Population-Based Fracture Risk Assessment and Osteoporosis Treatment Disparities by Race and Gender
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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.
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.
African Americans and Caucasians recruited from 2003–7 across the US as part of a longitudinal study.
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.
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.
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.
- National Osteoporosis Foundation: Clinician’s Guide to Prevention and Treatment of Osteoporosis. 2008 [updated 2008; cited accessed April 10, 2008].
- Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A. Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res. 2007;22(3):465–75. CrossRef
- Jacobsen SJ, Goldberg J, Miles TP, Brody JA, Stiers W, Rimm AA. Hip fracture incidence among the old and very old: a population-based study of 745,435 cases. Am J Public Health. 1990;80:871–3. CrossRef
- Kellie S, Brody J. Sex specific and Race specific Hip Fracture Rates. Am J Public Health. 1990;80(3):326–8. CrossRef
- Jacobsen S, Goldberg J, Miles T, Brody J, Stiers W, Rimm A. Race and sex differences in mortality following fracture of the hip. Am J Public Health. 1992;82(8):1147–50. CrossRef
- Mikuls TR, Saag KG, George V, Mudano AS, Banerjee S. Racial disparities in the receipt of osteoporosis related healthcare among community-dwelling older women with arthritis and previous fracture. J Rheumatol. 2005;32(5):870–5.
- Looker AC, Wahner HW, Dunn WL, Calvo MS, Harris TB, Heyse SP, et al. Updated data on proximal femur bone mineral levels of US adults. Osteoporos Int. 1998;8(5):468–89. CrossRef
- Looker AC, Wahner HW, Dunn WL, Calvo MS, Harris TB, Heyse SP, et al. Proximal femur bone mineral levels of US adults. Osteoporos Int. 1995;5(5):389–409. CrossRef
- Lewiecki EM, Watts NB, McClung MR, Petak SM, Bachrach LK, Shepherd JA, et al. Official positions of the international society for clinical densitometry. J Clin Endocrinol Metab. 2004;89(8):3651–5. CrossRef
- Curtis JR, Carbone L, Cheng H, Hayes B, Laster A, Matthews R, et al. Longitudinal trends in use of bone mass measurement among older americans, 1999–2005. J Bone Miner Res. 2008;23(7):1061–7. CrossRef
- Cummings SR, Bates D, Black DM. Clinical use of bone densitometry: scientific review. JAMA. 2002;288(15):1889–97. CrossRef
- Melton LJ 3rd, Johnell O, Lau E, Mautalen CA, Seeman E. Osteoporosis and the global competition for health care resources. J Bone Miner Res. 2004;19(7):1055–8. CrossRef
- Black DM, Steinbuch M, Palermo L, Dargent-Molina P, Lindsay R, Hoseyni MS, et al. An assessment tool for predicting fracture risk in postmenopausal women. Osteoporos Int. 2001;12(7):519–28. CrossRef
- Schneyer CR, Lopez H, Concannon M, Hochberg MC. Assessing population risk for postmenopausal osteoporosis: a new strategy using data from the Behavioral Risk Factor Surveillance System (BRFSS). J Bone Miner Res. 2008;23(1):151–8. CrossRef
- Kanis JA, for WHO Scientific Group. Assessment of Osteoporosis at the Primary Care Level. Technical Report.: World Health Organization Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, UK; 2007.
- Dawson-Hughes B, Tosteson AN, Melton LJ 3rd, Baim S, Favus MJ, Khosla S, et al. Implications of absolute fracture risk assessment for osteoporosis practice guidelines in the USA. Osteoporos Int. 2008;19(4):449–58. CrossRef
- Howard VJ, Cushman M, Pulley L, Gomez CR, Go RC, Prineas RJ, et al. The reasons for geographic and racial differences in stroke study: objectives and design. Neuroepidemiology. 2005;25(3):135–43. CrossRef
- Chen Z, Kooperberg C, Pettinger M, Bassford T, Cauley J, LaCroix AZ, et al. 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. 2004;11(3):264–74. CrossRef
- Melchior L, Huba G, Brown V, Reback C. A short depression index for women. Educ Psychol Meas. 1993;53:1117–25. CrossRef
- World Health Organization Fracture Risk Assessment Tool. Available from: http://shef.ac.uk/FRAX. Accessed May 31st, 2008.
- Tosteson AN, Melton LJ 3rd, Dawson-Hughes B, Baim S, Favus MJ, Khosla S, et al. Cost-effective osteoporosis treatment thresholds: the United States perspective. Osteoporos Int. 2008;19(4):437–47. CrossRef
- Hosmer JDW, Lemeshow S. Applied Logistic Regression: 2nd Edition. John Wiley and Sons; 2000.
- Lemeshow S, Hosmer JDW. A review of goodness of fit statistics for use in the development of logistic regression models. Am J Epidemiol. 1982;115:92–106.
- Curtis JR, Arora T, Donaldson M, Alarcon G, Callahan L, Moreland L, Bridges L, Mikuls TR. Skeletal health among African Americans with recent onset rheumatoid arthritis. Arthritis Care and Research. In press.
- Gourlay ML, Callahan LF, Preisser JS, Sloane PD. Osteoporosis preventive care in white and black women in community family medicine settings. South Med J. 2007;100(7):677–82.
- Mudano A, Casebeer L, Patino F, Allison J, Weissman N, Kiefe C, et al. Racial disparities in osteoporosis prevention in a managed care population. South Med J. 2003;96(5):445–51. CrossRef
- Block AE, Solomon DH, Cadarette SM, Mogun H, Choudhry NK. Patient and physician predictors of post-fracture osteoporosis management. J Gen Intern Med. 2008;23(9):1447–51. CrossRef
- Solomon DH, Morris C, Cheng H, Cabral D, Katz JN, Finkelstein JS, et al. Medication use patterns for osteoporosis: an assessment of guidelines, treatment rates, and quality improvement interventions. Mayo Clin Proc. 2005;80(2):194–202. CrossRef
- Curtis JR, Westfall AO, Allison JJ, Becker A, Casebeer L, Freeman A, et al. Longitudinal patterns in the prevention of osteoporosis in glucocorticoid-treated patients. Arthritis Rheum. 2005;52(8):2485–94. CrossRef
- Elliot-Gibson V, Bogoch ER, Jamal SA, Beaton DE. Practice patterns in the diagnosis and treatment of osteoporosis after a fragility fracture: a systematic review. Osteoporos Int. 2004;15(10):767–78. CrossRef
- Hamrick I, Whetstone LM, Cummings DM. Racial disparity in treatment of osteoporosis after diagnosis. Osteoporos Int. 2006;17(11):1653–8. CrossRef
- Morris CA, Cabral D, Cheng H, Katz JN, Finkelstein JS, Avorn J, et al. Patterns of bone mineral density testing: current guidelines, testing rates, and interventions. J Gen Intern Med. 2004;19(7):783–90. CrossRef
- Binkley N, Kiebzak GM, Lewiecki EM, Krueger D, Gangnon RE, Miller PD, et al. Recalculation of the NHANES database SD improves T-score agreement and reduces osteoporosis prevalence. J Bone Miner Res. 2005;20(2):195–201. CrossRef
- Mikuls TR, Saag KG, Curtis J, Bridges SL Jr., Alarcon GS, Westfall AO, et al. Prevalence of osteoporosis and osteopenia among African Americans with early rheumatoid arthritis: the impact of ethnic-specific normative data. J Natl Med Assoc. 2005;97(8):1155–60.
- Broussard DL, Magnus JH. Risk assessment and screening for low bone mineral density in a multi-ethnic population of women and men: does one approach fit all? Osteoporos Int. 2004;15(5):349–60. CrossRef
- Koh LK, Sedrine WB, Torralba TP, Kung A, Fujiwara S, Chan SP, et al. A simple tool to identify asian women at increased risk of osteoporosis. Osteoporos Int. 2001;12(8):699–705. CrossRef
- Cauley JA, Lui LY, Ensrud KE, Zmuda JM, Stone KL, Hochberg MC, et al. Bone mineral density and the risk of incident nonspinal fractures in black and white women. JAMA. 2005;293(17):2102–8. CrossRef
- Looker AC, Flegal KM, Melton LJ 3rd. Impact of increased overweight on the projected prevalence of osteoporosis in older women. Osteoporos Int. 2007;18(3):307–13. CrossRef
- Alamanos Y, Voulgari PV, Drosos AA. Incidence and prevalence of rheumatoid arthritis, based on the 1987 American College of Rheumatology criteria: a systematic review. Semin Arthritis Rheum. 2006;36(3):182–8. CrossRef
- Population-Based Fracture Risk Assessment and Osteoporosis Treatment Disparities by Race and Gender
Journal of General Internal Medicine
Volume 24, Issue 8 , pp 956-962
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- 1. Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, USA
- 6. Center for Education and Research on Therapeutics of Musculoskeletal Disorders, University of Alabama at Birmingham, FOT 840, 510 20th Street South, Birmingham, AL, 35294, USA
- 2. Department of Biostatistics, University of Alabama at Birmingham, Birmingham, USA
- 3. Department of Epidemiology, University of Alabama at Birmingham, Birmingham, USA
- 4. Department of Medicine, Oregon Health Sciences University, Portland, OR, USA
- 7. Department of Medicine and Epidemiology, University of Alabama at Birmingham, Birmingham, USA
- 5. Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, USA