Chapter 26 - Race, Ethnicity, and Osteoporosis

Abstract

Ethnicity and race are important factors influencing the incidence of osteoporosis. Highest fracture rates are found among white women. Rates in black women are about 50% lower than white women with rates in Hispanic and Asian women generally about 25% lower than rates in white women. Gender differences in fractures rates are greatest among Whites. Areal bone mineral density (aBMD) is highest among black women and it is estimated that about one-third of the lower fracture rates in black women may be accounted for by their higher bone mineral density (BMD). aBMD is also higher in Hispanic women compared to white women. Asian and white women have similar aBMD but some data suggest that volumetric BMD and cortical thickness is greater in Asians than Whites, which may contribute to their lower fracture rates. Ethnic differences in hip geometry, such as, hip axis length, also contributes to differences in fracture rates. There is, however, consistency of risk factors for fracture across ethnicity including older age, lower aBMD, previous history of fracture, and history of two or more falls. In addition, women with the greatest number of risk factors have the highest risk of fracture irrespective of ethnicity. Across ethnic and racial groups, more women experience fractures than the combined number of women who experience invasive breast cancer, coronary heart disease, or stroke in 1 year. There is also evidence that outcomes of fracture differ by ethnicity. Despite lower hip fracture rates, black women are more likely to die after their hip fracture, have longer hospital stays, and are less likely to be ambulatory at hospital discharge. Ethnic and racial disparities exist in the screening, diagnosis, and treatment of osteoporosis. Prevention efforts should target all women, especially, if they have multiple risk factors.