Racial and Ethnic Disparities in Bone Health and Outcomes in the United States

Abstract

Osteoporosis is a bone disease classified by deterioration of bone microarchitecture and decreased bone strength, thereby increasing subsequent risk of fracture. In the United States, approximately 54 million adults aged 50 years and older have osteoporosis or are at risk due to low bone mass. Osteoporosis has long been viewed as a chronic health condition affecting primarily non‐Hispanic white (NHW) women; however, emerging evidence indicates racial and ethnic disparities in bone outcomes and osteoporosis management. The primary objective of this review is to describe disparities in bone mineral density (BMD), prevalence of osteoporosis and fracture, as well as in screening and treatment of osteoporosis among non‐Hispanic black (NHB), Hispanic, and Asian adults compared with NHW adults living on the US mainland. The following areas were reviewed: BMD, osteoporosis prevalence, fracture prevalence and incidence, postfracture outcomes, DXA screening, and osteoporosis treatments. Although there are limited studies on bone and fracture outcomes within Asian and Hispanic populations, findings suggest that there are differences in bone outcomes across NHW, NHB, Asian, and Hispanic populations. Further, NHB, Asian, and Hispanic populations may experience suboptimal osteoporosis management and postfracture care, although additional population‐based studies are needed. There is also evidence that variation in BMD and osteoporosis exists within major racial and ethnic groups, highlighting the need for research in individual groups by origin or background. Although there is a clear need to prioritize future quantitative and qualitative research in these populations, initial strategies for addressing bone health disparities are discussed. © 2021 American Society for Bone and Mineral Research (ASBMR).

Higher modified dietary inflammatory index is associated with increased risk of osteoporosis in US adults: Data from NHANES

“…A cohort study from China reported a positive association between pro-inflammatory diets and an increase in the long-term risk of OP in older Chinese women ( 22 ). Consistent with a previous study, the above studies proved that bone mineral density differs with race, ethnic group, and diet ( 23 ). Therefore, determining the association between OP and modified dietary inflammatory index (MDII) might provide information for the prevention and treatment of OP among different races.…”

Association between osteoporosis or osteopenia and taking antiplatelet agents in general US population of NHANES

“…It is widely believed that menopause and aging lead to bone loss ( 21 – 23 ). The white race is considered an established risk factor for OP ( 24 , 25 ). Calcium and vitamin D are two trace elements that affect bone metabolism.…”

Evaluating health outcomes in the treatment of hypothyroidism

“…The interplay between age, sex, race/ethnicity, and thyroid function, and their relationship between clinical outcomes, is made more complex by potential differences in the “normal” ranges of thyroid function between different sociodemographic groups ( 100 ). Furthermore, a large body of investigative work has been dedicated to defining and measuring sociodemographic and racial/ethnic disparities in clinical outcomes relevant to hypothyroidism, including cardiovascular morbidity/mortality and bone health ( 101 – 103 ). While there is no expectation that changes in thyroid hormone prescribing alone would ameliorate these disparities, any future studies examining sociodemographic disparities in clinical outcomes in the hypothyroid population would have to be interpreted within the context of these baseline differences.…”