Original Article

Journal of General Internal Medicine

, Volume 24, Issue 8, pp 956-962

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

  • Jeffrey R. CurtisAffiliated withDivision of Clinical Immunology and Rheumatology, University of Alabama at BirminghamCenter for Education and Research on Therapeutics of Musculoskeletal Disorders, University of Alabama at Birmingham Email author 
  • , Leslie A. McClureAffiliated withDepartment of Biostatistics, University of Alabama at Birmingham
  • , Elizabeth DelzellAffiliated withDepartment of Epidemiology, University of Alabama at Birmingham
  • , Virginia J. HowardAffiliated withDepartment of Epidemiology, University of Alabama at Birmingham
  • , Eric OrwollAffiliated withDepartment of Medicine, Oregon Health Sciences University
  • , Kenneth G. SaagAffiliated withDivision of Clinical Immunology and Rheumatology, University of Alabama at BirminghamDepartment of Medicine and Epidemiology, University of Alabama at Birmingham
  • , Monika SaffordAffiliated withDivision of Preventive Medicine, University of Alabama at Birmingham
  • , George HowardAffiliated withDepartment of Biostatistics, University of Alabama at Birmingham

Rent the article at a discount

Rent now

* Final gross prices may vary according to local VAT.

Get Access

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 ≥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.

KEY WORDS

osteoporosis fracture African American Caucasian epidemiology FRAX bisphosphonate