Defining Ethnic and Racial Differences in Osteoporosis and Fragility Fractures

Abstract

Background Osteoporotic fractures are a major public health issue. The literature suggests there are variations in occurrence of fractures by ethnicity and race. Questions/purposes My purpose is to review current literature related to the influence of ethnicity and race on the (1) epidemiology of fracture; (2) prevalence of osteoporosis by bone mineral density; (3) consequences of osteoporotic hip fracture; (4) differences in risk fracture for fracture; and (5) disparities in screening, diagnosis, and treatment of osteoporosis. Methods Current literature was selectively reviewed related to osteoporosis, ethnicity, and race. Results Ethnicity and race, like sex, influence the epidemiology of fractures, with highest fracture rates in white women. Bone mineral density is higher in African Americans; however, these women are more likely to die after hip fracture, have longer hospital stays, and are less likely to be ambulatory at discharge. Consistent risk factors for fracture across ethnicity include older age, lower bone mineral density, previous history of fracture, and history of two or more falls. Ethnic and racial disparities exist in the screening, diagnosis, and treatment of osteoporosis. Conclusions Across ethnic and racial groups, more women experience fractures than the combined number of women who experience breast cancer, myocardial infarction, and coronary death in 1 year. Prevention efforts should target all women, irrespective of their race/ethnicity, especially if they have multiple risk factors.

Women Build Long Bones With Less Cortical Mass Relative to Body Size and Bone Size Compared With Men

“…However, the fact that the sex differences in robustness only accounted for 52% of the differences in bone strength between women and men suggested that the difference in cortical tissue mineral density was not sufficient to mechanically offset both the lesser robustness and smaller cortical area of women compared with men. Despite the deficit in cortical area found for black women relative to black men in the current study, modern black women do not show a significantly greater risk of sustaining a fragility fracture compared with black men [3,5,33]. The reason for this discrepancy may suggest that sex differences in robustness and cortical area found in the femoral midshaft may not necessarily mean that this mass deficit also exists for fracture prone sites like the distal radius and proximal femur.…”

“…Women show a two-to threefold greater lifetime risk of sustaining a fragility fracture compared with men [3,5,17]. The sex-specific difference in fracture susceptibility has been attributed, in part, to the sexually dimorphic skeleton, which is thought to arise from differential expression of sex hormones during puberty [16,28].…”

“…We examined individuals of black and white ethnicities because of their availability in the Hamann-Todd Osteological Collection and because white women show a twofold greater risk of fracturing compared with white men, whereas black women show a similar risk of fracturing compared with black men [3,5,17]. We separated our analysis by ethnicity given known differences in bone structure between black and white women [4] and to determine if the sex differences in fracture risk can be explained in part based on ethnic differences in sexual dimorphism.…”

How Does Bone Strength Compare Across Sex, Site, and Ethnicity?

“…The risk of fragility fractures in the United States is approximately 2.5 times greater among black and white women compared with their male counterparts [3,13]. Moreover, fracture rates among black women are approximately 50% less than that of white women, whereas fracture rates among men of both ethnicities are relatively similar [3].…”

Skeletal effects of long-term caloric restriction in rhesus monkeys

“…Age-related bone loss is a well-established human characteristic found in all populations despite nutritional and biomechanical differences (Garn 1975;Mazess 1982;Cauley 2011;Barrett-Connor et al 2005;Syed and Hoey 2010). Age-related bone loss has also been reported in several macaque species (Bowden et al 1979;Champ et al 1996;Colman et al 1999a, b;DeRousseau 1985;Grynpas et al 1993;Kessler et al 1986;Pope et al 1989;Przybeck 1985;Smith et al 2009;Binkley et al 1998;Brommage 2001;Fox et al 2007;Miller et al 1986), although none of these model systems replicate the osteoporotic fractures found in the human disease.…”