Bone Abstracts

Introduction: Fragility fracture care varies significantly between rural and urban populations, with rural residents often facing barriers to timely diagnosis and treatment. Pelvic fragility fractures are common but frequently under-recognised, a challenge that may be amplified in rural settings. This study examined the incidence of pelvic fractures in Gwent (population 592,000) using a standard ruralurban classification and explored associated clinical outcomes.

Methods: A retrospective review was conducted of all fragility fracture patients assessed by the Aneurin Bevan Fracture Liaison Service (AB-FLS). Patients with pelvic fragility fractures identified between 2022 and 2025 were included. Demographic characteristics, admission rates, prior fracture history, refracture incidence, and mortality were analysed.

Results: Of 9,832 patients assessed with fragility fractures, 6.0% (n590) sustained a pelvic fragility fracture. Ruralurban classification was available for 589 patients: 80.9% were urban residents (n477/589) and 19.1% rural residents (n112/589). Age and sex distributions were comparable between rural and urban groups. Hospital admission was more common among urban patients (63.9%, n305/477) compared with rural patients (56.3%, n63/112), although this difference did not reach statistical significance (P 0.135). A history of prior fragility fracture was present in more than half of both groups (urban: 58.9%, n281/477; rural: 54.5%, n61/112; P 0.396). Refracture during follow-up occurred in 16.6% of urban patients (n79/477) and 14.3% of rural patients (n16/112), with no significant difference observed (P 0.55). Overall mortality was higher among urban patients (24.7%, n118/477) compared with rural patients (16.9%, n19/112, (P 0.079). According to the 2021 Census, 81.3% of the Gwent population resides in urban areas and 18.7% in rural areas. Rural communities have an older age profile, with 48.6% aged ≥50 years compared with 39.8% in urban areas, indicating a potentially higher baseline risk of fragility fracture. Despite older age structure, rural patients were under-represented among identified pelvic fractures.

Conclusion: Rural patients appear to be under-identified within pelvic fragility fracture pathways despite having an older population profile and potentially higher fracture risk. This finding suggests possible under-ascertainment or barriers to diagnosis in rural settings. Larger multicentre studies are required to further explore geographic inequalities in pelvic fragility fracture detection, care pathways, and clinical outcomes.