Using 1998–2022 Women’s Health Initiative data, University of Alabama Birmingham–led researchers reported contemporary fracture data by race and ethnicity, uncovering new data especially related to Hispanic and Asian women.
The focus of the study, published in the Journal of Bone and Mineral Research, was clinical, hip, and major osteoporotic fractures (MOFs). Updated race and ethnicity information collected in 2003, which included seven Asian and five Hispanic origin groups, was used to calculate crude and age-standardized fracture incidence rates per 10,000 woman-years across race and ethnic categories and by Asian and Hispanic origin.
The study team used the data:
• By race compared with white women
• Asian origin compared with white women
• Hispanic compared with non-Hispanic women
• Asian and Hispanic origins to compare the most prevalent origin group.
Past research has demonstrated that non-Hispanic black (NHB) women were far less likely to receive osteoporosis medications than non-Hispanic white (NHW) women, even after adjusting for socioeconomic factors and clinical risk factors for fracture. Being NHB was associated with 64% lower odds of osteoporosis medications compared with NHW in one study. Few studies have looked at other ethnic groups, including those with growing U.S. populations, however.
In this effort, researchers reported that, over a median (interquartile range) follow-up of 19.4 (9.2-24.2) years, 44.2% of the 160,824 women experienced any clinical fracture, including 36,278 MOFs and 8,962 hip fractures.
“Compared to white women, black, Pacific Islander, Asian, and multiracial women had significantly lower risk of any clinical and MOFs, while only black and Asian women had significantly lower hip fracture risk,” the study team explained. “Within Asian women, Filipina women had 24% lower risk of any clinical fracture compared to Japanese women. Hispanic women had significantly lower risk of any clinical, hip, and MOF fractures compared to non-Hispanic women, with no differences in fracture risk observed within Hispanic origin groups.”
The authors concluded, “In this diverse sample of postmenopausal women, we confirmed racial and ethnic differences in fracture rates and risk, with novel findings among within Asian and Hispanic subgroups. These data can aid in future longitudinal studies evaluate contributors to racial and ethnic differences in fractures.”
A study last year from Kaiser Permanente Northern California pointed out that Asian adults have lower (areal) bone density than NHW adults, and thus they are more likely to be diagnosed and treated for osteoporosis even though they have lower risk of hip fracture. The authors explained in Current Osteoporosis Reports that the difference might be related to favorable characteristics in hip geometry, volumetric bone density, and bone microarchitecture; lower risk of falls; and other clinical factors.
While the fracture risk calculator FRAX explains the lower risk of hip fracture among U.S. Asian adults, not much data exists on major osteoporotic fracture risks, according to the study team, which pointed out that fracture rates also vary by Asian subgroup, which might have implications for fracture risk assessment.
“Furthermore, among women receiving bisphosphonate drugs, Asian race is a risk factor for atypical femur fracture, an uncommon complication associated with treatment duration,” the authors advised. “Recent clinical trial efficacy data pertaining to lower bisphosphonate doses and longer dosing intervals may be relevant for Asian adults.”
The researchers call for more research to inform osteoporosis care of Asian adults in the U.S., including risk-benefit considerations and the optimal duration of bisphosphonate treatment.
“Greater evidence-based guidance for primary fracture prevention among US Asian adults will ensure health equity in the prevention of osteoporotic fractures,” the study suggested.
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