Addressing Disparities in Osteoporosis Care and Outcomes for Black Americans

Osteoporosis, a condition characterized by weakened bones and an increased risk of fractures, affects millions worldwide. While often perceived as predominantly impacting White populations, osteoporosis significantly affects Black individuals, who face unique challenges in diagnosis, treatment, and outcomes. In honor of Black History Month, it’s crucial to shed light on these disparities and advocate for equitable bone health care.

Incidence and Prevalence

Studies indicate that non-Hispanic Black adults aged 50 and older have a lower reported prevalence of osteoporosis (6.8%) compared to their non-Hispanic White (12.9%), non-Hispanic Asian (18.4%), and Hispanic (14.7%) counterparts. (CDC) However, this lower prevalence does not translate to reduced risk, as Black individuals often experience more severe consequences from osteoporotic fractures.

Disparities in Diagnosis

Black women are 40% less likely than White women to undergo bone mineral density (BMD) testing, even when meeting the U.S. Preventive Services Task Force criteria for screening. (Springer) This under-screening leads to delayed diagnoses and interventions, exacerbating the risk of severe fractures.

Why Are Black Americans Not Screened for Osteoporosis?

Several factors contribute to the under-screening of Black individuals for osteoporosis:

1. Clinical Misconceptions: A long-standing misconception exists in the medical community that Black individuals have denser bones and are at lower risk for osteoporosis. While Black individuals on tend to have higher bone mineral density (BMD) on average, many Black individuals do have low bone density, so each individual needs to get screened as they still have a risk of fractures or complications from osteoporosis.
2. Bias in Risk Assessment Tools: Many osteoporosis screening tools, such as the Fracture Risk Assessment Tool (FRAX), use race as a factor. However, these tools may underestimate the fracture risk for Black individuals, leading to fewer referrals for BMD testing and treatment. (Bone Health & Osteoporosis Foundation)
3. Healthcare Access and Socioeconomic Barriers: Black individuals are more likely to encounter barriers to healthcare, including lack of insurance, limited access to specialists, and systemic inequities in healthcare delivery. These factors contribute to lower rates of osteoporosis screening and treatment.
4. Limited Patient Awareness: Due to lower screening rates and historical medical mistrust, many Black patients are unaware of their osteoporosis risk. Without targeted education and advocacy, many individuals do not seek or receive preventative care for bone health.
5. Underrepresentation in Clinical Studies: The majority of osteoporosis research has historically focused on White populations, leading to a lack of data on how the disease affects Black individuals. This gap in research translates into guidelines that may not adequately address the needs of Black patients. (JSTOR)

Fracture Risk and Outcomes

While White women have higher rates of hip fractures, Black women experience poorer outcomes, including increased morbidity and mortality. (JSTOR) This disparity may stem from delayed diagnoses, limited access to quality care, and socioeconomic factors influencing health outcomes.

Addressing the Disparities

Dr. Sherri-Ann Burnett-Bowie, an Associate Professor of Medicine at Harvard Medical School, emphasizes in her research the many social and economic factors that result in Black women being less likely to receive osteoporosis screening before and after fractures and have lower rates of treatment (e.g. medication and physical therapy) and higher mortality and loss of independence. (UCSF CME)  

To mitigate these inequities, healthcare providers must prioritize culturally competent care, ensuring that Black patients receive appropriate osteoporosis screening and treatment. Community education programs can raise awareness about osteoporosis risks and the importance of early detection. Moreover, revising clinical assessment tools, such as FRAX, to eliminate race-based adjustments may prevent the underestimation of fracture risk in Black individuals. (Bone Health & Osteoporosis Foundation)

Conclusion

Recognizing and addressing the disparities in osteoporosis care for Black individuals is a critical step toward health equity. By focusing on this important goal, enhancing awareness, improving access to screening, and providing equitable treatment, we can reduce the disproportionate burden of osteoporosis-related complications in the Black community.

References

1. Racial disparities, FRAX, and the care of patients with osteoporosis. Osteoporosis International. (Springer)
2. QuickStats: Percentage of Adults Aged ≥50 Years with Osteoporosis, by Race and Hispanic Origin — National Health and Nutrition Examination Survey, United States, 2017–2018. CDC. (CDC)
3. Racial Differences and Disparities in Osteoporosis-related Bone Health. Journal of Racial and Ethnic Health Disparities. (JSTOR)
4. Disparities in Reproductive Aging and Midlife Health between Black and White women: The Study of Women’s Health Across the Nation (SWAN). Women’s Midlife Health. (Deep Blue)
5. Racial and Ethnic Disparities in Osteoporosis Care. UCSF CME. (UCSF CME)
6. Racial disparities, FRAX, and the care of patients with osteoporosis. Bone Health & Osteoporosis Foundation. (Bone Health & Osteoporosis Foundation)