Population-based Fracture Risk Assessment and Osteoporosis Treatment Disparities by Race and Gender

Overview

Journal J Gen Intern Med

Publisher Springer

Specialty General Medicine

Date 2009 Jun 25

PMID 19551449

Citations 61

Authors

Jeffrey R Curtis

Leslie A McClure

Elizabeth Delzell

Virginia J Howard

Eric Orwoll

Kenneth G Saag

Monika Safford

George Howard

Affiliations

Soon will be listed here.

Abstract

Background: Undertreatment of osteoporosis has been recognized as a common problem in selected patient subgroups. However, primary prevention has been hampered by limited risk assessment tools that can be applied to large populations.

Objectives: Using clinical risk factors with a new tool from the World Health Organization (FRAX) and recommendations from the National Osteoporosis Foundation (NOF), we evaluated fracture risk and osteoporosis treatment in a US cohort.

Participants: African Americans and Caucasians recruited from 2003-7 across the US as part of a longitudinal study.

Design: Cross-sectional.

Measures: The number of persons receiving prescription osteoporosis medications was assessed by race, sex, and fracture risk. Multivariable logistic regression evaluated the association between receipt of osteoporosis medications and fracture risk after controlling for potential confounders.

Results: Among 24,783 participants, estimated fracture risk was highest for Caucasian women. After multivariable adjustment for fracture-related risk factors, the likelihood of receipt of osteoporosis medications among African Americans was lower than among Caucasians [odds ratio (OR) = 0.44, 95% confidence interval (CI) 0.37, 0.53] and for men compared to women (OR = 0.08, 95% CI 0.06-0.10). Even for the highest risk group, Caucasian women with 10-year hip fracture risk > or = 3% (n = 3,025, 39.7%), only 26% were receiving treatment.

Conclusions: A substantial gap exists between 2008 NOF treatment guidelines based on fracture risk and the receipt of prescription osteoporosis medications. This gap was particularly notable for African Americans and men. FRAX is likely to be useful to assess risk at a population level and identify high-risk persons in need of additional evaluation.

Citing Articles

Sex differences and predictors of anti-osteoporosis medication use in the 12 months after hip fracture surgery in adults 65 or older.

Kirk J, Rathbun A, Gruber-Baldini A, Hochberg M, Magaziner J, Shardell M Osteoporos Int. 2024; 35(11):1943-1950.

PMID: 39093438 PMC: 11886897. DOI: 10.1007/s00198-024-07211-4.

Disparities in Osteoporosis Prevention and Care: Understanding Gender, Racial, and Ethnic Dynamics.

Onizuka N, Onizuka T Curr Rev Musculoskelet Med. 2024; 17(9):365-372.

PMID: 38916641 PMC: 11335991. DOI: 10.1007/s12178-024-09909-8.

Examining treatment targets and equity in bone-active medication use within secondary fracture prevention: a systematic review and meta-analysis.

Ali A, Huszti E, Noordin S, Ali U, Sale J Osteoporos Int. 2024; 35(9):1497-1511.

PMID: 38740589 DOI: 10.1007/s00198-024-07078-5.

The digital health divide: Understanding telehealth adoption across racial lines in rural Illinois.

Crowe J, Nikolic-Khatatbeh J, Li R SSM Popul Health. 2024; 26:101665.

PMID: 38577064 PMC: 10992690. DOI: 10.1016/j.ssmph.2024.101665.

Challenges of fracture risk assessment in Asian and Black women.

Lo J, Chandra M, Yang W, Thompson N, Lee C, Ramaswamy M Am J Manag Care. 2024; 30(3):140-144.

PMID: 38457822 PMC: 11034894. DOI: 10.37765/ajmc.2024.89515.

References

Gourlay M, Callahan L, Preisser J, Sloane P . Osteoporosis preventive care in white and black women in community family medicine settings. South Med J. 2007; 100(7):677-82. DOI: 10.1097/SMJ.0b013e318038d45e. View

Kellie S, Brody J . Sex-specific and race-specific hip fracture rates. Am J Public Health. 1990; 80(3):326-8. PMC: 1404674. DOI: 10.2105/ajph.80.3.326. View

Elliot-Gibson V, Bogoch E, Jamal S, Beaton D . Practice patterns in the diagnosis and treatment of osteoporosis after a fragility fracture: a systematic review. Osteoporos Int. 2004; 15(10):767-78. DOI: 10.1007/s00198-004-1675-5. View

Melton 3rd L, Johnell O, Lau E, Mautalen C, Seeman E . Osteoporosis and the global competition for health care resources. J Bone Miner Res. 2004; 19(7):1055-8. DOI: 10.1359/JBMR.040316. View

Looker A, Wahner H, Dunn W, Calvo M, Harris T, Heyse S . Proximal femur bone mineral levels of US adults. Osteoporos Int. 1995; 5(5):389-409. DOI: 10.1007/BF01622262. View

Black D, Steinbuch M, Palermo L, Dargent-Molina P, Lindsay R, Hoseyni M . An assessment tool for predicting fracture risk in postmenopausal women. Osteoporos Int. 2001; 12(7):519-28. DOI: 10.1007/s001980170072. View

Burge R, Dawson-Hughes B, Solomon D, Wong J, King A, Tosteson A . Incidence and economic burden of osteoporosis-related fractures in the United States, 2005-2025. J Bone Miner Res. 2006; 22(3):465-75. DOI: 10.1359/jbmr.061113. View

Hamrick I, Whetstone L, Cummings D . Racial disparity in treatment of osteoporosis after diagnosis. Osteoporos Int. 2006; 17(11):1653-8. DOI: 10.1007/s00198-006-0178-y. View

Howard V, Cushman M, Pulley L, Gomez C, Go R, Prineas R . The reasons for geographic and racial differences in stroke study: objectives and design. Neuroepidemiology. 2005; 25(3):135-43. DOI: 10.1159/000086678. View

10.

Alamanos Y, Voulgari P, Drosos A . Incidence and prevalence of rheumatoid arthritis, based on the 1987 American College of Rheumatology criteria: a systematic review. Semin Arthritis Rheum. 2006; 36(3):182-8. DOI: 10.1016/j.semarthrit.2006.08.006. View

11.

Jacobsen S, Goldberg J, Miles T, Brody J, Stiers W, Rimm A . Hip fracture incidence among the old and very old: a population-based study of 745,435 cases. Am J Public Health. 1990; 80(7):871-3. PMC: 1404978. DOI: 10.2105/ajph.80.7.871. View

12.

Morris C, Cabral D, Cheng H, Katz J, Finkelstein J, Avorn J . Patterns of bone mineral density testing: current guidelines, testing rates, and interventions. J Gen Intern Med. 2004; 19(7):783-90. PMC: 1492483. DOI: 10.1111/j.1525-1497.2004.30240.x. View

13.

Lewiecki E, Watts N, McClung M, Petak S, Bachrach L, Shepherd J . Official positions of the international society for clinical densitometry. J Clin Endocrinol Metab. 2004; 89(8):3651-5. DOI: 10.1210/jc.2004-0124. View

14.

Mikuls T, Saag K, Curtis J, Bridges Jr S, Alarcon G, Westfall A . Prevalence of osteoporosis and osteopenia among African Americans with early rheumatoid arthritis: the impact of ethnic-specific normative data. J Natl Med Assoc. 2005; 97(8):1155-60. PMC: 1364462. View

15.

Jacobsen S, Goldberg J, Miles T, Brody J, Stiers W, Rimm A . Race and sex differences in mortality following fracture of the hip. Am J Public Health. 1992; 82(8):1147-50. PMC: 1695748. DOI: 10.2105/ajph.82.8.1147. View

16.

Binkley N, Kiebzak G, Lewiecki E, Krueger D, Gangnon R, Miller P . Recalculation of the NHANES database SD improves T-score agreement and reduces osteoporosis prevalence. J Bone Miner Res. 2005; 20(2):195-201. DOI: 10.1359/JBMR.041115. View

17.

Dawson-Hughes B, Tosteson A, Melton 3rd L, Baim S, Favus M, Khosla S . Implications of absolute fracture risk assessment for osteoporosis practice guidelines in the USA. Osteoporos Int. 2008; 19(4):449-58. DOI: 10.1007/s00198-008-0559-5. View

18.

Schneyer C, Lopez H, Concannon M, Hochberg M . Assessing population risk for postmenopausal osteoporosis: a new strategy using data from the Behavioral Risk Factor Surveillance System (BRFSS). J Bone Miner Res. 2007; 23(1):151-8. DOI: 10.1359/jbmr.071005. View

19.

Tosteson A, Melton 3rd L, Dawson-Hughes B, Baim S, Favus M, Khosla S . Cost-effective osteoporosis treatment thresholds: the United States perspective. Osteoporos Int. 2008; 19(4):437-47. PMC: 2729707. DOI: 10.1007/s00198-007-0550-6. View

20.

Mudano A, Casebeer L, Patino F, Allison J, Weissman N, Kiefe C . Racial disparities in osteoporosis prevention in a managed care population. South Med J. 2003; 96(5):445-51. DOI: 10.1097/01.SMJ.0000053918.93363.B0. View