Racial Differences and Disparities in Osteoporosis-related Bone Health

Abstract

Background Determining whether observed differences in healthcare can be called disparities requires persistence of differences after adjustment for relevant patient, provider and health system factors. We examined whether providing dual energy x-ray absorptiometry (DXA) test results directly to patients might reduce or eliminate racial differences in osteoporosis-related healthcare. Design, Subjects, and Measures We analyzed data from 3,484 White and 1,041 Black women who underwent DXA testing at two health systems participating in the Patient Activation after DXA Result Notification (PAADRN) pragmatic clinical trial (ClinicalTrials.gov NCT-01507662) between February 2012 and August 2014. We examined seven outcomes related to bone health at 12- and 52-weeks post-DXA: (1) whether the patient correctly identified their DXA baseline results; (2) whether the patient was on guideline-concordant osteoporosis pharmacotherapy; (3) osteoporosis-related satisfaction; (4) osteoporosis knowledge; (5 and 6) osteoporosis self-efficacy for exercise and for diet; and, (7) patient activation. We examined whether unadjusted differences in outcomes between Whites and Blacks persisted after adjusting for patient, provider and health system factors. Results Mean age was 66.5 years and 29% were Black. At baseline Black women had less education, poorer health status, and were less likely to report a history of osteoporosis (p < 0.001 for all). In unadjusted analyses Black women were less likely to correctly identify their actual DXA results, more likely to be on guideline concordant therapy, and had similar patient activation. After adjustment for patient demographics, baseline health status and other factors, Black women were still less likely to know their actual DXA result and less likely to be on guideline-concordant therapy, but Black women had greater patient activation. Conclusions Adjustment for patient and provider level factors can change how racial differences are viewed, unmasking new disparities and providing explanations for others. Trial Registration ClinicalTrials.gov Identifier: NCT01507662

Racial and ethnic difference in the risk of fractures in the United States: a systematic review and meta-analysis

“…Healthcare disparities exist in all stages of care, from screening to post-fracture outcomes. In studies of Black women, they were less likely than their white counterparts to be referred for dual-energy x-ray absorptiometry (DXA) screening, to know their DXA results, and to be properly prescribed osteoporosis medication 11 , 66 , 67 . In a large study of Medicare patients with hip fractures, Black and Hispanic women were 48% and 34%, respectively, less likely than white women to have undergone bone testing prior to their fractures 68 .…”

How Arch Support Insoles Help Persons with Flatfoot on Uphill and Downhill Walking

“…Before adhering the sensors on the muscles, the subjects stood tiptoe to mark the position of the gastrocnemius (GAS), did dorsiflexion to mark the position of the tibialis anterior (TA), did knee flexion to mark the position of the biceps femoris (BF), and did knee extension to mark the position of the rectus femoris (RF) with a black pen [21]. Then, the researchers shaved the participants' skin, removed hair impurities utilizing sandpaper, and cleaned with alcohol cotton sheet in order to gain better EMG signal.…”

Osteoporosis care amidst the prolonged pandemic

“…Most studies that have evaluated outcomes after fragility fractures have been conducted in Caucasian populations, but a few show racial disparities in bone health outcomes. [ 13 , 14 ] Caucasian women have higher rates of hip fracture, but black women have higher morbidity and mortality [ 15 , 16 ]. A recent observational cohort study using US Medicare data from 2010 to 2015 by Wright et al [ 14 ] found that black women had higher 1-year mortality (19.6% vs. 15.4%; P < 0.001) and higher 1-year incidence of debility following femur fractures (6.6% vs. 3.9%) compared with white women.…”