Skip to main content
SpringerLink
Log in

Breakout Session: Sex/Gender and Racial/Ethnic Disparities in the Care of Osteoporosis and Fragility Fractures

  • Symposium: AAOS/ORS/ABJS Musculoskeletal Healthcare Disparities Research Symposium
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Recent epidemiologic and clinical data suggest men and racial and ethnic minorities may receive lower-quality care for osteoporosis and fragility fractures than female and nonminority patients. The causes of such differences and optimal strategies for their reduction are unknown.

Questions/purposes

A panel was convened at the May 2010 American Academy of Orthopaedic Surgeons/Orthopaedic Research Society/Association of Bone and Joint Surgeons Musculoskeletal Healthcare Disparities Research Symposium to (1) assess current understanding of sex/gender and racial/ethnic disparities in the care of osteoporosis and after fragility fractures, (2) define goals for improving the equity and quality of care, and (3) identify strategies for achieving these goals.

Where are we now?

Participants identified shortcomings in the quality of care for osteoporosis and fragility fractures among male and minority populations and affirmed a need for novel strategies to improve the quality and equity of care.

Where do we need to go?

Participants agreed opportunities exist for health professionals to contribute to improved osteoporosis management and secondary fracture prevention. They agreed on a need to define standards of care and management for osteoporosis and fragility fractures and develop strategies to involve physicians and other health professionals in improving care.

How do we get there?

The group proposed strategies to improve the quality and equity of osteoporosis and care after fragility fractures. These included increased patient and physician education, with identification of “champions” for osteoporosis care within and outside of the healthcare workforce; creation of incentives for hospitals and physicians to improve care; and research comparing the effectiveness of approaches to osteoporosis screening and fracture management.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. American Orthopaedic Association. Own the Bone. Available at: http://www.ownthebone.org/. Accessed November 1, 2010.

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

    Article  PubMed  Google Scholar 

  3. Bitton A, Martin C, Landon BE. A nationwide survey of patient centered medical home demonstration projects. J Gen Intern Med. 2010;25:584–592.

    Article  PubMed  Google Scholar 

  4. Bliuc D, Nguyen ND, Milch VE, Nguyen TV, Eisman JA, Center JR. Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA. 2009;301:513–521.

    Article  PubMed  CAS  Google Scholar 

  5. Brauer CA, Coca-Perraillon M, Cutler DM, Rosen AB. Incidence and mortality of hip fractures in the United States. JAMA. 2009;302:1573–1579.

    Article  PubMed  CAS  Google Scholar 

  6. 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;22:465–475.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  9. Conway PH, Clancy C. Comparative-effectiveness research—implications of the Federal Coordinating Council’s report. N Engl J Med. 2009;361:328–330.

    Article  PubMed  CAS  Google Scholar 

  10. Cooper C. The crippling consequences of fractures and their impact on quality of life. Am J Med. 1997;103:12S–17S; discussion 17S–19S.

    Article  PubMed  CAS  Google Scholar 

  11. Curtis JR, McClure LA, Delzell E, Howard VJ, Orwoll E, Saag KG, Safford M, Howard G. Population-based fracture risk assessment and osteoporosis treatment disparities by race and gender. J Gen Intern Med. 2009;24:956–962.

    Article  PubMed  Google Scholar 

  12. Dell R, Greene D, Schelkun SR, Williams K. Osteoporosis disease management: the role of the orthopaedic surgeon. J Bone Joint Surg Am. 2008;90(Suppl 4):188–194.

    Article  PubMed  Google Scholar 

  13. Furstenberg AL, Mezey MD. Differences in outcome between black and white elderly hip fracture patients. J Chronic Dis. 1987;40:931–938.

    Article  PubMed  CAS  Google Scholar 

  14. Gardner MJ, Brophy RH, Demetrakopoulos D, Koob J, Hong R, Rana A, Lin JT, Lane JM. Interventions to improve osteoporosis treatment following hip fracture: a prospective, randomized trial. J Bone Joint Surg Am. 2005;87:3–7.

    Article  PubMed  Google Scholar 

  15. Haentjens P, Magaziner J, Colon-Emeric CS, Vanderschueren D, Milisen K, Velkeniers B, Boonen S. Meta-analysis: excess mortality after hip fracture among older women and men. Ann Intern Med. 2010;152:380–390.

    PubMed  Google Scholar 

  16. Ioannidis G, Papaioannou A, Hopman WM, Akhtar-Danesh N, Anastassiades T, Pickard L, Kennedy CC, Prior JC, Olszynski WP, Davison KS, Goltzman D, Thabane L, Gafni A, Papadimitropoulos EA, Brown JP, Josse RG, Hanley DA, Adachi JD. Relation between fractures and mortality: results from the Canadian Multicentre Osteoporosis Study. CMAJ. 2009;181:265–271.

    PubMed  Google Scholar 

  17. Jacobsen SJ, Goldberg J, Miles TP, Brody JA, Stiers W, Rimm AA. Race and sex differences in mortality following fracture of the hip. Am J Public Health. 1992;82:1147–1150.

    Article  PubMed  CAS  Google Scholar 

  18. Jennings LA, Auerbach AD, Maselli J, Pekow PS, Lindenauer PK, Lee SJ. Missed opportunities for osteoporosis treatment in patients hospitalized for hip fracture. J Am Geriatr Soc. 2010;58:650–657.

    Article  PubMed  Google Scholar 

  19. Magaziner J, Hawkes W, Hebel JR, Zimmerman SI, Fox KM, Dolan M, Felsenthal G, Kenzora J. Recovery from hip fracture in eight areas of function. J Gerontol A Biol Sci Med Sci. 2000;55:M498–M507.

    PubMed  CAS  Google Scholar 

  20. 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;32:870–875.

    PubMed  Google Scholar 

  21. Miller RG, Ashar BH, Cohen J, Camp M, Coombs C, Johnson E, Schneyer CR. Disparities in osteoporosis screening between at-risk African-American and white women. J Gen Intern Med. 2005;20:847–851.

    Article  PubMed  Google Scholar 

  22. Morris CA, Cabral D, Cheng H, Katz JN, Finkelstein JS, Avorn J, Solomon DH. Patterns of bone mineral density testing: current guidelines, testing rates, and interventions. J Gen Intern Med. 2004;19:783–790.

    Article  PubMed  Google Scholar 

  23. National Osteoporosis Foundation. Clinician’s Guide to Prevention and Treatment of Osteoporosis. Washington, DC: National Osteoporosis Foundation; 2010.

  24. Navarro RA, Greene DF, Burchette R, Funahashi T, Dell R. Minimizing disparities in osteoporosis care of minorities with an Electronic Medical Record Care Plan. Clin Orthop Relat Res. 2011. DOI Number 10.1007/s11999-011-1852-8.

  25. Neuman MD, Fleisher LA, Even-Shoshan O, Mi L, Silber JH. Nonoperative care for hip fracture in the elderly: the influence of race, income, and comorbidities. Med Care. 2010;48:314–320.

    Article  PubMed  Google Scholar 

  26. Neuner JM, Zhang X, Sparapani R, Laud PW, Nattinger AB. Racial and socioeconomic disparities in bone density testing before and after hip fracture. J Gen Intern Med. 2007;22:1239–1245.

    Article  PubMed  Google Scholar 

  27. Newman ED, Ayoub WT, Starkey RH, Diehl JM, Wood GC. Osteoporosis disease management in a rural health care population: hip fracture reduction and reduced costs in postmenopausal women after 5 years. Osteoporos Int. 2003;14:146–151.

    PubMed  CAS  Google Scholar 

  28. Pasco JA, Sanders KM, Hoekstra FM, Henry MJ, Nicholson GC, Kotowicz MA. The human cost of fracture. Osteoporos Int. 2005;16:2046–2052.

    Article  PubMed  Google Scholar 

  29. Penrod JD, Litke A, Hawkes WG, Magaziner J, Doucette JT, Koval KJ, Silberzweig SB, Egol KA, Siu AL. The association of race, gender, and comorbidity with mortality and function after hip fracture. J Gerontol A Biol Sci Med Sci. 2008;63:867–872.

    PubMed  Google Scholar 

  30. Rozental TD, Makhni EC, Day CS, Bouxsein ML. Improving evaluation and treatment for osteoporosis following distal radial fractures: a prospective randomized intervention. J Bone Joint Surg Am. 2008;90:953–961.

    Article  PubMed  Google Scholar 

  31. Tosi LL, Gliklich R, Kannan K, Koval KJ. The American Orthopaedic Association’s “Own the Bone” initiative to prevent secondary fractures. J Bone Joint Surg Am. 2008;90:163–173.

    Article  PubMed  Google Scholar 

  32. Vik SA, Jantzi M, Poss J, Hirdes J, Hanley DA, Hogan DB, Maxwell CJ. Factors associated with pharmacologic treatment of osteoporosis in an older home care population. J Gerontol A Biol Sci Med Sci. 2007;62:872–878.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesiology and Critical Care, The Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA, USA

    Mark D. Neuman MD

  2. Bone Health Program, Division of Orthopedic Surgery and Sports Medicine, Children’s National Medical Center, 111 Michigan Avenue, Washington, DC, 20010, USA

    Ann M. Kennelly BA & Laura L. Tosi MD

Authors
  1. Mark D. Neuman MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ann M. Kennelly BA
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Laura L. Tosi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Laura L. Tosi MD.

Additional information

Dr. Tosi serves as a consultant to Amgen Inc (Chesterbrook, PA) and Medtronic Inc (Langhorne, PA). Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

This work performed at the 2010 AAOS/ORS/ABJS Musculoskeletal Healthcare Disparities Research Symposium, University of Pennsylvania, and Children’s National Medical Center.

About this article

Cite this article

Neuman, M.D., Kennelly, A.M. & Tosi, L.L. Breakout Session: Sex/Gender and Racial/Ethnic Disparities in the Care of Osteoporosis and Fragility Fractures. Clin Orthop Relat Res 469, 1936–1940 (2011). https://doi.org/10.1007/s11999-011-1859-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-011-1859-1

Keywords

Search

Navigation