Significant Racial Disparities Exist in Postmenopausal Fracture Outcomes

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Screening and treatment of osteoporosis is statistically lower in black Americans, which may be related to the differences in fracture outcomes according to race.

Black women have considerably higher rates of debility, mortality, and destitution after fracture than white women, according to study results presented at the American Society for Bone and Mineral Research Annual Meeting, held September 20 to 23, 2019, in Orlando, Florida.

Nicole Wright, PhD, of the department of epidemiology at the University of Alabama at Birmingham, and colleagues conducted an observational cohort study to estimate postfracture outcomes by race. They identified 377,981 black and white women with postmenopausal osteoporosis and major fragility fractures using 2010 to 2015 Medicare data (black women: n=10,657 [2.8%]; white women: n=367,324 [97.2%]) and identified fragility fractures using a validated fracture episode algorithm. Study outcomes included age-adjusted incidence rates of mortality, debility (placement in long-term nursing facility), and destitution (newly eligible for Medicaid) 1 year postfracture.

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The study revealed that while fracture incidence was proportionate among all members of the cohort, black women had 34.3%, 19.6%, and 190.2% higher mortality, debility, and destitution, respectively. Overall, the mortality rates per 1000 person-years ranged from 68.8 (95% CI, 66.7-70.9) in radius/ulna fractures to 242.8 (95% CI, 234.0-251.7) in femur fractures, debility rates ranged from 37.0 (95% CI, 35.4-38.8) in hip fractures to 53.0 (95% CI, 51.6-54.4) in clinical vertebral fractures, and destitution rates ranged from 15.2 (95% CI, 14.1-16.4) in radius/ulna fractures to 40.8 (95% CI, 38.8-42.8) in hip fractures. Moreover, black women on average had a 52.5% higher mortality rate and a 332.4% higher destitution rate after humerus fractures, as well as a 87.6% higher debility rate after femur fractures.

The investigators concluded that this comprehensive, race-based evaluation of fracture events and postfracture outcomes is significant because it is “the first step to mitigating and reducing disparities in [postmenopausal osteoporosis] management and outcomes.”

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Wright N, Chen L, Curtis J, Brown C, Shikany J, Saag K. Racial disparities exist in outcomes post major fragility fractures. Presented at: American Society for Bone and Mineral Research 2019 Annual Meeting; September 20-23, 2019; Orlando, FL. Abstract 1125.