Osteoporosis International

, Volume 25, Issue 3, pp 837–845

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

  • M.-H. Shin
  • J. M. Zmuda
  • E. Barrett-Connor
  • Y. Sheu
  • A. L. Patrick
  • P. C. Leung
  • A. Kwok
  • S.-S. Kweon
  • H.-S. Nam
  • J. A. Cauley
  • for the Osteoporotic Fractures in Men (MrOS) Research Group
Original Article



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.


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.


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.


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.


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.


Bone mineral density Epidemiology Fracture Men Race/ethnicity 


  1. 1.
    Cauley JA (2011) Defining ethnic and racial differences in osteoporosis and fragility fractures. Clin Orthop Relat Res 469:1891–1899PubMedCrossRefGoogle Scholar
  2. 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 2010:757102PubMedCentralPubMedCrossRefGoogle Scholar
  3. 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 23:2239–2256PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Kellie SE, Brody JA (1990) Sex-specific and race-specific hip fracture rates. Am J Public Health 80:326–328PubMedCrossRefGoogle Scholar
  5. 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 80:871–873PubMedCrossRefGoogle Scholar
  6. 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 133:801–809PubMedGoogle Scholar
  7. 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 146:502–509PubMedCrossRefGoogle Scholar
  8. 8.
    Lauderdale DS, Jacobsen SJ, Furner SE, Levy PS, Brody JA, Goldberg J (1998) Hip fracture incidence among elderly Hispanics. Am J Public Health 88:1245–1247PubMedCrossRefGoogle Scholar
  9. 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 14:280–284PubMedGoogle Scholar
  10. 10.
    Silverman SL, Madison RE (1988) Decreased incidence of hip fracture in Hispanics, Asians, and blacks: California Hospital Discharge Data. Am J Public Health 78:1482–1483PubMedCrossRefGoogle Scholar
  11. 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 27:2325–2332PubMedCrossRefGoogle Scholar
  12. 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 21:2115–2123PubMedCentralPubMedCrossRefGoogle Scholar
  13. 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 87:3057–3067PubMedCrossRefGoogle Scholar
  14. 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 19:385–397PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Kanis JA, Oden A, Johansson H, Borgstrom F, Strom O, McCloskey E (2009) FRAX and its applications to clinical practice. Bone 44:734–743PubMedCrossRefGoogle Scholar
  16. 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 26:557–568PubMedCrossRefGoogle Scholar
  17. 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 26:569–585PubMedCrossRefGoogle Scholar
  18. 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 17:297–303PubMedCrossRefGoogle Scholar
  19. 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 19:227–234PubMedCrossRefGoogle Scholar
  20. 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 12:1463–1470PubMedCrossRefGoogle Scholar
  21. 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 12:438–444PubMedCrossRefGoogle Scholar
  22. 22.
    Hanley JA, McNeil BJ (1983) A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology 148:839–843PubMedGoogle Scholar
  23. 23.
    Kanis JA, Johnell O, De Laet C et al (2004) A meta-analysis of previous fracture and subsequent fracture risk. Bone 35:375–382PubMedCrossRefGoogle Scholar
  24. 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 28:771-779Google Scholar
  25. 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 44:970–975PubMedCrossRefGoogle Scholar
  26. 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 23:1381–1390PubMedCentralPubMedCrossRefGoogle Scholar
  27. 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 22:1377–1388PubMedCrossRefGoogle Scholar
  28. 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 19:277–287PubMedCrossRefGoogle Scholar
  29. 29.
    Marshall D, Johnell O, Wedel H (1996) Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ 312:1254–1259PubMedCrossRefGoogle Scholar
  30. 30.
    Johnell O, Kanis JA, Oden A et al (2005) Predictive value of BMD for hip and other fractures. J Bone Miner Res 20:1185–1194PubMedCrossRefGoogle Scholar
  31. 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 20:185–194PubMedCrossRefGoogle Scholar
  32. 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 293:2102–2108PubMedCrossRefGoogle Scholar
  33. 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 22:1816–1826PubMedCrossRefGoogle Scholar
  34. 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 11:264–274PubMedCrossRefGoogle Scholar
  35. 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 135:490–499PubMedGoogle Scholar
  36. 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 21:1227–1236PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2013

Authors and Affiliations

  • M.-H. Shin
    • 1
    • 2
  • J. M. Zmuda
    • 2
  • E. Barrett-Connor
    • 3
  • Y. Sheu
    • 2
  • A. L. Patrick
    • 4
  • P. C. Leung
    • 5
  • A. Kwok
    • 5
  • S.-S. Kweon
    • 1
  • H.-S. Nam
    • 6
  • J. A. Cauley
    • 2
  • for the Osteoporotic Fractures in Men (MrOS) Research Group
  1. 1.Department of Preventive MedicineChonnam National University Medical SchoolGwangjuSouth Korea
  2. 2.Department of Epidemiology, Graduate School of Public HealthUniversity of PittsburghPittsburghUSA
  3. 3.Department of Family and Preventive MedicineUniversity of California at San DiegoSan DiegoUSA
  4. 4.Tobago Health Studies OfficeScarboroughTrinidad and Tobago
  5. 5.The Chinese University of Hong Kong Jockey Club Centre for Osteoporosis Care and ControlHong KongChina
  6. 6.Department of Preventive MedicineChungnam National University Medical SchoolDaejeonSouth Korea

Personalised recommendations