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Race/ethnic differences in associations between bone mineral density and fracture history in older men

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Abstract

Summary

To determine whether there are race/ethnic differences in bone mineral density (BMD) by fracture history in men aged 65 years and older, we performed cross-sectional analysis in five large independent cohorts. Low BMD was associated with a higher prevalence of fracture in all cohorts, and the magnitude of the BMD differences by fracture status was similar across groups.

Introduction

We aimed to determine whether there are race/ethnic and geographic differences in bone mineral density by fracture history in men aged 65 years and older.

Method

The datasets included the Osteoporotic Fractures in Men (MrOS) Study (5,342 White, 243 African-American, 190 Asian, and 126 Hispanic), MrOS Hong Kong (1,968 Hong Kong Chinese), Tobago Bone Health Study (641 Afro-Caribbean), Namwon Study (1,834 Korean), and Dong-gu Study (2,057 Korean). The two Korean cohorts were combined.

Results

The prevalence of self-reported non-traumatic fracture was US white, 17.1 %; Afro-Caribbean, 5.5 %; US African-American, 15.1 %; US Hispanic, 13.7 %; US Asian, 10.5 %; Hong Kong Chinese, 5.6 %, and Korean, 5.1 %. The mean differences in hip and lumbar spine BMD between subjects with fracture and without fracture were statistically significant in all cohorts except US African American and US Asian men. There was a significant race/ethnic interaction for lumbar spine BMD by fracture status (p for interaction = 0.02), which was driven by the small number of Hispanic men. There was no interaction for femoral neck or total hip BMD. There were no significant race/ethnic differences in the odds ratio of fracture by BMD.

Conclusions

Low BMD was associated with a higher prevalence of fracture in all cohorts and the magnitude of the BMD differences by fracture status was similar across groups suggesting homogeneity in the BMD–fracture relationship among older men.

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References

  1. Cauley JA (2011) Defining ethnic and racial differences in osteoporosis and fragility fractures. Clin Orthop Relat Res 469:1891–1899

    Article  PubMed  Google Scholar 

  2. Dhanwal DK, Cooper C, Dennison EM (2010) Geographic variation in osteoporotic hip fracture incidence: the growing importance of Asian influences in coming decades. J Osteoporos 2010:757102

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  3. Kanis JA, Oden A, McCloskey EV, Johansson H, Wahl DA, Cooper C, IOF WGo Epidemiology Quality of L (2012) A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int 23:2239–2256

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  4. Kellie SE, Brody JA (1990) Sex-specific and race-specific hip fracture rates. Am J Public Health 80:326–328

    Article  CAS  PubMed  Google Scholar 

  5. Jacobsen SJ, Goldberg J, Miles TP, Brody JA, Stiers W, Rimm AA (1990) Hip fracture incidence among the old and very old: a population-based study of 745,435 cases. Am J Public Health 80:871–873

    Article  CAS  PubMed  Google Scholar 

  6. Ross PD, Norimatsu H, Davis JW, Yano K, Wasnich RD, Fujiwara S, Hosoda Y, Melton LJ 3rd (1991) A comparison of hip fracture incidence among native Japanese, Japanese Americans, and American Caucasians. Am J Epidemiol 133:801–809

    CAS  PubMed  Google Scholar 

  7. Lauderdale DS, Jacobsen SJ, Furner SE, Levy PS, Brody JA, Goldberg J (1997) Hip fracture incidence among elderly Asian-American populations. Am J Epidemiol 146:502–509

    Article  CAS  PubMed  Google Scholar 

  8. Lauderdale DS, Jacobsen SJ, Furner SE, Levy PS, Brody JA, Goldberg J (1998) Hip fracture incidence among elderly Hispanics. Am J Public Health 88:1245–1247

    Article  CAS  PubMed  Google Scholar 

  9. Fang J, Freeman R, Jeganathan R, Alderman MH (2004) Variations in hip fracture hospitalization rates among different race/ethnicity groups in New York City. Ethn Dis 14:280–284

    PubMed  Google Scholar 

  10. Silverman SL, Madison RE (1988) Decreased incidence of hip fracture in Hispanics, Asians, and blacks: California Hospital Discharge Data. Am J Public Health 78:1482–1483

    Article  CAS  PubMed  Google Scholar 

  11. Wright NC, Saag KG, Curtis JR, Smith WK, Kilgore ML, Morrisey MA, Yun H, Zhang J, Delzell ES (2012) Recent trends in hip fracture rates by race/ethnicity among older US adults. J Bone Miner Res 27:2325–2332

    Article  PubMed  Google Scholar 

  12. Nam HS, Shin MH, Zmuda JM, Leung PC, Barrett-Connor E, Orwoll ES, Cauley JA (2010) Race/ethnic differences in bone mineral densities in older men. Osteoporos Int 21:2115–2123

    Article  PubMed Central  PubMed  Google Scholar 

  13. Finkelstein JS, Lee ML, Sowers M, Ettinger B, Neer RM, Kelsey JL, Cauley JA, Huang MH, Greendale GA (2002) Ethnic variation in bone density in premenopausal and early perimenopausal women: effects of anthropometric and lifestyle factors. J Clin Endocrinol Metab 87:3057–3067

    Article  CAS  PubMed  Google Scholar 

  14. Kanis JA, Johnell O, Oden A, Johansson H, McCloskey E (2008) FRAX and the assessment of fracture probability in men and women from the UK. Osteoporos Int 19:385–397

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  15. Kanis JA, Oden A, Johansson H, Borgstrom F, Strom O, McCloskey E (2009) FRAX and its applications to clinical practice. Bone 44:734–743

    Article  PubMed  Google Scholar 

  16. Blank JB, Cawthon PM, Carrion-Petersen ML, Harper L, Johnson JP, Mitson E, Delay RR (2005) Overview of recruitment for the osteoporotic fractures in men study (MrOS). Contemp Clin Trials 26:557–568

    Article  PubMed  Google Scholar 

  17. Orwoll E, Blank JB, Barrett-Connor E et al (2005) Design and baseline characteristics of the osteoporotic fractures in men (MrOS) study—a large observational study of the determinants of fracture in older men. Contemp Clin Trials 26:569–585

    Article  PubMed  Google Scholar 

  18. Lau EM, Leung PC, Kwok T, Woo J, Lynn H, Orwoll E, Cummings S, Cauley J (2006) The determinants of bone mineral density in Chinese men—results from Mr. Os (Hong Kong), the first cohort study on osteoporosis in Asian men. Osteoporos Int 17:297–303

    Article  CAS  PubMed  Google Scholar 

  19. Hill DD, Cauley JA, Sheu Y, Bunker CH, Patrick AL, Baker CE, Beckles GL, Wheeler VW, Zmuda JM (2008) Correlates of bone mineral density in men of African ancestry: the Tobago bone health study. Osteoporos Int 19:227–234

    Article  CAS  PubMed  Google Scholar 

  20. Hui SL, Gao S, Zhou XH, Johnston CC Jr, Lu Y, Gluer CC, Grampp S, Genant H (1997) Universal standardization of bone density measurements: a method with optimal properties for calibration among several instruments. J Bone Miner Res 12:1463–1470

    Article  CAS  PubMed  Google Scholar 

  21. Lu Y, Fuerst T, Hui S, Genant HK (2001) Standardization of bone mineral density at femoral neck, trochanter and Ward's triangle. Osteoporos Int 12:438–444

    Article  CAS  PubMed  Google Scholar 

  22. Hanley JA, McNeil BJ (1983) A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology 148:839–843

    CAS  PubMed  Google Scholar 

  23. Kanis JA, Johnell O, De Laet C et al (2004) A meta-analysis of previous fracture and subsequent fracture risk. Bone 35:375–382

    Article  CAS  PubMed  Google Scholar 

  24. Danielson ME, Beck TJ, Lian Y, Karlamangla AS, Greendale GA, Ruppert K, Lo J, Greenspan S, Vuga M, Cauley JA (2012) Ethnic variability in bone geometry as assessed by hip structure analysis: findings from the hip strength across the menopausal transition study. J Bone Miner Res 28:771-779

    Google Scholar 

  25. Wetzsteon RJ, Hughes JM, Kaufman BC, Vazquez G, Stoffregen TA, Stovitz SD, Petit MA (2009) Ethnic differences in bone geometry and strength are apparent in childhood. Bone 44:970–975

    Article  CAS  PubMed  Google Scholar 

  26. Ishii S, Cauley JA, Greendale GA, Danielson ME, Safaei Nili N, Karlamangla A (2012) Ethnic differences in composite indices of femoral neck strength. Osteoporos Int 23:1381–1390

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  27. Nelson DA, Beck TJ, Wu G, Lewis CE, Bassford T, Cauley JA, LeBoff MS, Going SB, Chen Z (2011) Ethnic differences in femur geometry in the women's health initiative observational study. Osteoporos Int 22:1377–1388

    Article  CAS  PubMed  Google Scholar 

  28. Travison TG, Beck TJ, Esche GR, Araujo AB, McKinlay JB (2008) Age trends in proximal femur geometry in men: variation by race and ethnicity. Osteoporos Int 19:277–287

    Article  CAS  PubMed  Google Scholar 

  29. Marshall D, Johnell O, Wedel H (1996) Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ 312:1254–1259

    Article  CAS  PubMed  Google Scholar 

  30. Johnell O, Kanis JA, Oden A et al (2005) Predictive value of BMD for hip and other fractures. J Bone Miner Res 20:1185–1194

    Article  PubMed  Google Scholar 

  31. Barrett-Connor E, Siris ES, Wehren LE, Miller PD, Abbott TA, Berger ML, Santora AC, Sherwood LM (2005) Osteoporosis and fracture risk in women of different ethnic groups. J Bone Miner Res 20:185–194

    Article  PubMed  Google Scholar 

  32. Cauley JA, Lui LY, Ensrud KE, Zmuda JM, Stone KL, Hochberg MC, Cummings SR (2005) Bone mineral density and the risk of incident nonspinal fractures in black and white women. JAMA 293:2102–2108

    Article  CAS  PubMed  Google Scholar 

  33. Cauley JA, Wu L, Wampler NS, Barnhart JM, Allison M, Chen Z, Jackson R, Robbins J (2007) Clinical risk factors for fractures in multi-ethnic women: the Women's Health Initiative. J Bone Miner Res 22:1816–1826

    Article  PubMed  Google Scholar 

  34. Chen Z, Kooperberg C, Pettinger MB, Bassford T, Cauley JA, LaCroix AZ, Lewis CE, Kipersztok S, Borne C, Jackson RD (2004) Validity of self-report for fractures among a multiethnic cohort of postmenopausal women: results from the Women's Health Initiative observational study and clinical trials. Menopause 11:264–274

    Article  PubMed  Google Scholar 

  35. Nevitt MC, Cummings SR, Browner WS, Seeley DG, Cauley JA, Vogt TM, Black DM (1992) The accuracy of self-report of fractures in elderly women: evidence from a prospective study. Am J Epidemiol 135:490–499

    CAS  PubMed  Google Scholar 

  36. Fan B, Lu Y, Genant H, Fuerst T, Shepherd J (2010) Does standardized BMD still remove differences between Hologic and GE-Lunar state-of-the-art DXA systems? Osteoporos Int 21:1227–1236

    Article  CAS  PubMed Central  PubMed  Google Scholar 

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Acknowledgments

This study was supported by Research Institute of Medical Sciences, Chonnam National University. Dong-gu study was partially supported by the Health Promotion Fund, Ministry of Health &Welfare, Republic of Korea (07–27). The Osteoporotic Fractures in Men (MrOS) Study is supported by National Institutes of Health funding. The following institutes provide support: the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), the National Institute on Aging (NIA), the National Center for Research Resources (NCRR), and NIH Roadmap for Medical Research under the following grant numbers: U01 AR45580, U01 AR45614, U01 AR45632, U01 AR45647, U01 AR45654, U01 AR45583, U01 AG18197, U01-AG027810, and UL1 RR024140. The Tobago Bone Health Study is supported by NIAMS grant R01-AR049747.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, South Korea

    M.-H. Shin & S.-S. Kweon

  2. Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Crabtree Hall A510, Pittsburgh, PA, 15261, USA

    M.-H. Shin, J. M. Zmuda, Y. Sheu & J. A. Cauley

  3. Department of Family and Preventive Medicine, University of California at San Diego, San Diego, CA, USA

    E. Barrett-Connor

  4. Tobago Health Studies Office, Scarborough, Tobago, Trinidad and Tobago

    A. L. Patrick

  5. The Chinese University of Hong Kong Jockey Club Centre for Osteoporosis Care and Control, Hong Kong, China

    P. C. Leung & A. Kwok

  6. Department of Preventive Medicine, Chungnam National University Medical School, Daejeon, South Korea

    H.-S. Nam

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  1. M.-H. Shin
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  2. J. M. Zmuda
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  10. J. A. Cauley
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Correspondence to J. A. Cauley.

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Shin, MH., Zmuda, J.M., Barrett-Connor, E. et al. Race/ethnic differences in associations between bone mineral density and fracture history in older men. Osteoporos Int 25, 837–845 (2014). https://doi.org/10.1007/s00198-013-2503-6

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  • DOI: https://doi.org/10.1007/s00198-013-2503-6

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