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

Curtis, Jeffrey R.; McClure, Leslie A.; Delzell, Elizabeth; Howard, Virginia J.; Orwoll, Eric; Saag, Kenneth G.; Safford, Monika M.; Howard, George

doi:10.1007/s11606-009-1031-8

Cited by 109 publications

(87 citation statements)

References 37 publications

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“…While some progress has been made over the last two decades in the prevention and treatment of osteoporosis, the proportion of women who have had a BMD measurement is only 30% in white women and 15% in African American women [13]. At every level of predicted hip fracture risk, the percentage of women receiving osteoporosis therapies is lower among African American women [14].…”

Section: Discussionmentioning

confidence: 99%

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Defining Ethnic and Racial Differences in Osteoporosis and Fragility Fractures

Cauley

2011

Clinical Orthopaedics &Amp; Related Research

203

148

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Background Osteoporotic fractures are a major public health issue. The literature suggests there are variations in occurrence of fractures by ethnicity and race. Questions/purposes My purpose is to review current literature related to the influence of ethnicity and race on the (1) epidemiology of fracture; (2) prevalence of osteoporosis by bone mineral density; (3) consequences of osteoporotic hip fracture; (4) differences in risk fracture for fracture; and (5) disparities in screening, diagnosis, and treatment of osteoporosis. Methods Current literature was selectively reviewed related to osteoporosis, ethnicity, and race. Results Ethnicity and race, like sex, influence the epidemiology of fractures, with highest fracture rates in white women. Bone mineral density is higher in African Americans; however, these women are more likely to die after hip fracture, have longer hospital stays, and are less likely to be ambulatory at discharge. Consistent risk factors for fracture across ethnicity include older age, lower bone mineral density, previous history of fracture, and history of two or more falls. Ethnic and racial disparities exist in the screening, diagnosis, and treatment of osteoporosis. Conclusions Across ethnic and racial groups, more women experience fractures than the combined number of women who experience breast cancer, myocardial infarction, and coronary death in 1 year. Prevention efforts should target all women, irrespective of their race/ethnicity, especially if they have multiple risk factors.

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Section: Discussionmentioning

confidence: 99%

“…However, roughly 20% of white women and less than 12% of African American women who meet this guideline receive treatment. At every level of predicted hip fracture risk, the percentage of women receiving osteoporosis therapies is lower among African American women [14].…”

Section: Are There Disparities In Screening Diagnosis and Treatmentmentioning

confidence: 99%

Defining Ethnic and Racial Differences in Osteoporosis and Fragility Fractures

Cauley

2011

Clinical Orthopaedics &Amp; Related Research

203

148

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“…Wei et al [12] also showed pharmacologic osteoporosis treatment (calcium supplements and antiresorptive drugs) was more likely in white than black women. Curtis et al [3] found a substantial gap existed between 2008 National Osteoporosis Foundation treatment guidelines based on fracture risk and the receipt of prescription osteoporosis medications. This gap was particularly notable for African Americans and men [3].…”

Section: Discussionmentioning

confidence: 99%

Minimizing Disparities in Osteoporosis Care of Minorities With an Electronic Medical Record Care Plan

Navarro

Greene

Burchette

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background Ethnic disparities in care have been documented with a number of musculoskeletal disorders including osteoporosis. We suggest a systems approach for ensuring osteoporosis care can minimize potential ethnic disparities in care. Questions/purposes We evaluated variations in osteoporosis treatment by age, sex, and race/ethnicity by (1) measuring the rates of patients after a fragility fracture who had been evaluated by dual-energy xray absorptiometry and/or in whom antiosteoporosis treatment had been initiated and (2) determining the rates of osteoporosis treatment in patients who subsequently had a hip fracture. Patients and MethodsWe implemented an integrated osteoporosis prevention program in a large health plan. Continuous screening of electronic medical records identified patients who met the criteria for screening for osteoporosis, were diagnosed with osteoporosis, or sustained a fragility fracture. At-risk patients were referred to care managers and providers to complete practice guidelines to close care gaps. Race/ethnicity was selfreported. Treatment rates after fragility fracture or osteoporosis treatment failures with later hip fracture were calculated. Data for the years 2008 to 2009 were stratified by age, sex, and race/ethnicity. Results Women (92.1%) were treated more often than men (75.2%) after index fragility fracture. The treatment rate after fragility fracture was similar among race/ethnic groups in either sex (women 87.4%-93.4% and men 69.3%-76.7%). Osteoporotic treatment before hip fracture was more likely in white men and women and Hispanic men than other race/ethnic and gender groups. Conclusions Racial variation in osteoporosis care after fragility fracture in race/ethnic groups in this healthcare system was low when using the electronic medical record identifying care gaps, with continued reminders to osteoporosis disease management care managers and providers until those care gaps were closed.

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“…The estimated cost of these fractures exceeded $17 billion in 2005 and is projected to rise by 50% by 2025 because of the rapid increase in the number of older Americans [6]. While major efforts at osteoporosis treatment and fracture prevention have focused on white and Asian women, recent data demonstrate osteoporosis is an emerging public health concern among men [4,6] and a range of minority populations in the United States [7,8,11]. While the overall incidence of fragility fractures is anticipated to increase by more than 87% by 2025, the anticipated increase among minority populations is nearly 175% [6].…”

Section: Introductionmentioning

confidence: 99%

“…Decreased bone mineral density increases fracture risk across multiple racial groups [7]; however, rates of screening and treatment for osteoporosis are lower among minorities than among whites, both within populations at risk for osteoporosis [11,21] and among patients who have already sustained a fracture [20,26]. Similarly, the hospital treatment of fragility fractures differs among racial groups: African American Medicare beneficiaries receive indicated operative repair for hip fracture at lower rates than comparable white patients [25].…”

Section: Introductionmentioning

confidence: 99%