SYMPOSIUM: AAOS/ORS/ABJS MUSCULOSKELETAL HEALTHCARE DISPARITIES RESEARCH
Deﬁning Ethnic and Racial Differences in Osteoporosis
and Fragility Fractures
Jane A. Cauley DrPH
Published online: 23 March 2011
Ó The Association of Bone and Joint Surgeons1 2011
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 lit-
erature related to the inﬂuence of ethnicity and race on the
(1) epidemiology of fracture; (2) prevalence of osteopo-
rosis 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 epide-
miology of fractures, with highest fracture rates in white
women. Bone mineral density is higher in African Amer-
icans; 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 infarc-
tion, and coronary death in 1 year. Prevention efforts
should target all women, irrespective of their race/ethnic-
ity, especially if they have multiple risk factors.
Osteoporotic fractures are a major public health problem.
Such fractures result in serious morbidity, disability,
quality of life, and mortality consequences. Understanding
osteoporotic fractures is important for creating successful
interventions to decrease such fractures and improve the
delivery of health care.
Ethnicity and race are important factors inﬂuencing the
incidence of osteoporosis. Furthermore, there are differences
in risk factors and treatment outcomes for osteoporosis based
on ethnicity and race. Understanding ethnic and racial
inﬂuences on osteoporotic fractures is critical to decreasing
the burden of such fractures on patients and society.
Given the current demographic trends leading to an
increase in the number of persons older than 65 years, the
numbers of fractures will increase even if fracture inci-
dence rates remain stable. While a decline in hip fractures
has occurred in white women , it has increased in His-
panic women . Moreover, given the increase in life
expectancy among African Americans and Hispanics, the
number of fractures will increase in these groups. In 2005,
12% of all fractures occurred in nonwhites. By 2025, this
percentage will rise to 21% . Osteoporotic fractures are
clearly a critical public health issue.
The purpose of this review is to address the following
questions: (1) Does ethnicity and race inﬂuence the epide-
miology of osteoporotic fracture? (2) Does the prevalence
of osteoporosis by bone mineral density (BMD) vary by
The author certiﬁes that she has no commercial associations (eg,
consultancies, stock ownership, equity interest, patent/licensing
arrangements, etc) that might pose a conﬂict of interest in connection
with the submitted article.
J. A. Cauley (&)
Department of Epidemiology, University of Pittsburgh,
130 DeSoto Street, Crabtree A543, Pittsburgh, PA 15261, USA
e-mail: firstname.lastname@example.org; JCauley@edc.pitt.edu
Clin Orthop Relat Res (2011) 469:1891–1899