteopenia and osteoporosis in older men, defined by areal BMD and using cut-points derived from male and female reference data.
As part of the Geelong Osteoporosis Study, we followed 619 men aged 60-93 years after BMD assessments (performed 2001-2006) until 2010, fracture, death or emigration. Post-baseline fractures were radiologically confirmed, and proportions of fractures in each BMD category were age-standardised to national profiles.
Based on World Health Organization criteria, and using male reference data, 207 men had normal BMD at the femoral neck, 357 were osteopenic and 55 were osteoporotic. Using female reference data, corresponding numbers were 361, 227 and 31. During the study, 130 men died, 15 emigrated and 63 sustained at least one fracture. Using male reference data, most (86.5 %) of the fractures occurred in men without osteoporosis on BMD criteria (18.4 % normal BMD, 68.1 % osteopenia). The pattern differed when female reference data were used; while most fractures arose from men without osteoporosis (88.2 %), the burden shifted from those with osteopenia (34.8 %) to those with normal BMD (53.4 %).
Decreasing BMD categories defined increasing risk of fracture. Although men with osteoporotic BMD were at greatest risk, they made a relatively small contribution to the total burden of fractures. Using male reference data, two-thirds of the fractures arose from men with osteopenia. However, using female reference data, approximately half of the fractures arose from those with normal BMD. Using female reference data to define osteoporosis in men does not appear to be the optimal approach.
No preview · Article · Nov 2013 · Osteoporosis International
[Show abstract][Hide abstract] ABSTRACT: Objective:
Osteoarthritis (OA) most commonly affects the patellofemoral compartment of the knee, and is a major cause of pain and disability. Structural changes that evolve prior to the onset of symptoms can be visualised using magnetic resonance imaging (MRI). There is little known information about the role of adiposity on the early structural changes in the patella cartilage in younger, asymptomatic adult females.
One hundred and sixty asymptomatic women (20-49 years) participating in the Geelong Osteoporosis Study underwent knee MRI (2006-8). Weight and body mass index (BMI) were measured 10 years prior (1994-7, baseline) and at the time of MRI (current), with change over the period calculated (current-baseline). Relationships between measures of adiposity and patella cartilage volume and defects were examined.
After adjustment for age and patella bone volume, there was a reduction of 13 ml (95% confidence interval (95% CI), -25.7, -0.55) in patella cartilage volume for every 1 unit increase in current BMI, and a reduction of 27 ml (95% CI -52.6, -1.5) per BMI unit increase over 10 years (P=0.04 for both). No significant association was observed between baseline BMI and patella cartilage volume (P=0.16). Increased baseline and current weight and BMI were associated with increased prevalence of patella cartilage defects (all P<0.001).
Adiposity and weight gain during midlife are associated with detrimental structural change at the patella in young to middle-aged healthy non-osteoarthritic women. Maintaining a healthy weight and avoiding weight gain in younger asymptomatic women may be important in the prevention of patellofemoral OA.
No preview · Article · Apr 2013 · International journal of obesity (2005)
[Show abstract][Hide abstract] ABSTRACT: Background Osteoarthritis most commonly affects the patellofemoral compartment of the knee, being a major cause of pain and disability. The structural changes that evolve prior to the onset of symptoms can be visualised using magnetic resonance imaging (MRI). There is little known about the role of obesity on the early structural changes in the patella cartilage in younger, asymptomatic adult females.
Objectives The objective of this study was to examine the relationship between patella cartilage and obesity and change in obesity over the previous 10 years.
Methods 160 asymptomatic women (20-49years) participating in the Geelong Osteoporosis Study underwent knee MRI between 2006-8. Weight and body mass index (BMI) were measured 10 years prior (1994-7, baseline) and at the time of the MRI (current) with change over the period calculated (current-baseline). The relationships between the measures of obesity and patella cartilage volume and defects were examined.
Results After adjustment for age and patella bone volume, there was a reduction of 13 (95% CI -25.7, -0.55) microliters (mL) in patella cartilage volume for every 1 unit increase in current BMI and reduction of 27mL (95% CI -52.6, -1.5) per BMI unit increase over 10 years (p=0.04 for both). There was no significant association between baseline BMI and patella cartilage volume (p=0.16). Increased baseline and current weight and BMI were associated with increased prevalence of patella cartilage defects (all p<0.001).
Conclusions Obesity and weight gain over midlife are both associated with detrimental structural change at the patella in young to middle aged healthy women without clinical osteoarthritis. Maintaining a healthy weight, avoiding obesity and weight gain in younger asymptomatic women may be important in the prevention of patellofemoral osteoarthritis.
Disclosure of Interest None Declared
Preview · Article · Apr 2013 · Osteoarthritis and Cartilage
[Show abstract][Hide abstract] ABSTRACT: Abstract
There are few Australian data that examine the association between total knee joint replacement (TKR) utilisation and socioeconomic status (SES). This study examined TKR surgeries with a diagnosis of osteoarthritis (OA) performed for residents of Barwon Statistical Division (BSD) for 2006-2007.
BSD, South-eastern Victoria, Australia
All patients who underwent a TKR for OA, 2006-2007, and whose residential postcode was identified as within the BSD of Australia, and for whom SES data were available, were eligible for inclusion.
PRIMARY OUTCOME MEASURE:
Primary TKR data ascertained from the Australian Orthopaedic Association National Joint Replacement Registry. Residential addresses were matched with the Australian Bureau of Statistics census data, and the Index of Relative Socioeconomic Disadvantage was used to determine SES, categorised into quintiles whereby quintile 1 indicated the most disadvantaged and quintile 5 the least disadvantaged. Age-specific and sex-specific rates of TKR utilisation per 1000 person-years were reported for 10-year age bands.
Females accounted for 62.7% of the 691 primary TKR surgeries performed during 2006-2007. The greatest utilisation rates of TKR in males was 7.6 observed in those aged >79 years, and in 10.2 in females observed in those aged 70-79 years. An increase in TKR was observed for males in SES quintile four compared to quintile 1 in which the lowest utilisation which was observed (p=0.04). No differences were observed in females across SES quintiles.
Further investigation is warranted on a larger scale to examine the role that SES may play in TKR utilisation, and to determine whether any social disparities in TKR utilisation reflect health system biases or geographic differences.
[Show abstract][Hide abstract] ABSTRACT: Heel ultrasound is a more portable modality for assessing fracture risk than dual-energy X-ray absorptiometry and does not use ionising radiation. Fracture risk assessment requires appropriate reference data to enable comparisons. This study reports the first heel ultrasound reference ranges for the Australian population.
This study aimed to develop calcaneal (heel) ultrasound reference ranges for the Australian adult population using a population-based random sample.
Men and women aged ≥20 years were randomly selected from the Barwon Statistical Division in 2001–2006 and 1993–1997, respectively, using the electoral roll. Broadband ultrasound attenuation (BUA), speed of sound (SOS) and stiffness index (SI) were measured at the heel using a Lunar Achilles Ultrasonometer. Gender-specific means and standard deviations for BUA, SOS and SI were calculated for the entire sample (men 20–93 years, n = 1,104; women 20–92 years, n = 914) and for participants aged 20–29 years (men, n = 157; women, n = 151). Associations between ultrasound measures and age were examined using linear regression.
For men, mean ± standard deviation BUA, SOS and SI were 118.7 ± 15.8 dB/MHz, 1,577.0 ± 43.7 m/s and 100.5 ± 20.7, respectively; values for women were consistently lower (111.0 ± 16.4 dB/MHz, P < 0.001; 1,571.0 ± 39.0 m/s, P = 0.001; and 93.7 ± 20.3, P < 0.001, respectively). BUA was higher in young men compared with young women (124.5 ± 14.4 vs 121.0 ± 15.1 dB/MHz), but SOS (1,590.1 ± 43.1 vs 1,592.5 ± 35.0 m/s) and SI (108.0 ± 19.9 vs 106.3 ± 17.7) were not. The relationships between age and each ultrasound measure were linear and negative across the age range in men; associations were also negative in women but non-linear.
These data provide reference standards to facilitate the assessment of fracture risk in an Australian population using heel ultrasound.
No preview · Article · Jul 2012 · Osteoporosis International
[Show abstract][Hide abstract] ABSTRACT: The association between osteoporosis and osteoarthritis (OA) is controversial. Although previous studies have shown total body, lower limb, spinal and knee BMD and knee cartilage volume to be positively associated, the relationship between other distant site-specific measures of BMD and other knee structures is unknown. The aim of this study was to determine the associations between BMD at eight skeletal sites, and knee structure in asymptomatic young to middle-aged females without any clinical signs of OA.
One hundred and sixty healthy, asymptomatic females (29-50 yr) underwent magnetic resonance imaging of the knee. BMD was measured at the spine, hip, total body and forearm by dual energy X-ray absorptiometry, and at the calcaneus by quantitative ultrasound. BMD was tested for an association with cartilage volume, defects, and bone marrow lesions (BMLs).
Medial cartilage volume was positively associated with BMD at the spine, total body, femoral neck, and Ward's triangle (all p<0.05), with non-significant associations in the same direction at the trochanter (p=0.07). Findings in the lateral compartment were similar. The presence of medial cartilage knee defects were also associated with BMD at the spine; defects in the lateral compartment were associated with BMD at the forearm (both p=0.05). BMD was not associated with the presence of BMLs. No associations were observed with calcaneus BMD.
Site-specific BMD is associated with cartilage volume at the knee in asymptomatic young to middle-aged adults, with the direction and effects trending in the same direction. The magnitude of changes correlates with clinically relevant changes. QUS defined calcaneus BMD, showed no associations with knee structure. Although systemic factors may underlie the association between knee cartilage volume and axial/lower limb BMD, these data suggest that common local, possibly biomechanical factors may also play a role.
[Show abstract][Hide abstract] ABSTRACT: Paget's disease of bone (PDB) is a common disorder characterized by focal abnormalities of bone remodeling. We previously identified variants at the CSF1, OPTN and TNFRSF11A loci as risk factors for PDB by genome-wide association study. Here we extended this study, identified three new loci and confirmed their association with PDB in 2,215 affected individuals (cases) and 4,370 controls from seven independent populations. The new associations were with rs5742915 within PML on 15q24 (odds ratio (OR) = 1.34, P = 1.6 × 10(-14)), rs10498635 within RIN3 on 14q32 (OR = 1.44, P = 2.55 × 10(-11)) and rs4294134 within NUP205 on 7q33 (OR = 1.45, P = 8.45 × 10(-10)). Our data also confirmed the association of TM7SF4 (rs2458413, OR = 1.40, P = 7.38 × 10(-17)) with PDB. These seven loci explained ∼13% of the familial risk of PDB. These studies provide new insights into the genetic architecture and pathophysiology of PDB.
[Show abstract][Hide abstract] ABSTRACT: Genomewide association studies (GWAS) are a powerful method for identifying genes of small to moderate effect involved in common heritable diseases. A phase 1 GWAS was performed in an Australian and UK cohort of postmenopausal female probands (age 50-85 years) with extreme truncate selection for FN BMD (1.5<|z-score|<4), with 317,000 SNPs genotyped using Illumina HumanHap300 chips. 130 SNPs, selected for further study based on the initial results, were genotyped in families selected from the FAMOS cohort (proband FN or LS BMD z-score <-1, n=429 families including 1286 individuals) using Sequenom MALDI-TOF technology. PLINK was used to test association in the GWA component, and QTDT to test total association controlling for linkage in the confirmation family study. For a range of different genetic models, the phase 1 component of 140 subjects has equivalent power to a cohort study of 850-920 unselected individuals. Overall genotyping success rate was 99.6% in phase 1 and 93.1% in phase 2. No gene achieved genomewide statistical significance in the phase 1 screen (as expected due to small sample size). However, 31 markers achieved p-values of 10-5 to 10-7. One SNP, rs10904952, was associated with FN BMD in both phase 1 (P=0.0021) and phase 2 (P=0.00072) studies. Combining these findings, the overall level of significance for this SNP is 4.86x10-6. This SNP lies in the gene encoding ST8 alpha-n-acetyl-neuraminide alpha-2,8-sialyltransferase 6 (ST8SIA6), a protein that interacts with fetuin-alpha, which controls apatite formation and bone and tissue mineralisation. Four other SNPs lying in ST8SIA6 were associated with FN BMD with p-values of 0.0078-0.00048 in the phase 1 study. This study suggests that polymorphisms of ST8SIA6 influence FN BMD in the general population. Whilst the finding did not achieve genomewide significance in the discovery cohort, association was confirmed in the replication cohort, despite modest study power. A much larger cohort of cases with extreme high and low BMD is being recruited for further studies. If confirmed, ST8SIA6 represents a novel gene associated with BMD. The mechanism underlying the association and its effect on fracture risk have yet to be determined.
[Show abstract][Hide abstract] ABSTRACT: We have performed a metabolite quantitative trait locus (mQTL) study of the (1)H nuclear magnetic resonance spectroscopy ((1)H NMR) metabolome in humans, building on recent targeted knowledge of genetic drivers of metabolic regulation. Urine and plasma samples were collected from two cohorts of individuals of European descent, with one cohort comprised of female twins donating samples longitudinally. Sample metabolite concentrations were quantified by (1)H NMR and tested for association with genome-wide single-nucleotide polymorphisms (SNPs). Four metabolites' concentrations exhibited significant, replicable association with SNP variation (8.6x10(-11)<p<2.8x10(-23)). Three of these-trimethylamine, 3-amino-isobutyrate, and an N-acetylated compound-were measured in urine. The other-dimethylamine-was measured in plasma. Trimethylamine and dimethylamine mapped to a single genetic region (hence we report a total of three implicated genomic regions). Two of the three hit regions lie within haplotype blocks (
[Show abstract][Hide abstract] ABSTRACT: To understand how miRNAs contribute to the molecular phenotype of adipose tissues and related traits, we performed global miRNA expression profiling in subcutaneous abdominal and gluteal adipose tissue of 70 human subjects and characterised which miRNAs were differentially expressed between these tissues. We found that 12% of the miRNAs were significantly differentially expressed between abdominal and gluteal adipose tissue (FDR adjusted p<0.05) in the primary study, of which 59 replicated in a follow-up study of 40 additional subjects. Further, 14 miRNAs were found to be associated with metabolic syndrome case-control status in abdominal tissue and three of these replicated (primary study: FDR adjusted p<0.05, replication: p<0.05 and directionally consistent effect). Genome-wide genotyping was performed in the 70 subjects to enable miRNA expression quantitative trait loci (eQTL) analysis. Candidate miRNA eQTLs were followed-up in the additional 40 subjects and six significant, independent cis-located
[Show abstract][Hide abstract] ABSTRACT: Emerging evidence indicates that early life exposures influence adult health outcomes and there is cause to hypothesise a role for physical activity (PA) in childhood as a protective factor in adult depression. This study aimed to investigate the association between self-reported levels of PA in childhood and self-reported depressive illness. Lifetime depression and levels of physical activity (low/high) in childhood (<15 yr) were ascertained by self-report in 2152 adults (20-97 yr) participating in an ongoing epidemiological study in south-eastern Australia. Data were collected between 2000 and 2006. In this sample, 141 women (18.9%) and 169 men (12.0%) reported ever having a depressive episode. Low PA in childhood was associated with an increased risk of reporting depression in adulthood (OR=1.70, 95%CI=1.32-2.17, p<0.001). Adjustment for age, gender and adult PA attenuated the relationship somewhat (OR=1.35, 95%CI=1.01-1.78, p=0.04), however further adjustment for SES or country of birth did not affect this relationship. In this community-based study, lower levels of self-reported PA in childhood were associated with a 35% increase in odds for self-reported depression in adulthood. These results are consistent with the hypothesis that lower levels of PA in childhood may be a risk factor for adult depression.
[Show abstract][Hide abstract] ABSTRACT: There is an inverse association between socioeconomic status (SES) and most causes of morbidity. Hip fractures pose a significant public health burden on society. However, the association between quintiles of area-based SES and incident hip fractures has not been examined in Australia. Using a comprehensive register of hip fractures for the entire Barwon Statistical Division (BSD), we assessed the association between area-based SES and incident hip fractures over a two-year period in residents aged ≥ 50years.
Incident hip fractures were identified using a computerized keyword search of all radiological reports from all the radiological centers serving the BSD. Pathological fractures were excluded. SES was determined by cross-referencing residential addresses with Australian Bureau of Statistics census data and categorized in quintiles based upon the BSD reference range. Homogeneity of population at risk in each SES quintile was tested using chi square comparison. Hip fractures in each quintile and within each age strata for the entire BSD region were defined as rates per 1000 person-years.
During 2006-2007, there were 495 hip fractures (336 female). An inverse pattern of association was observed between SES and hip fracture incidence, with a peak in fracture numbers observed in the second quintile of SES, with differences between SES quintiles observed for both females (p = 0.005) and males (p = 0.007).
The association between incident hip fractures and quintiles of area-based SES provides evidence that those of greater social disadvantage should be a specific target population for intervention to reduce the burden of hip fracture within Australia.