Osteoporosis and Fracture Risk in Women of Different Ethnic Groups

Abstract

Osteoporosis and 1-year fracture risk were studied in 197,848 postmenopausal American women from five ethnic groups. Weight explained differences in BMD, except among blacks, who had the highest BMD. One SD decrease in BMD predicted a 50% increased fracture risk in each group. Despite similar relative risks, absolute fracture rates differed.Introduction: Most information about osteoporosis comes from studies of white women. This study describes the frequency of osteoporosis and the association between BMD and fracture in women from five ethnic groups. Materials and Methods: This study was made up of a cohort of 197,848 community-dwelling postmenopausal women (7784 blacks, 1912 Asians, 6973 Hispanics, and 1708 Native Americans) from the United States, without known osteoporosis or a recent BMD test. Heel, forearm, or finger BMD was measured, and risk factor information was obtained; 82% were followed for 1 year for new fractures. BMD and fracture rates were compared, adjusting for differences in covariates. Results: By age 80, more than one-fifth of women in each ethnic group had peripheral BMD T scores <−2.5. Black women had the highest BMD; Asian women had the lowest. Only the BMD differences for blacks were not explained by differences in weight. After 1 year, 2414 new fractures of the spine, hip, forearm, wrist, or rib were reported. BMD at each site predicted fractures equally well within each ethnic group. After adjusting for BMD, weight, and other covariates, white and Hispanic women had the highest risk for fracture (relative risk [RR] 1.0 [referent group] and 0.95, 95% CI, 0.76, 1.20, respectively), followed by Native Americans (RR, 0.87; 95% CI, 0.57, 1.32), blacks (RR, 0.52; 95% CI, 0.38, 0.70), and Asian Americans (RR, 0.32; 95% CI, 0.15, 0.66). In age-and weight-adjusted models, each SD decrease in peripheral BMD predicted a 1.54 times increased risk of fracture in each ethnic group (95% CI, 1.48-1.61). Excluding wrist fractures, the most common fracture, did not materially change associations. Conclusions: Ethnic differences in BMD are strongly influenced by body weight; fracture risk is strongly influenced by BMD in each group. Ethnic differences in absolute fracture risk remain, which may warrant ethnic-specific clinical recommendations.

The association between thiazolidinediones and hospitalisation for fracture in type 2 diabetic patients: a Taiwanese population-based nested case–control study

“…They reported ORs for one to seven, 8-14 and ≥15 thiazolidinediones prescriptions of 0.90 (95% CI 0.46-1.74, p=0.75), 1.85 (95% CI 0.86-3.98, p=0.12) and 2.86 (95% CI 1.57-5.22, p<0.001). Our study uses a more thorough and comprehensive methodological approach by calculating exposure in terms of duration (days) of exposure, an aspect of thiazolidinediones use and fracture risk not discussed in previous studies [12,14,16]. Furthermore, by exploring the Taiwanese nationwide data, we had access to a larger diabetes patient cohort than found in existing studies.…”

“…Given the common use of thiazolidinediones and relatively lower bone mass in Asian groups [14], it is important to examine the fracture risk in the potentially vulnerable Asian diabetic population. Our findings not only serve as a comparison to the Western diabetic population, but also suggest clinically relevant warnings surrounding the risk of fracture among Asian thiazolidinediones users.…”

“…In contrast, an analysis [13] using data derived from the UKbased General Practice Research Database (GPRD) showed that the fracture risk also increased in men. Racial/ethnic differences in fracture risk have been shown in the general population [14], but no study has evaluated the association between fracture risk and thiazolidinediones use in the Asian population.…”

Vitamin D supplementation in African Americans: dose-response

“…Finally, in considering the issues raised by Ng et al (1), it is important to keep in mind that African Americans are an understudied population group for whom target serum concentrations of vitamin D are unclear, especially because the DRI was established on the basis of bone health, for which African Americans have an advantage relative to white populations (9). Furthermore, as shown by the recent report from Powe et al (10) concerning vitamin D binding protein among blacks, they may also experience genetic variation and other differences relative to the metabolism or bioavailability of vitamin D that have not been clearly elucidated.…”

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.…”