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Erschienen in: Osteoporosis International 11/2006

01.11.2006 | Original Article

Racial disparity in treatment of osteoporosis after diagnosis

verfasst von: I. Hamrick, L. M. Whetstone, D. M. Cummings

Erschienen in: Osteoporosis International | Ausgabe 11/2006

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Abstract

Introduction

Racial disparities have been identified in a number of areas in clinical medicine. Patients diagnosed with osteoporosis should be treated similarly regardless of race. However, limited data are available on the relative frequency of treatment by race after diagnosis of osteoporosis.

Methods

We analyzed all 739 dual-energy X-ray absorptiometry (DXA) results obtained of women 50  years old and older between 1998 and 2002 at our medical center. Our study sample was 82% Caucasian and 15% African American. Of 353 women who had low bone mineral density on first DXA, we abstracted the electronic and paper medical records to compare treatment rates by race.

Results

Of the women diagnosed with osteoporosis or osteopenia, 80.0% and 68.3%, respectively, were started on antiresorptive medications. Of the African American women, 61.9% diagnosed with osteoporosis were started on antiresorptive treatment compared with 83.3% of Caucasian women (p<0.05). African American women with low bone mass were less likely than Caucasian women to be smokers (p<0.05) and use alcohol (p<0.01) but were more likely to be on corticosteroids (p<0.05). No other significant differences were found among treated and nontreated groups that might explain the disparity in treatment.

Conclusion

A smaller proportion of African American than Caucasian women with osteoporosis received antiresorptive medications after a DXA diagnosis. This significant disparity requires further study in a larger population.
Literatur
1.
Zurück zum Zitat Smedley BD, Stith AY, Nelson AR, Institute of Medicine (U.S.), Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care. (2003) Unequal treatment : confronting racial and ethnic disparities in health care. National Academies Press, Washington, D.C Smedley BD, Stith AY, Nelson AR, Institute of Medicine (U.S.), Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care. (2003) Unequal treatment : confronting racial and ethnic disparities in health care. National Academies Press, Washington, D.C
2.
Zurück zum Zitat Schulman KA, Berlin JA, Harless W, Kerner JF, Sistrunk S, Gersh BJ, Dube R, Taleghani CK, Burke JE, Williams S, Eisenberg JM, Escarce JJ (1999) The effect of race and sex on physicians’ recommendations for cardiac catheterization. N Engl J Med 340:618–626PubMedCrossRef Schulman KA, Berlin JA, Harless W, Kerner JF, Sistrunk S, Gersh BJ, Dube R, Taleghani CK, Burke JE, Williams S, Eisenberg JM, Escarce JJ (1999) The effect of race and sex on physicians’ recommendations for cardiac catheterization. N Engl J Med 340:618–626PubMedCrossRef
3.
Zurück zum Zitat Johnson PA, Lee TH, Cook EF, Rouan GW, Goldman L (1993) Effect of race on the presentation and management of patients with acute chest pain. Ann Intern Med 118:593–601PubMed Johnson PA, Lee TH, Cook EF, Rouan GW, Goldman L (1993) Effect of race on the presentation and management of patients with acute chest pain. Ann Intern Med 118:593–601PubMed
4.
Zurück zum Zitat Pope JH, Aufderheide TP, Ruthazer R, Woolard RH, Feldman JA, Beshansky JR, Griffith JL, Selker HP (2000) Missed diagnoses of acute cardiac ischemia in the emergency department. N Engl J Med 342:1163–1170PubMedCrossRef Pope JH, Aufderheide TP, Ruthazer R, Woolard RH, Feldman JA, Beshansky JR, Griffith JL, Selker HP (2000) Missed diagnoses of acute cardiac ischemia in the emergency department. N Engl J Med 342:1163–1170PubMedCrossRef
5.
Zurück zum Zitat Wasnich RD, Ross PD, Davis JW, Vogel JM (1989) A comparison of single and multi-site BMC measurements for assessment of spine fracture probability. J Nucl Med 30:1166–1171PubMed Wasnich RD, Ross PD, Davis JW, Vogel JM (1989) A comparison of single and multi-site BMC measurements for assessment of spine fracture probability. J Nucl Med 30:1166–1171PubMed
6.
Zurück zum Zitat Cummings SR, Black DM, Nevitt MC, Browner W, Cauley J, Ensrud K, Genant HK, Palermo L, Scott J, Vogt TM (1993) Bone density at various sites for prediction of hip fractures. The Study of Osteoporotic Fractures Research Group. Lancet 341:72–75PubMedCrossRef Cummings SR, Black DM, Nevitt MC, Browner W, Cauley J, Ensrud K, Genant HK, Palermo L, Scott J, Vogt TM (1993) Bone density at various sites for prediction of hip fractures. The Study of Osteoporotic Fractures Research Group. Lancet 341:72–75PubMedCrossRef
7.
Zurück zum Zitat Cauley JA, Lui LY, Ensrud KE, Zmuda JM, Stone KL, Hochberg MC, Cummings SR (2005) Bone mineral density and the risk of incident nonspinal fractures in black and white women. JAMA 293:2102–2108PubMedCrossRef Cauley JA, Lui LY, Ensrud KE, Zmuda JM, Stone KL, Hochberg MC, Cummings SR (2005) Bone mineral density and the risk of incident nonspinal fractures in black and white women. JAMA 293:2102–2108PubMedCrossRef
8.
Zurück zum Zitat Andrade SES, Sumit R, Majumdar MK, Chan AM, Buist DSP, Alan S, Go M, Goodman MP, Smith DHP, Platt RP, Gurwitz JHM (2003) Low Frequency of Treatment of Osteoporosis Among Postmenopausal Women Following a Fracture. Arch Intern Med 163:2052–2057PubMedCrossRef Andrade SES, Sumit R, Majumdar MK, Chan AM, Buist DSP, Alan S, Go M, Goodman MP, Smith DHP, Platt RP, Gurwitz JHM (2003) Low Frequency of Treatment of Osteoporosis Among Postmenopausal Women Following a Fracture. Arch Intern Med 163:2052–2057PubMedCrossRef
9.
Zurück zum Zitat Harrington JT, Broy SB, Derosa AM, Licata AA, Shewmon DA (2002) Hip fracture patients are not treated for osteoporosis: a call to action. Arthritis Rheum 47:651–654PubMedCrossRef Harrington JT, Broy SB, Derosa AM, Licata AA, Shewmon DA (2002) Hip fracture patients are not treated for osteoporosis: a call to action. Arthritis Rheum 47:651–654PubMedCrossRef
10.
Zurück zum Zitat Neuner JM, Zimmer JK, Hamel MB (2003) Diagnosis and treatment of osteoporosis in patients with vertebral compression fractures. J Am Geriatr Soc 51:483–491PubMedCrossRef Neuner JM, Zimmer JK, Hamel MB (2003) Diagnosis and treatment of osteoporosis in patients with vertebral compression fractures. J Am Geriatr Soc 51:483–491PubMedCrossRef
11.
Zurück zum Zitat Freedman KB, Kaplan FS, Bilker WB, Strom BL, Lowe RA (2000) Treatment of osteoporosis: are physicians missing an opportunity? J Bone Joint Surg Am 82:1063–1070PubMed Freedman KB, Kaplan FS, Bilker WB, Strom BL, Lowe RA (2000) Treatment of osteoporosis: are physicians missing an opportunity? J Bone Joint Surg Am 82:1063–1070PubMed
12.
Zurück zum Zitat Cuddihy MT, Gabriel SE, Crowson CS, Atkinson EJ, Tabini C, O’Fallon WM, Melton LJ, 3rd (2002) Osteoporosis intervention following distal forearm fractures: a missed opportunity? Arch Intern Med 162:421–426PubMedCrossRef Cuddihy MT, Gabriel SE, Crowson CS, Atkinson EJ, Tabini C, O’Fallon WM, Melton LJ, 3rd (2002) Osteoporosis intervention following distal forearm fractures: a missed opportunity? Arch Intern Med 162:421–426PubMedCrossRef
13.
Zurück zum Zitat Khan SA, de Geus C, Holroyd B, Russell AS (2001) Osteoporosis follow-up after wrist fractures following minor trauma. Arch Intern Med 161:1309–1312PubMedCrossRef Khan SA, de Geus C, Holroyd B, Russell AS (2001) Osteoporosis follow-up after wrist fractures following minor trauma. Arch Intern Med 161:1309–1312PubMedCrossRef
14.
Zurück zum Zitat Alam NM, Archer JA, Lee E (2004) Osteoporotic fragility fractures in African Americans: under-recognized and undertreated. J Natl Med Assoc 96:1640–1645PubMed Alam NM, Archer JA, Lee E (2004) Osteoporotic fragility fractures in African Americans: under-recognized and undertreated. J Natl Med Assoc 96:1640–1645PubMed
15.
Zurück zum Zitat Brennan RM, Wactawski-Wende J, Crespo CJ, Dmochowski J (2004) Factors associated with treatment initiation after osteoporosis screening. Am J Epidemiol 160:475–483PubMedCrossRef Brennan RM, Wactawski-Wende J, Crespo CJ, Dmochowski J (2004) Factors associated with treatment initiation after osteoporosis screening. Am J Epidemiol 160:475–483PubMedCrossRef
16.
Zurück zum Zitat Hamrick I, Steinweg KK, Cummings DM, Whetstone LM (2006) Health care disparities in postmenopausal women referred for DXA screening. Fam Med 4:265–269CrossRef Hamrick I, Steinweg KK, Cummings DM, Whetstone LM (2006) Health care disparities in postmenopausal women referred for DXA screening. Fam Med 4:265–269CrossRef
17.
Zurück zum Zitat Bell NH, Bilezikian JP, Bone HG, 3rd, Kaur A, Maragoto A, Santora AC (2002) Alendronate increases bone mass and reduces bone markers in postmenopausal African-American women. J Clin Endocrinol Metab 87:2792–2797PubMedCrossRef Bell NH, Bilezikian JP, Bone HG, 3rd, Kaur A, Maragoto A, Santora AC (2002) Alendronate increases bone mass and reduces bone markers in postmenopausal African-American women. J Clin Endocrinol Metab 87:2792–2797PubMedCrossRef
18.
Zurück zum Zitat (2002) Management of postmenopausal osteoporosis: position statement of the North American Menopause Society. Menopause 9:84–101 (2002) Management of postmenopausal osteoporosis: position statement of the North American Menopause Society. Menopause 9:84–101
19.
Zurück zum Zitat National Osteoporosis Foundation (2004) Physician’s Guide to Prevention and Treatment of Osteoporosis. In: National Osteoporosis Foundation National Osteoporosis Foundation (2004) Physician’s Guide to Prevention and Treatment of Osteoporosis. In: National Osteoporosis Foundation
20.
Zurück zum Zitat Carmona RH (2004) Bone health and osteoporosis: A report of the Surgeon General. In: General OohS (ed) Public Health Reports of the Surgeon General. United States Department of Health and Human Services Carmona RH (2004) Bone health and osteoporosis: A report of the Surgeon General. In: General OohS (ed) Public Health Reports of the Surgeon General. United States Department of Health and Human Services
21.
Zurück zum Zitat Wei GS, Jackson JL, Herbers JE Jr (2003) Ethnic disparity in the treatment of women with established low bone mass. J Am Med Womens Assoc 58:173–177PubMed Wei GS, Jackson JL, Herbers JE Jr (2003) Ethnic disparity in the treatment of women with established low bone mass. J Am Med Womens Assoc 58:173–177PubMed
22.
Zurück zum Zitat (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. World Health Organ Tech Rep Ser 843:1–129 (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. World Health Organ Tech Rep Ser 843:1–129
24.
Zurück zum Zitat Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, Jackson RD, Beresford SA, Howard BV, Johnson KC, Kotchen JM, Ockene J (2002) Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women’s Health Initiative randomized controlled trial. JAMA 288:321–333PubMedCrossRef Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, Jackson RD, Beresford SA, Howard BV, Johnson KC, Kotchen JM, Ockene J (2002) Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women’s Health Initiative randomized controlled trial. JAMA 288:321–333PubMedCrossRef
25.
Zurück zum Zitat (2001) Osteoporosis prevention, diagnosis, and therapy. JAMA 285:785–795 (2001) Osteoporosis prevention, diagnosis, and therapy. JAMA 285:785–795
26.
Zurück zum Zitat Jacobsen SJ, Goldberg J, Miles TP, Brody JA, Stiers W, Rimm AA (1992) Race and sex differences in mortality following fracture of the hip. Am J Public Health 82:1147–1150PubMedCrossRef Jacobsen SJ, Goldberg J, Miles TP, Brody JA, Stiers W, Rimm AA (1992) Race and sex differences in mortality following fracture of the hip. Am J Public Health 82:1147–1150PubMedCrossRef
27.
Zurück zum Zitat Furstenberg AL, Mezey MD (1987) Differences in outcome between black and white elderly hip fracture patients. J Chronic Dis 40:931–938PubMedCrossRef Furstenberg AL, Mezey MD (1987) Differences in outcome between black and white elderly hip fracture patients. J Chronic Dis 40:931–938PubMedCrossRef
29.
Zurück zum Zitat Cadarette SM, Jaglal SB, Kreiger N, McIsaac WJ, Darlington GA, Tu JV (2000) Development and validation of the Osteoporosis Risk Assessment Instrument to facilitate selection of women for bone densitometry. CMAJ 162:1289–1294PubMed Cadarette SM, Jaglal SB, Kreiger N, McIsaac WJ, Darlington GA, Tu JV (2000) Development and validation of the Osteoporosis Risk Assessment Instrument to facilitate selection of women for bone densitometry. CMAJ 162:1289–1294PubMed
30.
Zurück zum Zitat Weinstein L, Ullery B (2000) Identification of at-risk women for osteoporosis screening. Am J Obstet Gynecol 183:547–549PubMedCrossRef Weinstein L, Ullery B (2000) Identification of at-risk women for osteoporosis screening. Am J Obstet Gynecol 183:547–549PubMedCrossRef
31.
Zurück zum Zitat National OF (1999) Physician’s Guide to Prevention and Treatment of Osteoporosis. Excerpta Medica, Inc., Belle Mead, NJ National OF (1999) Physician’s Guide to Prevention and Treatment of Osteoporosis. Excerpta Medica, Inc., Belle Mead, NJ
32.
Zurück zum Zitat Lydick E, Cook K, Turpin J, Melton M, Stine R, Byrnes C (1998) Development and validation of a simple questionnaire to facilitate identification of women likely to have low bone density. Am J Manag Care 4:37–48PubMed Lydick E, Cook K, Turpin J, Melton M, Stine R, Byrnes C (1998) Development and validation of a simple questionnaire to facilitate identification of women likely to have low bone density. Am J Manag Care 4:37–48PubMed
36.
Zurück zum Zitat Binkley NC, Schmeer P, Wasnich RD, Lenchik L (2002) What are the criteria by which a densitometric diagnosis of osteoporosis can be made in males and non-Caucasians? J Clin Densitom 5(Suppl):S19–27CrossRef Binkley NC, Schmeer P, Wasnich RD, Lenchik L (2002) What are the criteria by which a densitometric diagnosis of osteoporosis can be made in males and non-Caucasians? J Clin Densitom 5(Suppl):S19–27CrossRef
37.
Zurück zum Zitat Woolf SH, Johnson RE, Fryer GE, Jr., Rust G, Satcher D (2004) The health impact of resolving racial disparities: an analysis of US mortality data. Am J Public Health 94:2078–2081PubMed Woolf SH, Johnson RE, Fryer GE, Jr., Rust G, Satcher D (2004) The health impact of resolving racial disparities: an analysis of US mortality data. Am J Public Health 94:2078–2081PubMed
Metadaten
Titel
Racial disparity in treatment of osteoporosis after diagnosis
verfasst von
I. Hamrick
L. M. Whetstone
D. M. Cummings
Publikationsdatum
01.11.2006
Verlag
Springer-Verlag
Erschienen in
Osteoporosis International / Ausgabe 11/2006
Print ISSN: 0937-941X
Elektronische ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-006-0178-y

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