Factors Associated With Osteoporosis Care of Men Hospitalized for Hip Fracture: A Retrospective Cohort Study

Disparities in the Epidemiology and Management of Fragility Hip Fractures

PURPOSE OF REVIEW

The purpose of this review is to synthesize the recently published scientific evidence on disparities in epidemiology and management of fragility hip fractures.

RECENT FINDINGS

There have been a number of investigations focusing on the presence of disparities in the epidemiology and management of fragility hip fractures. Race-, sex-, geographic-, socioeconomic-, and comorbidity-based disparities have been the primary focus of these investigations. Comparatively fewer studies have focused on why these disparities may exist and interventions to reduce disparities. There are widespread and profound disparities in the epidemiology and management of fragility hip fractures. More studies are needed to understand why these disparities exist and how they can be addressed.

Osteoporosis Screening Disparities among Ethnic and Racial Minorities: A Systematic Review

Background

Osteoporosis is a preventable disease that is simple and cost-effective to screen based on clinical practice guidelines, yet many patients go undiagnosed and untreated leading to increased burden of the disease. Specifically, racial and ethnic minorities have lower rates of dual energy absorptiometry (DXA) screening. Inadequate screening may lead to an increased risk of fracture, higher health care costs, and increased morbidity and mortality disproportionately experienced by racial-ethnic minority populations.

Purpose

This systematic review assessed and summarized the racial and ethnic disparities that exist for osteoporosis screening by DXA.

Methods

Using terms related to osteoporosis, racial and ethnic minorities, and DXA, an electronic search of databases was performed in SCOPUS, CINAHL, and PubMed. Articles were screened using predefined inclusion and exclusion criteria which dictated the final articles used in the review. Full text articles that were selected for inclusion underwent quality appraisal and data extraction. Once extracted, data from the articles were combined at an aggregate level.

Results

The search identified 412 articles. After screening, a total of 16 studies were included in the final review. The overall quality of the studies included was high. Of the 16 articles reviewed, 14 identified significant disparities between racial minority and majority groups and determined that the eligible patients in racial minority groups were less likely to be referred to DXA screening.

Conclusion

There is a significant disparity in osteoporosis screening among racial and ethnic minorities. Future efforts should focus on addressing these inconsistencies in screening and removing bias from the healthcare system. Additional research is required to determine the consequence of this discrepancy in screening and methods of equitizing osteoporosis care.

Attitudes toward bone health among rural-dwelling veterans identified as at risk of fracture: a qualitative analysis

Although much is known about system‐level barriers to prevention and treatment of bone health problems, little is known about patient‐level barriers. The objective of this study was to identify factors limiting engagement in bone health care from the perspective of rural‐dwelling patients with known untreated risk. Over 6 months, 39 patients completed a qualitative interview. Interview questions focused on the patient's experience of care, their decision to not accept care, as well as their knowledge of osteoporosis and the impact it has had on their lives. Participants were well‐informed and could adequately describe osteoporosis and its deleterious effects, and their decision making around accepting or declining a dual‐energy x‐ray absorptiometry (DXA) scan and treatment was both cautious and intentional. Decisions about how to engage in treatment were tempered by expectations for quality of life. Our findings suggest that people hold beliefs about bone health treatment that we can build on. Work to improve care of this population needs to recognize that bone health providers are not adding a behavior of medication taking to patients, they are changing a behavior or belief. Published 2021. This article is a U.S. Government work and is in the public domain in the USA. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.