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Benítez TM, Ouyang Z, Khouri AN, Fahmy JN, Wang L, Chung KC. Medicare Eligibility and Racial and Ethnic Disparities in Operative Fixation for Distal Radius Fracture. JAMA Netw Open 2023; 6:e2349621. [PMID: 38153736 PMCID: PMC10755624 DOI: 10.1001/jamanetworkopen.2023.49621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 10/31/2023] [Indexed: 12/29/2023] Open
Abstract
Importance Medicare provides near-universal health insurance to US residents aged 65 years or older. How eligibility for Medicare coverage affects racial and ethnic disparities in operative management after orthopedic trauma is poorly understood. Objective To assess the association of Medicare eligibility with racial and ethnic disparities in open reduction and internal fixation (ORIF) after distal radius fracture (DRF). Design, Setting, and Participants This retrospective cohort study with a regression discontinuity design obtained data from the Healthcare Cost and Utilization Project all-payer statewide databases for Florida, Maryland, and New York. These databases contain encounter-level data and unique patient identifiers for longitudinal follow-up across emergency departments, outpatient surgical centers, and hospitals. The cohort included patients aged 57 to 72 years who sustained DRFs between January 1, 2016, and November 30, 2019. Data analysis was performed between March 1 and October 15, 2023. Exposure Eligibility for Medicare coverage at age 65 years. Main Outcomes and Measures Type of management for DRF (closed treatment, external fixation, percutaneous pinning, and ORIF). Time to surgery was ascertained in patients undergoing ORIF. Multivariable logistic regression and regression discontinuity design were used to compare racial and ethnic disparities in patients who underwent ORIF before or after age 65 years. Results A total of 26 874 patients with DRF were included (mean [SD] age, 64.6 [4.6] years; 22 359 were females [83.2%]). Of these patients, 2805 were Hispanic or Latino (10.4%; hereafter, Hispanic), 1492 were non-Hispanic Black (5.6%; hereafter, Black), and 20 548 were non-Hispanic White (76.5%; hereafter, White) and 2029 (7.6%) were individuals of other races and ethnicities (including Asian or Pacific Islander, Native American, and other races). Overall, 32.6% of patients received ORIF but significantly lower use was observed in Black (20.2% vs 35.4%; P < .001) and Hispanic (25.8% vs 35.4%; P < .001) patients compared with White individuals. After adjusting for potential confounders, multivariable logistic regression analysis confirmed the disparity in ORIF use in Black (odds ratio [OR], 0.60; 95% CI, 0.50-0.72) and Hispanic patients (OR, 0.82; 95% CI, 0.72-0.94) compared with White patients. No significant difference in ORIF use was found among racial and ethnic groups at age 65 years. The expected disparity in ORIF use between White and Black patients at age 65 years without Medicare coverage was 12.6 percentage points; however, the actual disparity was 22.0 percentage points, 9.4 percentage points (95% CI, 0.3-18.4 percentage points) greater than expected, a 75% increase (P = .04). In the absence of Medicare coverage, the expected disparity in ORIF use between White and Hispanic patients was 8.3 percentage points, and this result persisted without significant change in the presence of Medicare coverage. Conclusions and Relevance Results of this study showed that surgical management for DRF was popular in adults aged 57 to 72 years, but there was lower ORIF use in racial or ethnic minority patients. Medicare eligibility at age 65 years did not attenuate race and ethnicity-based disparities in surgical management of DRFs.
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Affiliation(s)
- Trista M. Benítez
- University of Michigan Medical School, Ann Arbor
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor
| | - Zhongzhe Ouyang
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor
| | - Alexander N. Khouri
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor
| | - Joseph N. Fahmy
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor
| | - Lu Wang
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor
| | - Kevin C. Chung
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor
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Wu Q, Dai J. Racial/Ethnic Differences in Bone Mineral Density for Osteoporosis. Curr Osteoporos Rep 2023; 21:670-684. [PMID: 38019343 DOI: 10.1007/s11914-023-00838-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/13/2023] [Indexed: 11/30/2023]
Abstract
PURPOSE OF REVIEW We primarily aim to review differences in bone mineral density (BMD) for osteoporosis among different racial/ethnic groups and to highlight the magnitude of racial/ethnic differences in obesity and diabetes. We also explore the factors contributing to the BMD differences among various subgroups. In addition, we investigate the existing disparities in research, educational initiatives, screening practices, and treatment options for osteoporosis and discuss these findings' clinical and public health implications. RECENT FINDINGS Racial/ethnic differences in BMD for osteoporosis exist in the USA and other countries. There are disparities regarding osteoporosis screening and treatment. Understanding the factors contributing to these differences can help develop targeted interventions and policies to reduce their impact. Clinicians should consider the racial/ethnic differences in BMD when making treatment decisions and providing preventive care. Future research could contribute to developing effective strategies for preventing osteoporosis among different racial/ethnic groups. This review offered a comprehensive examination of differences in BMD across various racial and ethnic groups, elucidating the influence of genetic, lifestyle, and cultural factors on these differences. This review also highlighted the disparities in osteoporosis screening, treatment options, research on medical effectiveness, and educational outreach tailored to each subgroup. Recognizing the importance of addressing these inequalities, we present this review to advocate for targeted interventions to reduce disparities in osteoporosis and improve bone health for all populations.
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Affiliation(s)
- Qing Wu
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, 250 Lincoln Tower, 1800 Cannon Drive, Columbus, OH, 43210, USA.
| | - Jingyuan Dai
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, 250 Lincoln Tower, 1800 Cannon Drive, Columbus, OH, 43210, USA
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Lo JC, Yang W, Park-Sigal JJ, Ott SM. Osteoporosis and Fracture Risk among Older US Asian Adults. Curr Osteoporos Rep 2023; 21:592-608. [PMID: 37542683 PMCID: PMC10858302 DOI: 10.1007/s11914-023-00805-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/06/2023] [Indexed: 08/07/2023]
Abstract
PURPOSE OF REVIEW This review summarizes the current knowledge regarding osteoporosis and fracture among older US Asian adults. RECENT FINDINGS Asian adults have lower (areal) bone density than non-Hispanic White adults and thus are more likely to be diagnosed and treated for osteoporosis, despite their lower risk of hip fracture. The latter may relate to favorable characteristics in hip geometry, volumetric bone density, and bone microarchitecture; lower risk of falls; and other clinical factors. The fracture risk calculator FRAX accounts for the lower risk of hip fracture among US Asian adults. However, data on major osteoporotic fracture risk remain limited. Fracture rates also vary by Asian subgroup, which may 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. Recent clinical trial efficacy data pertaining to lower bisphosphonate doses and longer dosing intervals may be relevant for Asian adults. More research is needed to inform osteoporosis care of US Asian adults, 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.
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Affiliation(s)
- Joan C Lo
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA.
- The Permanente Medical Group, Oakland, CA, USA.
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA.
| | - Wei Yang
- The Permanente Medical Group, Oakland, CA, USA
- Department of Endocrinology, Kaiser Permanente San Jose Medical Center, San Jose, CA, USA
| | - Jennifer J Park-Sigal
- The Permanente Medical Group, Oakland, CA, USA
- Department of Endocrinology, Kaiser Permanente South San Francisco Medical Center, South San Francisco, CA, USA
| | - Susan M Ott
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
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4
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Bao Y, Xu Y, Li Z, Wu Q. Racial and ethnic difference in the risk of fractures in the United States: a systematic review and meta-analysis. Sci Rep 2023; 13:9481. [PMID: 37301857 PMCID: PMC10257681 DOI: 10.1038/s41598-023-32776-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 04/02/2023] [Indexed: 06/12/2023] Open
Abstract
This systematic review and meta-analysis examined the association between race and ethnicity and fracture risk in the United States. We identified relevant studies by searching PubMed and EMBASE for studies published from the databases' inception date to December 23, 2022. Only observational studies conducted in the US population that reported the effect size of racial-ethnic minority groups versus white people were included. Two investigators independently conducted literature searches, study selection, risk of bias assessment, and data abstraction; discrepancies were resolved by consensus or consultation of a third investigator. Twenty-five studies met the inclusion criteria, and the random-effects model was used to calculate the pooled effect size due to heterogeneity between the studies. Using white people as the reference group, we found that people of other races and ethnic groups had a significantly lower fracture risk. In Black people, the pooled relative risk (RR) was 0.46 (95% confidence interval (CI), 0.43-0.48, p < 0.0001). In Hispanics, the pooled RR was 0.66 (95% CI, 0.55-0.79, p < 0.0001). In Asian Americans, the pooled RR was 0.55 (95% CI, 0.45-0.66, p < 0.0001). In American Indians, the pooled RR was 0.80 (95% CI, 0.41-1.58, p = 0.3436). Subgroup analysis by sex in Black people revealed the strength of association was greater in men (RR = 0.57, 95% CI = 0.51-0.63, p < 0.0001) than in women (RR = 0.43, 95% CI = 0.39-0.47, p < 0.0001). Our findings suggest that people of other races and ethnic groups have a lower fracture risk than white people.
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Affiliation(s)
- Yueyang Bao
- Nevada Institute of Personalized Medicine, College of Sciences, University of Nevada, Las Vegas, NV, USA
- Department of Biology, McMaster University, Hamilton, ON, L8S 4L8, Canada
| | - Yingke Xu
- Nevada Institute of Personalized Medicine, College of Sciences, University of Nevada, Las Vegas, NV, USA
- Department of Epidemiology and Biostatistics, School of Public Health, University of Nevada, Las Vegas, NV, USA
| | - Zhuowei Li
- Nevada Institute of Personalized Medicine, College of Sciences, University of Nevada, Las Vegas, NV, USA
| | - Qing Wu
- Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University, Columbus, OH, USA.
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Agarwal S, Germosen C, Bucovsky M, Colon I, Kil N, Walker M. Skeletal Microstructure in Caribbean Hispanic Women. JBMR Plus 2023; 7:e10725. [PMID: 37197315 PMCID: PMC10184017 DOI: 10.1002/jbm4.10725] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/18/2023] [Accepted: 01/23/2023] [Indexed: 01/27/2023] Open
Abstract
Hispanic individuals are underrepresented in skeletal research. Bone mineral density (BMD) and fracture data are conflicting. We investigated skeletal health in elderly Caribbean Hispanic (HW), non-Hispanic white (NHW), and non-Hispanic black (NHB) women in a population-based study in New York City. We utilized high-resolution peripheral quantitative CT (HRpQCT), dual-energy X-ray absorptiometry (DXA), and finite element analysis (FEA). Of 442, 48.4% were HW, 21.3% NHW, and 30.3% NHB. Adjusted analyses are shown. Compared to NHW, HW had 8.5% (p < 0.01) lower spine areal BMD (aBMD) and 5.1% lower trabecular bone score (TBS). The frequency of morphometric vertebral fractures did not differ between HW and NHW. By HRpQCT, HW had 2.9% higher cortical (Ct) volumetric BMD (vBMD), 7.9% greater Ct area (Ct.Ar) and 9.4% greater Ct thickness (Ct.Th) at the radius compared to NHW. Results were similar at the tibia but trabecular microstructure tended to be worse. Ultimately, failure load (FL) did not differ between HW and NHW at either site. aBMD was 3.8% to 11.1% lower at the spine, femoral neck, and radius in HW compared to NHB (all p < 0.001) and vertebral fractures were twice as common. Compared to NHB, HW had 7.7% to 10.3% lower Ct.Ar at both the radius and tibia as well as 8.4% lower total vBMD, 6.3% lower trabecular number, and 10.3% lower Ct.Th at the tibia associated with 18.2% and 12.5% lower FL at both sites, respectively. In conclusion, HW had lower spine aBMD and TBS versus NHW women, whereas microstructural differences at the radius and tibia were small and not associated with differences in FL. In contrast, HW had lower aBMD, as well as deteriorated radial and tibial microstructure associated with worse FL compared to NHB women. Our results provide insight into racial/ethnic differences in skeletal health, adding to data that may be used to improve osteoporosis screening and treatment in HW. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Sanchita Agarwal
- Division of EndocrinologyColumbia University Irving Medical CenterNew YorkNYUSA
| | - Carmen Germosen
- Division of EndocrinologyColumbia University Irving Medical CenterNew YorkNYUSA
| | - Mariana Bucovsky
- Division of EndocrinologyColumbia University Irving Medical CenterNew YorkNYUSA
| | - Ivelisse Colon
- Division of EndocrinologyColumbia University Irving Medical CenterNew YorkNYUSA
| | - Nayoung Kil
- Division of EndocrinologyColumbia University Irving Medical CenterNew YorkNYUSA
| | - Marcella Walker
- Division of EndocrinologyColumbia University Irving Medical CenterNew YorkNYUSA
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6
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Canto-Cetina T, Rojano-Mejía D, Coral-Vázquez RM, Cetina-Manzanilla JA, Polanco-Reyes L, Canto P. Bone Mineral Density and Fractures In Postmenopausal Women Of Mayan-Mestizo Ethnic Origin With Different Body Mass Indices. Ann Hum Biol 2022; 48:567-571. [PMID: 35139707 DOI: 10.1080/03014460.2022.2041093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Obesity protects against bone loss, but it increases the risk of fragility fractures. AIM To determine if bone mineral density (BMD) and the prevalence of fractures are different in postmenopausal Mayan-mestizo women grouped according to their body mass index. SUBJECTS AND METHODS We studied 600 postmenopausal Maya-Mestizo women. A structured questionnaire for risk factors was applied. Body mass index (BMI) was determined. BMD was assessed at the lumbar spine and total hip by dual-energy X-ray absorptiometry. History of low trauma fracture was determined from medical records. ANOVA was used to compare mean BMD between women with different BMI. To compare the frequency of fractures according to BMI group, we used χ2. RESULTS According to WHO classification of BMI, 16.3% of women had normal BMI, 35.3% were overweight, and 48.4% had obesity. We found that women with obesity had a higher BMD versus women with normal BMI or overweight in all the anatomical sites analysed. The prevalence of history of fractures was 18.2%. We did not find differences between the women of different BMI; the wrist was the most frequent skeletal site of the fracture. CONCLUSIONS Obesity in postmenopausal Maya-Mestizo women is not a risk factor for developing fragility fractures.
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Affiliation(s)
- Thelma Canto-Cetina
- Laboratorio de Biología de la Reproducción, Centro de Investigaciones Regionales "Dr. Hideyo Noguchi", Mérida Yucatán, México
| | - David Rojano-Mejía
- UMAE Hospital de Traumatología, Ortopedia y Rehabilitación "Dr. Victorio de la Fuente Narváez", Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Ramón Mauricio Coral-Vázquez
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Ciudad de México, México.,Subdirección de Enseñanza e Investigación, Centro Médico Nacional "20 de Noviembre", Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Ciudad de México, México
| | | | - Lucila Polanco-Reyes
- Laboratorio de Biología de la Reproducción, Centro de Investigaciones Regionales "Dr. Hideyo Noguchi", Mérida Yucatán, México
| | - Patricia Canto
- Unidad de Investigación en Obesidad, Facultad de Medicina, Universidad Nacional Autónoma de Ciudad de México, México.,Subdirección de Investigación Clínica, Dirección de Investigación, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Ciudad de México, México
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Noel SE, Santos MP, Wright NC. Racial and Ethnic Disparities in Bone Health and Outcomes in the United States. J Bone Miner Res 2021; 36:1881-1905. [PMID: 34338355 PMCID: PMC8607440 DOI: 10.1002/jbmr.4417] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 07/12/2021] [Accepted: 07/21/2021] [Indexed: 11/10/2022]
Abstract
Osteoporosis is a bone disease classified by deterioration of bone microarchitecture and decreased bone strength, thereby increasing subsequent risk of fracture. In the United States, approximately 54 million adults aged 50 years and older have osteoporosis or are at risk due to low bone mass. Osteoporosis has long been viewed as a chronic health condition affecting primarily non-Hispanic white (NHW) women; however, emerging evidence indicates racial and ethnic disparities in bone outcomes and osteoporosis management. The primary objective of this review is to describe disparities in bone mineral density (BMD), prevalence of osteoporosis and fracture, as well as in screening and treatment of osteoporosis among non-Hispanic black (NHB), Hispanic, and Asian adults compared with NHW adults living on the US mainland. The following areas were reviewed: BMD, osteoporosis prevalence, fracture prevalence and incidence, postfracture outcomes, DXA screening, and osteoporosis treatments. Although there are limited studies on bone and fracture outcomes within Asian and Hispanic populations, findings suggest that there are differences in bone outcomes across NHW, NHB, Asian, and Hispanic populations. Further, NHB, Asian, and Hispanic populations may experience suboptimal osteoporosis management and postfracture care, although additional population-based studies are needed. There is also evidence that variation in BMD and osteoporosis exists within major racial and ethnic groups, highlighting the need for research in individual groups by origin or background. Although there is a clear need to prioritize future quantitative and qualitative research in these populations, initial strategies for addressing bone health disparities are discussed. © 2021 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Sabrina E Noel
- Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, Lowell, MA, USA.,Center for Population Health, University of Massachusetts Lowell, Lowell, MA, USA
| | - Michelly P Santos
- Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, Lowell, MA, USA.,Center for Population Health, University of Massachusetts Lowell, Lowell, MA, USA
| | - Nicole C Wright
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
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Lo JC, Chandra M, Lee C, Darbinian JA, Ramaswamy M, Ettinger B. Bone Mineral Density in Older U.S. Filipino, Chinese, Japanese, and White Women. J Am Geriatr Soc 2020; 68:2656-2661. [PMID: 33047307 DOI: 10.1111/jgs.16785] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/15/2020] [Accepted: 07/17/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES Bone mineral density (BMD) reference data exist for U.S. White, Black, and Hispanic (Mexican American) populations but not for U.S. Asians. Few studies have compared BMD findings among different U.S. Asian ethnicities. DESIGN Retrospective observational study. SETTING Large northern California healthcare system. PARTICIPANTS Asian and White women aged 50 to 79 years with BMD testing from 1998 to 2017 excluding those with estrogen or osteoporosis treatment, recent fracture, or select disorders affecting skeletal health. MEASUREMENTS Femoral neck (FN)-BMD and height data. METHODS Differences in FN-BMD were examined by ethnicity and age, comparing Filipino, Chinese, and Japanese women and non-Hispanic White women. Differences in BMD were also examined after adjustment for height. RESULTS There were 37,224 Asian women (including 11,147 Filipino, 10,648 Chinese, and 2,519 Japanese) and 115,318 non-Hispanic White women. Mean height was similar among the Asian subgroups and about 6 to 8 cm lower than Whites. Mean FN-BMDs differed by less than 3% for Filipino, Chinese, and Japanese and all were lower than Whites, with smaller Asian-White differences among younger women (<3%; ages 50-59) and larger differences among older women (6-8%; ages 65-79). Adjusting FN-BMD for height reduced White-Asian differences by about 30% to 40%. CONCLUSION Mean FN-BMD and height for Filipino, Chinese, and Japanese women were similar but consistently lower than White women, especially among older women. Although Asian-White BMD differences were substantially attenuated after height adjustment; some differences persisted for older women. Future studies should investigate potential age-cohort effects and the extent to which these BMD differences influence fracture risk and clinical care.
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Affiliation(s)
- Joan C Lo
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.,The Permanente Medical Group, Oakland, California, USA
| | - Malini Chandra
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Catherine Lee
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.,The Permanente Medical Group, Oakland, California, USA
| | - Jeanne A Darbinian
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Mohan Ramaswamy
- The Permanente Medical Group, Oakland, California, USA.,Department of Nuclear Medicine, Kaiser Permanente Walnut Creek Medical Center, Walnut Creek, California, USA
| | - Bruce Ettinger
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
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9
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Agarwal P, Morris MC, Barnes LL. Racial Differences in Dietary Relations to Cognitive Decline and Alzheimer's Disease Risk: Do We Know Enough? Front Hum Neurosci 2020; 14:359. [PMID: 33100990 PMCID: PMC7497764 DOI: 10.3389/fnhum.2020.00359] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 08/06/2020] [Indexed: 01/08/2023] Open
Abstract
The elderly population in the US is increasing and projected to be 44% minority by 2060. African Americans and Hispanics are at increased risk of cognitive impairment and Alzheimer’s disease compared to non-Hispanic whites. These conditions are associated with many other adverse health outcomes, lower quality of life, and substantial economic burden. In the past few decades, diet has been identified as an important modifiable risk factor for cognitive decline and Alzheimer’s disease. Some studies report poor diet quality among African American and Hispanic older adult populations compared to their white counterparts. We have a limited understanding of how diet affects brain health in different racial-ethnic groups. One primary reason for our lack of knowledge is that most cohort studies are of majority non-Hispanic white participants. Moreover, those that do include minority participants do not publish their findings stratified by racial-ethnic groups, and likely have a less accurate measurement of dietary intake among minority groups. In this review, we summarize the current, albeit limited, literature on racial/ethnic differences in dietary relations to dementia outcomes. We will also discuss methodological issues in conducting nutrition studies in diverse cultures, and suggestions for future research directions. Overcoming the gaps will make it possible to make dietary recommendations for Alzheimer’s prevention that are more relevant for different racial/ethnic groups and set us on a faster track to reduce health disparities.
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Affiliation(s)
- Puja Agarwal
- Department of Internal Medicine, Rush Institute for Healthy Aging, Rush University Medical Center, Chicago, IL, United States
| | - Martha C Morris
- Department of Internal Medicine, Rush Institute for Healthy Aging, Rush University Medical Center, Chicago, IL, United States
| | - Lisa L Barnes
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, United States.,Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States
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10
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Noel SE, Mangano KM, Griffith JL, Wright NC, Dawson-Hughes B, Tucker KL. Prevalence of Osteoporosis and Low Bone Mass Among Puerto Rican Older Adults. J Bone Miner Res 2018; 33:396-403. [PMID: 29044768 PMCID: PMC5840013 DOI: 10.1002/jbmr.3315] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 10/10/2017] [Accepted: 10/16/2017] [Indexed: 11/08/2022]
Abstract
Historically, osteoporosis has not been considered a public health priority for the Hispanic population. However, recent data indicate that Mexican Americans are at increased risk for this chronic condition. Although it is well established that there is heterogeneity in social, lifestyle, and health-related factors among Hispanic subgroups, there are currently few studies on bone health among Hispanic subgroups other than Mexican Americans. The current study aimed to determine the prevalence of osteoporosis and low bone mass (LBM) among 953 Puerto Rican adults, aged 47 to 79 years and living on the US mainland, using data from one of the largest cohorts on bone health in this population: The Boston Puerto Rican Osteoporosis Study (BPROS). Participants completed an interview to assess demographic and lifestyle characteristics and bone mineral density measures. To facilitate comparisons with national data, we calculated age-adjusted estimates for osteoporosis and LBM for Mexican American, non-Hispanic white, and non-Hispanic black adults, aged ≥50 years, from the National Health and Nutrition Examination Survey (NHANES). The overall prevalence of osteoporosis and LBM were 10.5% and 43.3% for participants in the BPROS, respectively. For men, the highest prevalence of osteoporosis was among those aged 50 to 59 years (11%) and lowest for men ≥70 years (3.7%). The age-adjusted prevalence of osteoporosis for Puerto Rican men was 8.6%, compared with 2.3% for non-Hispanic white, and 3.9% for Mexican American men. There were no statistically significant differences between age-adjusted estimates for Puerto Rican women (10.7%), non-Hispanic white women (10.1%), or Mexican American women (16%). There is a need to understand specific factors contributing to osteoporosis in Puerto Rican adults, particularly younger men. This will provide important information to guide the development of culturally and linguistically tailored interventions to improve bone health in this understudied and high-risk population. © 2017 American Society for Bone and Mineral Research.
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Affiliation(s)
- Sabrina E Noel
- Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, Lowell, MA, USA
| | - Kelsey M Mangano
- Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, Lowell, MA, USA
| | - John L Griffith
- Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Nicole C Wright
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Bess Dawson-Hughes
- Bone Metabolism Laboratory, Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Katherine L Tucker
- Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, Lowell, MA, USA
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11
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Munhoz L, Aoki EM, Cortes ARG, de Freitas CF, Arita ES. Osteoporotic alterations in a group of different ethnicity Brazilian postmenopausal women: An observational study. Gerodontology 2018; 35:101-109. [PMID: 29380906 DOI: 10.1111/ger.12322] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To compare peripheral bone mineral density alterations among Brazilian postmenopausal women from three ethnic groups considering age and body mass index influence; to correlate their bone mineral density with the mandibular cortical index (MCI); and to evaluate the influence of age, body mass index and ethnicity in the MCI using risk factor analysis. BACKGROUND Osteoporosis risk is known to have ethical influences. However, little is known about the differences in ethnicity in radiomorphometric indices. MATERIALS AND METHODS A total of 150 postmenopausal women with different ethnicities (Caucasian, Asian and Afro-descendant) who underwent peripheral dual X-ray absorptiometry and panoramic examination were included. Bone mineral density and MCI were assessed. Adjusted odds ratio analyses were performed on bone density and MCI considering the effect of age, ethnicity and body mass index. The correlations between the MCI and the dual X-ray absorptiometry results were made. RESULTS Old age, low body mass index and non-Afro-descendant were associated with low bone density. Compared with Afro-descendants, Asians and Caucasians have higher chances of having decreased bone mass. For the MCI, statistical analysis showed that age is the only variable associated with osteoporotic alterations in the mandible. Furthermore, an inverse correlation was found between the MCI and the T-scores. CONCLUSION Bone density is higher in Brazilian Afro-descendant women than in Caucasians and Asians. Patient's age is associated with bone density and the MCI. The mandibular cortical index is inversely correlated with the peripheral densitometry results within the study ethnic population.
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Affiliation(s)
- Luciana Munhoz
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Eduardo M Aoki
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Arthur R G Cortes
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Cláudio F de Freitas
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Emiko S Arita
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
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Walker MD, Kepley A, Nishiyama K, Zhou B, Guo E, Nickolas TL. Cortical microstructure compensates for smaller bone size in young Caribbean Hispanic versus non-Hispanic white men. Osteoporos Int 2017; 28:2147-2154. [PMID: 28341899 DOI: 10.1007/s00198-017-4013-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 03/15/2017] [Indexed: 10/19/2022]
Abstract
UNLABELLED Hispanic men have smaller bone size but thicker and denser cortices compared to white men, leading to similar mechanical competence. INTRODUCTION The purpose of this study was to assess differences in vBMD and microarchitecture in young Caribbean Hispanic (n = 30) and non-Hispanic Caucasian (n = 30) men. METHODS We measured areal bone mineral density (aBMD) at the spine, total hip (TH), femoral neck (FN), and forearm by dual-energy X-ray absorptiometry (DXA) and bone geometry, mass, microarchitecture, and mechanical competence by high-resolution peripheral quantitative computed tomography (HRpQCT), individual trabecula segmentation (ITS), and finite element analysis (FEA). RESULTS Hispanic men were slightly older, shorter, and heavier and had higher BMI compared with white men. aBMD, measured by DXA, did not differ at the spine, TH, or forearm before or after adjustment for age, height, weight, and the interaction of height and weight. At the FN, marginally significant higher BMD in Hispanics prior to adjustment was attenuated and no longer differed after adjustment for covariates. Adjusted HRpQCT indices indicated smaller total and trabecular area at the radius but greater total volumetric density and cortical thickness in Hispanic versus white men. The adjusted difference in cortical density at the radius was of borderline significance. Trabecular and ITS microstructure tended not to differ at the radius. At the tibia, results were similar. Bone size tended to be smaller and covariate-adjusted cortical density and cortical thickness were greater in Hispanic versus white men. Additionally, cortical porosity was lower at the tibia in Hispanic compared to white men. Stiffness and failure load did not differ at either skeletal site by ethnicity. CONCLUSION In conclusion, greater cortical thickness and density as well as lower cortical porosity tend to compensate for smaller bone size in Hispanic men, leading to similar mechanical competence compared with white men.
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Affiliation(s)
- M D Walker
- Department of Medicine, Columbia University, College of Physicians and Surgeons, New York, NY, 10032, USA.
| | - A Kepley
- Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - K Nishiyama
- Department of Medicine, Columbia University, College of Physicians and Surgeons, New York, NY, 10032, USA
| | - B Zhou
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Fu Foundation School of Engineering and Applied Science, Columbia University, New York, NY, 10027, USA
| | - E Guo
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Fu Foundation School of Engineering and Applied Science, Columbia University, New York, NY, 10027, USA
| | - T L Nickolas
- Department of Medicine, Columbia University, College of Physicians and Surgeons, New York, NY, 10032, USA
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13
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Noel SE, Arevalo S, Smith CE, Lai CQ, Dawson-Hughes B, Ordovas JM, Tucker KL. Genetic admixture and body composition in Puerto Rican adults from the Boston Puerto Rican Osteoporosis Study. J Bone Miner Metab 2017; 35:448-455. [PMID: 27628044 PMCID: PMC5400727 DOI: 10.1007/s00774-016-0775-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 07/30/2016] [Indexed: 01/17/2023]
Abstract
Population admixture plays a role in the risk of chronic conditions that are related to body composition; however, our understanding of these associations in Puerto Ricans, a population characterized by multiple ancestries, is limited. This study investigated the relationship between genetic admixture and body composition in 652 Puerto Ricans from the Boston Puerto Rican Osteoporosis Study. Genetic ancestry was estimated from 100 ancestry-informative markers. Body composition measures were obtained from dual-energy X-ray absorptiometry. Multivariable linear regression analyses examined associations between bone mineral density (BMD) of the hip and lumbar spine and percent fat mass and lean mass with genetic admixture. In Puerto Ricans living on the US mainland, European ancestry was associated with lower BMD at the trochanter (P = 0.039) and femoral neck (P = 0.01), and Native American ancestry was associated with lower BMD of the trochanter (P = 0.04). African ancestry was associated with a higher BMD at the trochanter (P = 0.004) and femoral neck (P = 0.001). Ancestry was not associated with percent fat mass or lean mass or waist circumference. Our findings are consistent with existing research demonstrating inverse associations between European and Native American ancestries and BMD and positive relationships between African ancestry and BMD. This work contributes to our understanding of the high prevalence of chronic disease experienced by this population and has implications for other ethnic minority groups, particularly those with multiple ancestries. Future research should consider interactions between ancestry and environmental factors, as this may provide individualized approaches for disease prevention.
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Affiliation(s)
- Sabrina E Noel
- Department of Clinical Laboratory and Nutritional Sciences, University of Massachusetts Lowell, 3 Solomont Way, Suite 4, Lowell, MA, 01854, USA.
| | - Sandra Arevalo
- Department of Clinical Laboratory and Nutritional Sciences, University of Massachusetts Lowell, 3 Solomont Way, Suite 4, Lowell, MA, 01854, USA
| | - Caren E Smith
- Nutrition and Genomics Laboratory, Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, 711 Washington Street, Boston, MA, 02111, USA
| | - Chao-Qiang Lai
- Nutrition and Genomics Laboratory, Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, 711 Washington Street, Boston, MA, 02111, USA
| | - Bess Dawson-Hughes
- Bone Metabolism Laboratory, Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, 711 Washington Street, Boston, MA, 02111, USA
| | - Jose M Ordovas
- Nutrition and Genomics Laboratory, Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, 711 Washington Street, Boston, MA, 02111, USA
- IMDEA Food, Ctra. de Cantoblanco, num. 8 Ancient Central Pavilion of the Cantoblanco Hospital (Building num. 7), 28049, Madrid, Spain
| | - Katherine L Tucker
- Department of Clinical Laboratory and Nutritional Sciences, University of Massachusetts Lowell, 3 Solomont Way, Suite 4, Lowell, MA, 01854, USA
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Park E, Tran B, Best B, Singh R. Relationships between Known Risk Factors for Osteoporosis and Heel Bone Mineral Density in Asian Populations. JOURNAL OF CONTEMPORARY PHARMACY PRACTICE 2017. [DOI: 10.37901/jcphp16-00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Esther Park
- University of California, San Diego, Skaggs School of Pharmacy and Pharmaceutical Sciences
| | - Binh Tran
- University of California, San Diego, Skaggs School of Pharmacy and Pharmaceutical Sciences
| | - Brookie Best
- University of California, San Diego, Skaggs School of Pharmacy and Pharmaceutical Sciences
| | - Renu Singh
- University of California, San Diego, Skaggs School of Pharmacy and Pharmaceutical Sciences
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15
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Zhou J, Huang Q, Wang X, Peng D, Li Y, Zhang L, Liu J, Zhang S, Zhao K, Jiang X, Zhou Y. Early loading of splinted implants in the posterior mandible: a prospective multicentre case series. J Clin Periodontol 2016; 43:298-304. [PMID: 26790007 DOI: 10.1111/jcpe.12513] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2016] [Indexed: 11/28/2022]
Abstract
AIM To evaluate the 12-months clinical and radiological outcomes with the OsseoSpeed(™) TX implant using an early loading protocol in patients with missing teeth in the posterior mandible. MATERIAL AND METHODS Forty-five subjects, with Kennedy class I or II edentulism in the mandible, were enrolled at three centres in China. Two or three implants were placed in one edentulous region using a one-stage procedure. Patients received a screw-retained splinted fixed permanent restoration in one edentulous region 6-8 weeks after surgery. Follow-up took place at 6 and 12 months after loading. Marginal bone level alteration, implant survival and clinical findings were assessed using descriptive statistics. The data were analysed on a patient level, implying that the mean overall implants by patient was used as the statistical unit. The data from the three centres were pooled in the statistical analyses. RESULTS A total of 107 implants were inserted in 45 patients. Twelve months after loading, the implant survival rate was 100%, with a mean (± std) marginal bone gain of 0.08 ± 0.411 mm and healthy soft tissue status. CONCLUSIONS Early loading of splinted OsseoSpeed(™) TX implants was an effective and safe treatment for partial edentulism of the posterior mandible. CLINICAL TRIAL REGISTRATION NUMBER ON CLINICALTRIALS.GOV: NCT01346683.
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Affiliation(s)
- Jianfeng Zhou
- Department of Prosthodontics, Peking University School and Hospital of Stomatology, Beijing, China
| | - Qingfeng Huang
- Department of Prosthodontics, The Ninth People's Hospital affiliated to Shanghai Jiaotong University, School of Medicine, Shanghai, China
| | - Xiaodong Wang
- Department of Prosthodontics, Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Dong Peng
- Department of Prosthodontics, Peking University School and Hospital of Stomatology, Beijing, China
| | - Yan Li
- Department of Prosthodontics, Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Lei Zhang
- Department of Prosthodontics, Peking University School and Hospital of Stomatology, Beijing, China
| | - Jianzhang Liu
- Department of Prosthodontics, Peking University School and Hospital of Stomatology, Beijing, China
| | - Songmei Zhang
- Department of Prosthodontics, The Ninth People's Hospital affiliated to Shanghai Jiaotong University, School of Medicine, Shanghai, China
| | - Ke Zhao
- Department of Prosthodontics, Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Xinquan Jiang
- Department of Prosthodontics, The Ninth People's Hospital affiliated to Shanghai Jiaotong University, School of Medicine, Shanghai, China
| | - Yongsheng Zhou
- Department of Prosthodontics, Peking University School and Hospital of Stomatology, Beijing, China.,National Engineering Lab for Digital and Material Technology of Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
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16
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Daswani B, Desai M, Mitra S, Gavali S, Patil A, Kukreja S, Khatkhatay MI. Influence of bone mineral density measurement on fracture risk assessment tool® scores in postmenopausal Indian women. Post Reprod Health 2016; 22:20-4. [PMID: 26826081 DOI: 10.1177/2053369116628722] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM Fracture risk assessment tool® calculations can be performed with or without addition of bone mineral density; however, the impact of this addition on fracture risk assessment tool® scores has not been studied in Indian women. Given the limited availability and high cost of bone mineral density testing in India, it is important to know the influence of bone mineral density on fracture risk assessment tool® scores in Indian women. Therefore, our aim was to assess the contribution of bone mineral density in fracture risk assessment tool® outcome in Indian women. METHODS Apparently healthy postmenopausal Indian women (n = 506), aged 40-72 years, without clinical risk factors for bone disease, were retrospectively selected, and their fracture risk assessment tool® scores calculated with and without bone mineral density were compared. RESULTS Based on WHO criteria, 30% women were osteoporotic, 42.9% were osteopenic and 27.1% had normal bone mineral density. Fracture risk assessment tool® scores for risk of both major osteoporotic fracture and hip fracture significantly increased on including bone mineral density (P < 0.0001). When criteria of National Osteoporosis Foundation, US was applied number of participants eligible for medical therapy increased upon inclusion of bone mineral density, (for major osteoporotic fracture risk number of women eligible without bone mineral density was 0 and with bone mineral density was 1, P > 0.05, whereas, for hip fracture risk number of women eligible without bone mineral density was 2 and with bone mineral density was 17, P < 0.0001). CONCLUSION Until the establishment of country-specific medication intervention thresholds, bone mineral density should be included while calculating fracture risk assessment tool® scores in Indian women.
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Affiliation(s)
- Bhavna Daswani
- Division of Molecular Immunodiagnostics, National Institute for Research in Reproductive Health (ICMR), J.M. Street, Parel, Mumbai - 400012, India
| | - Meena Desai
- Division of Molecular Immunodiagnostics, National Institute for Research in Reproductive Health (ICMR), J.M. Street, Parel, Mumbai - 400012, India
| | - Sumegha Mitra
- Division of Molecular Immunodiagnostics, National Institute for Research in Reproductive Health (ICMR), J.M. Street, Parel, Mumbai - 400012, India
| | - Shubhangi Gavali
- Division of Molecular Immunodiagnostics, National Institute for Research in Reproductive Health (ICMR), J.M. Street, Parel, Mumbai - 400012, India
| | - Anushree Patil
- Division of Clinical Research, National Institute for Research in Reproductive Health (ICMR), J. M. Street, Parel, Mumbai - 400012, India
| | | | - M Ikram Khatkhatay
- Division of Molecular Immunodiagnostics, National Institute for Research in Reproductive Health (ICMR), J.M. Street, Parel, Mumbai - 400012, India
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Zhou B, Wang J, Stein EM, Zhang Z, Nishiyama KK, Zhang CA, Nickolas TL, Shane E, Guo XE. Bone density, microarchitecture and stiffness in Caucasian and Caribbean Hispanic postmenopausal American women. Bone Res 2014; 2:14016. [PMID: 26273525 PMCID: PMC4472134 DOI: 10.1038/boneres.2014.16] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Revised: 07/30/2014] [Accepted: 07/30/2014] [Indexed: 12/24/2022] Open
Abstract
Hispanic Americans of Caribbean origin are a fast-growing subset of the US population, but there are no studies on bone density, microstructure and biomechanical integrity in this minority group. In this study, we aimed to compare Caucasian and Caribbean Hispanic postmenopausal American women with respect to these characteristics. Thirty-three Caribbean Hispanics were age-matched to thirty-three Caucasian postmenopausal women. At the lumbar spine, the Hispanic women had significantly lower areal bone mineral density (aBMD). At the radius by high-resolution peripheral quantitative computed tomography (HR-pQCT), there were minimal differences between Hispanic and Caucasian women. At the tibia, Hispanic women had lower trabecular volumetric bone density and trabecular number, and higher trabecular separation. Individual trabecula segmentation (ITS) analyses indicated that at the tibia, Hispanic women not only had significantly lower bone volume fraction, but also had significantly lower rod bone volume fraction, plate trabecular number, rod trabecular number and lower plate–plate, plate–rod and rod–rod junction densities compared to Caucasian women. The differences in bone quantity and quality contributed to lower whole bone stiffness at the radius, and both whole bone and trabecular bone stiffness at the tibia in Hispanic women. In conclusion, Hispanic women had poorer bone mechanical and microarchitectural properties than Caucasian women, especially at the load-bearing distal tibia.
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Affiliation(s)
- Bin Zhou
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University , New York, USA
| | - Ji Wang
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University , New York, USA
| | - Emily M Stein
- Division of Endocrinology, Department of Medicine, Columbia University , New York, USA
| | - Zhendong Zhang
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University , New York, USA ; Department of Orthopedic Surgery, First Affiliated Hospital, School of Medicine Shihezi University , Shihezi, Xinjiang, China
| | - Kyle K Nishiyama
- Division of Endocrinology, Department of Medicine, Columbia University , New York, USA
| | - Chiyuan A Zhang
- Division of Endocrinology, Department of Medicine, Columbia University , New York, USA
| | - Thomas L Nickolas
- Division of Endocrinology, Department of Medicine, Columbia University , New York, USA
| | - Elizabeth Shane
- Division of Endocrinology, Department of Medicine, Columbia University , New York, USA
| | - X Edward Guo
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University , New York, USA
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18
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Bone mineral density in postmenopausal Mexican-Mestizo women with normal body mass index, overweight, or obesity. Menopause 2014; 20:568-72. [PMID: 23615649 DOI: 10.1097/gme.0b013e318277694f] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Obesity and osteoporosis are two important public health problems that greatly impact mortality and morbidity. Several similarities between these complex diseases have been identified. The aim of this study was to analyze if different body mass indexes (BMIs) are associated with variations in bone mineral density (BMD) among postmenopausal Mexican-Mestizo women with normal weight, overweight, or different degrees of obesity. METHODS We studied 813 postmenopausal Mexican-Mestizo women. A structured questionnaire for risk factors was applied. Height and weight were used to calculate BMI, whereas BMD in the lumbar spine (LS) and total hip (TH) was measured by dual-energy x-ray absorptiometry. We used ANCOVA to examine the relationship between BMI and BMDs of the LS, TH, and femoral neck (FN), adjusting for confounding factors. RESULTS Based on World Health Organization criteria, 15.13% of women had normal BMI, 39.11% were overweight, 25.96% had grade 1 obesity, 11.81% had grade 2 obesity, and 7.99% had grade 3 obesity. The higher the BMI, the higher was the BMD at the LS, TH, and FN. The greatest differences in size variations in BMD at these three sites were observed when comparing women with normal BMI versus women with grade 3 obesity. CONCLUSIONS A higher BMI is associated significantly and positively with a higher BMD at the LS, TH, and FN.
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Relation of the estrogen receptor and vitamin D receptor polymorphisms with bone mineral density in postmenopausal Mexican-mestizo women. Gene 2013; 537:10-4. [PMID: 24389498 DOI: 10.1016/j.gene.2013.12.054] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 12/17/2013] [Accepted: 12/21/2013] [Indexed: 12/25/2022]
Abstract
BACKGROUND Since osteoporosis is a complex disease characterized by low bone mineral density (BMD), which is determined by an interaction of genetics with metabolic and environmental factors, the aim of this study was to analyze the possible association among one polymorphism of VDR and two polymorphisms of ESR1; as well as their haplotypes with BMD in postmenopausal Mexican-mestizo women. METHODS We studied 742 postmenopausal Mexican-mestizo women. A structured questionnaire for risk factors was applied and BMD was measured in the lumbar spine and total hip by dual-energy X-ray absorptiometry. DNA was obtained from blood leukocytes. One polymorphism of VDR (rs11568820) and two of ESR1 (rs2234693 and rs9340799) were studied. Real-time PCR allelic discrimination was used for genotyping. The differences between the means of the BMDs according to genotype were analyzed with covariance. Hardy-Weinberg equilibrium was tested. Pairwise linkage disequilibrium between single nucleotide polymorphisms was calculated by direct correlation r(2); haplotype analysis was conducted. RESULTS Rs9340799 of ESR1 and one haplotype formed by the two polymorphisms of the ESR1 were significantly associated with FN-BMD variations. Moreover, analysis of the genotype of rs11568820 of VDR and the rs2234693 of ESR1 showed no significant differences with BMD variations. CONCLUSIONS Our results showed that rs9340799 and one haplotype of ESR1 were significantly associated with BMD only at the femoral neck and this association remained after adjusting for covariates.
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Canto-Cetina T, Polanco Reyes L, González Herrera L, Rojano-Mejía D, Coral-Vázquez RM, Coronel A, Canto P. Polymorphism of LRP5, but not of TNFRSF11B, is associated with a decrease in bone mineral density in postmenopausal Maya-Mestizo women. Am J Hum Biol 2013; 25:713-8. [PMID: 24130145 DOI: 10.1002/ajhb.22464] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 09/06/2013] [Accepted: 09/07/2013] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE Osteoporosis is a complex disease characterized principally by low bone mineral density (BMD), which is determined by an interaction of genetic, metabolic, and environmental factors. The aim of this study was to analyze the possible association among one polymorphism of LRP5 and three polymorphisms of TNFRSF11B as well as their haplotypes with BMD variations in Maya-Mestizo postmenopausal women. METHODS We studied 583 postmenopausal women of Maya-Mestizo ethnic origin. A structured questionnaire for risk factors was applied and BMD was measured in lumbar spine (LS), total hip (TH), and femoral neck (FN) by dual-energy X-ray absorptiometry. DNA was obtained from blood leukocytes. One single-nucleotide polymorphism of LRP5 (rs3736228, p.A1330V) and three of TNFRSF11B (rs4355801, rs2073618, and rs6993813) were studied using real-time PCR allelic discrimination for genotyping. Differences between the means of the BMDs according to the genotype were analyzed with covariance. Deviations from Hardy-Weinberg equilibrium were tested. Pairwise linkage disequilibrium between single nucleotide polymorphisms was calculated by direct correlation r(2), and haplotype analysis of TNFRSF11B was conducted. RESULTS The Val genotype of the rs3736228 (p.A1330V) of LRP5 was significantly associated with BMD variations at the LS, TH, and FN. None of the three polymorphisms of TNFRSF11B was associated with BMD variations. CONCLUSIONS Our results show that p.A1330V was significantly associated with BMD variations at all three skeletal sites analyzed; the Val allele and the Val/Val genotype were those most frequently found in our population.
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Affiliation(s)
- Thelma Canto-Cetina
- Laboratorio de Biología de la Reproducción, Centro de Investigaciones Regionales "Dr. Hideyo Noguchi,", Mérida Yucatán, México
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21
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The importance of imaging for status epilepticus patients to rule out fractures – A case report. J Taibah Univ Med Sci 2013. [DOI: 10.1016/j.jtumed.2013.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Staimez LR, Weber MB, Narayan KMV, Oza-Frank R. A systematic review of overweight, obesity, and type 2 diabetes among Asian American subgroups. Curr Diabetes Rev 2013; 9:312-31. [PMID: 23590534 PMCID: PMC4465442 DOI: 10.2174/15733998113099990061] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 04/06/2013] [Accepted: 04/08/2013] [Indexed: 11/22/2022]
Abstract
This systematic review synthesizes data published between 1988 and 2009 on mean BMI and prevalence of overweight, obesity, and type 2 diabetes among Asian subgroups in the U.S. We conducted systematic searches in Pub- Med for peer-reviewed, English-language citations that reported mean BMI and percent overweight, obesity, and diabetes among South Asians/Asian Indians, Chinese, Filipinos, Koreans, and Vietnamese. We identified 647 database citations and 23 additional citations from hand-searching. After screening titles, abstracts, and full-text publications, 97 citations remained. None were published between 1988 and 1992, 28 between 1993 and 2003, and 69 between 2004 and 2009. Publications were identified for the following Asian subgroups: South Asian (n=8), Asian Indian (n=20), Chinese (n=44), Filipino (n=22), Korean (n= 8), and Vietnamese (n=3). The observed sample sizes ranged from 32 to 4245 subjects with mean ages from 24 to 78 years. Among samples of men and women, the lowest reported mean BMI was in South Asians (22.1 kg/m(2)), and the highest was in Filipinos (26.8 kg/m(2)). Estimates for overweight (12.8-46.7%) and obesity (2.1-59.0%) were variable. Among men and women, the highest rate of diabetes was reported in Asian Indians with BMI ≥ 30 kg/m(2) (32.9%, age and sex standardized). This review suggests heterogeneity among U.S. Asian populations in cardiometabolic risk factors, yet comparisons are limited due to variability in study populations, methods, and definitions used in published reports. Future efforts should adopt standardized methods to understand overweight, obesity and diabetes in this growing U.S. ethnic population.
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Affiliation(s)
- Lisa R Staimez
- Emory University, Laney Graduate School, Division of Biological and Biomedical Sciences, Nutrition and Health Sciences Program, Atlanta, GA, USA.
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Looker AC, Melton LJ, Borrud LG, Shepherd JA. Lumbar spine bone mineral density in US adults: demographic patterns and relationship with femur neck skeletal status. Osteoporos Int 2012; 23:1351-60. [PMID: 21720893 DOI: 10.1007/s00198-011-1693-z] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 06/01/2011] [Indexed: 10/18/2022]
Abstract
UNLABELLED This analysis examines lumbar spine bone mineral density (BMD) of US adults from NHANES 2005-2008 by age, sex, and race/ethnicity. Prevalence of low spine BMD and agreement between the prevalence of low BMD at the spine and femur neck in older adults are also assessed. INTRODUCTION Lumbar spine BMD data from a representative sample of the US population have not been previously available. METHODS We used data from the National Health and Nutrition Examination Survey 2005-2008 to examine demographic patterns in lumbar spine BMD among US adults age ≥20 years and the prevalence of low lumbar spine BMD in adults age ≥50 years. Agreement between the prevalence of low BMD at the femur neck and spine in older adults was also assessed. Dual-energy X-ray absorptiometry was used to measure lumbar spine and femur neck BMD. World Health Organization definitions were used to categorize skeletal status as normal, osteopenia, or osteoporosis. RESULTS Compared to non-Hispanic whites, non-Hispanic blacks had higher and Mexican Americans had lower lumbar spine BMD. Lumbar spine BMD declined with age in women, but not in men. Approximately 4.7 million (10%) older US women and 1 million (3%) older men had lumbar spine osteoporosis in 2005-2008. Roughly one third of them differed in skeletal status at the spine and hip but most were normal at one site and osteopenic at the other. Only 3-10%, depending on sex, had osteoporosis at one skeletal site but not at the other skeletal site. Between 76% and 87% with discordant skeletal status had lumbar spine T-scores within 1 unit of the category threshold. CONCLUSIONS These findings suggest that measuring either the femur neck or the lumbar spine will correctly classify the majority of individuals who present for care as osteoporotic or not.
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Affiliation(s)
- A C Looker
- National Center for Health Statistics, Centers for Disease Control and Prevention, Room 4310, 3311 Toledo Road, Hyattsville, MD 20782, USA.
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Megyesi MS, Hunt LM, Brody H. A critical review of racial/ethnic variables in osteoporosis and bone density research. Osteoporos Int 2011; 22:1669-79. [PMID: 21207012 DOI: 10.1007/s00198-010-1503-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Accepted: 11/11/2010] [Indexed: 12/16/2022]
Abstract
UNLABELLED Racial and ethnic variables are common in research on variation in bone density. This literature review describes some of the common flaws associated with the use of these variables and provides some suggestions for how bone density research may be able to better document and address skeletal health disparities. INTRODUCTION Racial/ethnic differences in bone density have been commonly documented in the research literature. While effective identification of the specific factors underlying these trends might go a long way in informing treatment and screening for osteoporosis, this would require careful consideration of exactly what these variables are capturing. However, the basis and implications of what racial/ethnic variables represent have not carefully been examined in bone density research. METHODS For this paper, we systematically reviewed 55 articles that included bone density and race/ethnicity as key variables. Our analysis reveals that racial/ethnic terminology in these articles is highly variable, and discussion of how race/ethnicity is determined is often vague and idiosyncratic. Racial/ethnic variables are being used for a wide range of analytical purposes in statistical tests, which may not be appropriate for such a complex and poorly defined variable. RESULTS Many articles attribute racial/ethnic differences in bone mass/bone density to genetic causes, although few studies actually examine genetic data. CONCLUSION This analysis indicates that more rigorous examination of what race/ethnicity actually captures, more careful definitions of group labels and the procedures for assigning them, and attention to the limitations of how such variables can reliably be used in data analyses is needed to help address the problems and issues outlined in this review.
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Affiliation(s)
- M S Megyesi
- Joint POW/MIA Accounting Command, Central Identification Laboratory, 310 Worchester Ave Bldg 45, Hickam AFB, HI 96853-5530, USA.
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Rojano-Mejía D, Aguilar-Madrid G, López-Medina G, Cortes-Espinosa L, Hernández-Chiu MC, Canto-Cetina T, Vergara-López A, Coral-Vázquez RM, Canto P. Risk factors and impact on bone mineral density in postmenopausal Mexican mestizo women. Menopause 2011; 18:302-6. [DOI: 10.1097/gme.0b013e3181f2d3fb] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Looker AC, Melton LJ, Harris TB, Borrud LG, Shepherd JA. Prevalence and trends in low femur bone density among older US adults: NHANES 2005-2006 compared with NHANES III. J Bone Miner Res 2010; 25:64-71. [PMID: 19580459 PMCID: PMC3312738 DOI: 10.1359/jbmr.090706] [Citation(s) in RCA: 183] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Accepted: 05/14/2009] [Indexed: 01/13/2023]
Abstract
Hip fracture incidence appears to be declining in the United States, but changes in bone mineral density (BMD) of the population have not been evaluated. We used femur BMD data from the National Health and Nutrition Examination Survey (NHANES) 2005-2006 to estimate the prevalence of low femoral BMD in adults age 50 years and older and compared it with estimates from NHANES III (1988-1994). Dual-energy X-ray absorptiometry systems (pencil-beam geometry in NHANES III, fan-beam geometry in NHANES 2005-2006) were used to measure femur BMD, and World Health Organization (WHO) definitions of low BMD were used to categorize skeletal status. In 2005-2006, 49% of older US women had osteopenia and 10% had osteoporosis at the femur neck. In men, 30% had femur neck osteopenia and 2% had femur neck osteoporosis. An estimated 5.3 million older men and women had osteoporosis at the femur neck, and 34.5 million more had osteopenia in 2005-2006. When compared with NHANES III, the age-adjusted prevalence of femur neck osteoporosis in NHANES 2005-2006 was lower in men (by 3 percentage units) and women (by 7 percentage units) overall and among non-Hispanic whites. Changes in body mass index or osteoporosis medication use between surveys did not fully explain the decline in osteoporosis. Owing to the increase in the number of older adults in the US population, however, more older adults had low femur neck BMD (osteoporosis + osteopenia) in 2005-2006 than in 1988-1994. Thus, despite the decline in prevalence, the estimated number of affected older adults in 2005-2006 remained high.
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Affiliation(s)
- Anne C Looker
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD 20782, USA.
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Holinka CF, Christiansen C, Tian XW, Ausmanas MK. Ethnic differences in levels of bone and cartilage biomarkers and hormonal responsiveness in nine groups of postmenopausal Asian women: The Pan-Asia Menopause (PAM) study. Climacteric 2009; 11:44-54. [DOI: 10.1080/13697130701744886] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Looker AC, Melton LJ, Harris T, Borrud L, Shepherd J, McGowan J. Age, gender, and race/ethnic differences in total body and subregional bone density. Osteoporos Int 2009; 20:1141-9. [PMID: 19048179 PMCID: PMC3057045 DOI: 10.1007/s00198-008-0809-6] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2008] [Accepted: 10/01/2008] [Indexed: 10/21/2022]
Abstract
SUMMARY Total body bone density of adults from National Health and Nutrition Examination Survey (NHANES) 1999-2004 differed as expected for some groups (men>women and blacks>whites) but not others (whites>Mexican Americans). Cross-sectional age patterns in bone mineral density (BMD) of older adults differed at skeletal sites that varied by degree of weight-bearing. INTRODUCTION Total body dual-energy X-ray absorptiometry (DXA) data offer the opportunity to compare bone density of demographic groups across the entire skeleton. METHODS The present study uses total body DXA data (Hologic QDR 4500A, Hologic, Bedford MA, USA) from the NHANES 1999-2004 to examine BMD of the total body and selected skeletal subregions in a wide age range of adult men and women from three race/ethnic groups. Total body, lumbar spine, pelvis, right leg, and left arm BMD and lean mass from 13,091 adults aged 20 years and older were used. The subregions were chosen to represent sites with different degrees of weight-bearing. RESULTS Mean BMD varied in expected ways for some demographic characteristics (men>women and non-Hispanic blacks>non-Hispanic whites) but not others (non-Hispanic whites>Mexican Americans). Differences in age patterns in BMD also emerged for some characteristics (sex) but not others (race/ethnicity). Differences in cross-sectional age patterns in BMD and lean mass by degree of weight-bearing in older adults were observed for the pelvis, leg, and arm. CONCLUSION This information may be useful for generating hypotheses about age, race, and sex differences in fracture risk in the population.
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Affiliation(s)
- A C Looker
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD 20782, USA.
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Abstract
Osteoporosis poses a huge challenge in developing countries due to demographic transition and aging of the population coupled with limited availability of resources. The exact disease burden is difficult to quantify because of the paucity of data. Ethnicity affects bone density as well as fracture risk. Population-specific normative data for bone density are lacking in large parts of the world. Vitamin D deficiency is common even in sunny countries. The WHO has developed an algorithm for estimation of 10-year fracture risk which may be used even in the absence of bone mineral density.
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Affiliation(s)
- Rohini Handa
- Clinical Immunology & Rheumatology Service, All India Institute of Medical Sciences, New Delhi, India.
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WALKER MD, BILEZIKIAN JP. Racial differences in bone density and fracture risk in the United States. Int J Rheum Dis 2008. [DOI: 10.1111/j.1756-185x.2008.00390.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
In this paper I examine claims of racial difference in bone density and find that the use and definitions of race in medicine lack a theoretical foundation. My central argument is that the social produces the biological in a system of constant feedback between body and social experience. By providing a different angle of vision on claimed racial differences I hope to move the conversation away from an ultimately futile discussion of nature versus nurture, where time is held constant and place seen as irrelevant, and begin to build a new paradigm for examining the contributions of geographic ancestry, individual lifecycle experience, race, and gender to varied patterns of health and disease.
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Affiliation(s)
- Anne Fausto-Sterling
- Department of Molecular Biology, Cell Biology and Biochemistry, Brown University, Providence, RI 02912, USA.
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Walker MD, Novotny R, Bilezikian JP, Weaver CM. Race and diet interactions in the acquisition, maintenance, and loss of bone. J Nutr 2008; 138:1256S-60S. [PMID: 18492866 DOI: 10.1093/jn/138.6.1256s] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Racial differences in bone become apparent during puberty. Studies of areal bone mineral density (aBMD) generally show the greatest aBMD in African Americans followed by American white, Hispanic, and Native Americans, with the least aBMD in Asian Americans. Racial differences in fracture risk, however, do not exactly follow racial variation in aBMD. These group differences in bone mass are largely explained by differences in bone size, although calcium intake and physical activity are also significant predictors of aBMD and bone mineral content. Racial differences in calcium metabolism, as influenced by calcium and sodium intake, explain much of the black vs. white differences in skeletal calcium accretion during puberty. The relative importance of calcium and sodium in calcium metabolism has not yet been elucidated among Asians. Predictors of aBMD have been reported for African American and American white adults and predictors of aBMD in Chinese American women have recently been studied. Much remains to be studied regarding interactions between race and diet.
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Affiliation(s)
- Marcella D Walker
- Division of Endocrinology, Metabolic Bone Disease Unit, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
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Langenberg C, Araneta MRG, Bergstrom J, Marmot M, Barrett-Connor E. Diabetes and coronary heart disease in Filipino-American women: role of growth and life-course socioeconomic factors. Diabetes Care 2007; 30:535-41. [PMID: 17327317 PMCID: PMC2542981 DOI: 10.2337/dc06-1403] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate associations between adult markers of childhood growth and the prevalence of diabetes and coronary heart disease (CHD) in Filipino-American women and to determine the role of social and educational differences, including the influence of social mobility between childhood and adulthood. RESEARCH DESIGN AND METHODS Socioeconomic disadvantage and poor infant growth, resulting in short leg length, may contribute to the dramatically increased risk of diabetes and CHD in Filipino-American women, but this has not been investigated. This study is a cross-sectional study of 389 Filipino-American women (age 58.7 +/- 9.4 years [mean +/- SD]). Diabetes was defined by 1999 World Health Organization criteria and CHD by ischemic electrocardiogram changes, Rose angina, a history of myocardial infarction, or revascularization surgery. A score of social mobility (0-4) was calculated by summarizing childhood and adult financial circumstances. RESULTS Diabetes prevalence (31.4%) was not associated with measures of growth but was significantly lower in women with greater education, childhood and adult income, or social mobility score. Compared with Filipinas who were poorest in childhood and adulthood, respective odds ratios (95% CI) for diabetes were 0.55 (0.18-1.68), 0.19 (0.06-0.62), and 0.11 (0.03-0.42), down to 0.07 (0.01-0.51) in the most advantaged women (P < 0.0001). Family history of diabetes [5.14 (2.72-9.70)] and larger waist [1.07 per cm (1.03-1.10)] were also significant predictors in multiple adjusted models. In contrast, CHD prevalence (22.4%) was most strongly associated with leg length, but not trunk length; compared with individuals with the shortest legs, respective odds ratios (95% CI) for CHD were 0.60 (0.31-1.19), 0.53 (0.26-1.05), and 0.44 (0.22-0.91) in the tallest group, in age- (P(trend) = 0.02) and multiple-adjusted models (P(trend) = 0.01). CONCLUSIONS Socioeconomic disadvantage contributes to the high prevalence of diabetes in Filipinas. Factors limiting early growth of the legs may increase the risk of CHD in this comparatively short population.
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Affiliation(s)
- Claudia Langenberg
- Department of Family and Preventive Medicine, School of Medicine, University of California, San Diego, 9500 Gilman Dr., La Jolla, CA 92093-0607, USA
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Pothiwala P, Evans EM, Chapman-Novakofski KM. Ethnic Variation in Risk for Osteoporosis among Women: A Review of Biological and Behavioral Factors. J Womens Health (Larchmt) 2006; 15:709-19. [PMID: 16910903 DOI: 10.1089/jwh.2006.15.709] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Most studies of risk factors for osteoporosis and nontraumatic fracture involve white women, although more research is being geared toward bone health among various ethnic groups. The purpose of this review is to provide an overview of health disparity in osteoporosis, including assessment of bone mineral density (BMD), bone health screening, lifestyle risk factors, and treatment involving white, black, Hispanic, Asian, and Native American women. This review summarizes evidence that white, Asian, Hispanic, and Native American women are more at risk for osteoporosis than black women. These conclusions are supported by the disparity in BMD between white and black women, although the reason for this biological difference is not well characterized. Additional research is needed to determine if there is a significant difference in BMD among Hispanic, Asian, and Native American women independent of body weight and size. Similarly, there is also disparity in fracture rates, with the causes presumed to be multifactorial. Calcium intake is lower than recommended in all females at all ages; however, it is much lower in black and Native American women and highest in white and Hispanic women. Black women also have a lower vitamin D status than white women, with mean vitamin D status of Hispanic American women lying between that of black and white women. Similarly, although white women are more active than black and Hispanic women at all ages, data are lacking about physical activity habits of women of other ethnic backgrounds and how this impacts bone health. Finally, screening protocols for women of various ethnicities and effectiveness of treatments are not well established and remain a priority in women's health.
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Affiliation(s)
- Pooja Pothiwala
- Department of Internal Medicine, University of Illinois, College of Medicine at Urbana, Illinois 61801, USA
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Barrett-Connor E, Siris ES, Wehren LE, Miller PD, Abbott TA, Berger ML, Santora AC, Sherwood LM. Osteoporosis and fracture risk in women of different ethnic groups. J Bone Miner Res 2005; 20:185-94. [PMID: 15647811 DOI: 10.1359/jbmr.041007] [Citation(s) in RCA: 390] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2004] [Revised: 09/02/2004] [Accepted: 09/14/2004] [Indexed: 11/18/2022]
Abstract
UNLABELLED Osteoporosis and 1-year fracture risk were studied in 197,848 postmenopausal American women from five ethnic groups. Weight explained differences in BMD, except among blacks, who had the highest BMD. One SD decrease in BMD predicted a 50% increased fracture risk in each group. Despite similar relative risks, absolute fracture rates differed. INTRODUCTION Most information about osteoporosis comes from studies of white women. This study describes the frequency of osteoporosis and the association between BMD and fracture in women from five ethnic groups. MATERIALS AND METHODS This study was made up of a cohort of 197,848 community-dwelling postmenopausal women (7784 blacks, 1912 Asians, 6973 Hispanics, and 1708 Native Americans) from the United States, without known osteoporosis or a recent BMD test. Heel, forearm, or finger BMD was measured, and risk factor information was obtained; 82% were followed for 1 year for new fractures. BMD and fracture rates were compared, adjusting for differences in covariates. RESULTS By age 80, more than one-fifth of women in each ethnic group had peripheral BMD T scores <-2.5. Black women had the highest BMD; Asian women had the lowest. Only the BMD differences for blacks were not explained by differences in weight. After 1 year, 2414 new fractures of the spine, hip, forearm, wrist, or rib were reported. BMD at each site predicted fractures equally well within each ethnic group. After adjusting for BMD, weight, and other covariates, white and Hispanic women had the highest risk for fracture (relative risk [RR] 1.0 [referent group] and 0.95, 95% CI, 0.76, 1.20, respectively), followed by Native Americans (RR, 0.87; 95% CI, 0.57, 1.32), blacks (RR, 0.52; 95% CI, 0.38, 0.70), and Asian Americans (RR, 0.32; 95% CI, 0.15, 0.66). In age- and weight-adjusted models, each SD decrease in peripheral BMD predicted a 1.54 times increased risk of fracture in each ethnic group (95% CI, 1.48-1.61). Excluding wrist fractures, the most common fracture, did not materially change associations. CONCLUSIONS Ethnic differences in BMD are strongly influenced by body weight; fracture risk is strongly influenced by BMD in each group. Ethnic differences in absolute fracture risk remain, which may warrant ethnic-specific clinical recommendations.
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Affiliation(s)
- Elizabeth Barrett-Connor
- Department of Family and Preventive Medicine, University of California San Diego, La Jolla, CA 92093-0607, USA.
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Scragg R, Sowers M, Bell C. Serum 25-hydroxyvitamin D, diabetes, and ethnicity in the Third National Health and Nutrition Examination Survey. Diabetes Care 2004; 27:2813-8. [PMID: 15562190 DOI: 10.2337/diacare.27.12.2813] [Citation(s) in RCA: 627] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine the association between serum 25-hydroxyvitamin D (25OHD) and diabetes risk and whether it varies by ethnicity. RESEARCH DESIGN AND METHODS We performed an analysis of data from participants who attended the morning examination of the Third National Health and Nutrition Examination Survey (1988-1994), a cross-sectional survey of a nationally representative sample of the U.S. population. Serum levels of 25OHD, which reflect vitamin D status, were available from 6,228 people (2,766 non-Hispanic whites, 1,736 non-Hispanic blacks, and 1,726 Mexican Americans) aged > or =20 years with fasting and/or 2-h plasma glucose and serum insulin measurements. RESULTS Adjusting for sex, age, BMI, leisure activity, and quarter of year, ethnicity-specific odds ratios (ORs) for diabetes (fasting glucose > or =7.0 mmol/l) varied inversely across quartiles of 25OHD in a dose-dependent pattern (OR 0.25 [95% CI 0.11-0.60] for non-Hispanic whites and 0.17 [0.08-0.37] for Mexican Americans) in the highest vitamin D quartile (25OHD > or =81.0 nmol/l) compared with the lowest 25OHD (< or =43.9 nmol/l). This inverse association was not observed in non-Hispanic blacks. Homeostasis model assessment of insulin resistance (log e) was inversely associated with serum 25OHD in Mexican Americans (P=0.0024) and non-Hispanic whites (P=0.058) but not non-Hispanic blacks (P=0.93), adjusting for confounders. CONCLUSIONS These results show an inverse association between vitamin D status and diabetes, possibly involving insulin resistance, in non-Hispanic whites and Mexican Americans. The lack of an inverse association in non-Hispanic blacks may reflect decreased sensitivity to vitamin D and/or related hormones such as the parathyroid hormone.
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Affiliation(s)
- Robert Scragg
- School of Population Health, University of Auckland, Private Bag, Auckland, New Zealand.
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Zingmond DS, Melton LJ, Silverman SL. Increasing hip fracture incidence in California Hispanics, 1983 to 2000. Osteoporos Int 2004; 15:603-10. [PMID: 15004666 DOI: 10.1007/s00198-004-1592-7] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2003] [Accepted: 01/12/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND Hip fracture incidence in non-Hispanic whites (NHW) has decreased nationwide for the past 20 years. Little is known regarding hip fracture incidence among Hispanics, the largest, fastest growing minority in the United States. OBJECTIVE To assess the change in standardized hip fracture incidence from 1983 through 2000 in California Hispanics relative to other racial groups. DESIGN Hospitalizations for individuals older than 55 years with hip fracture requiring repair in acute care hospitals. Annual population estimates based on US Census Bureau estimates. Incidence standardized to national gender-age strata. Change in annual incidence calculated by weighted linear regression with robust variance estimates. RESULTS 372,078 hip fractures were identified. Age-adjusted annual incidence of hip fractures declined by 0.74% per year among women (655 to 568 per 100,000), but was unchanged among men (247 to 238 per 100,000). Among NHW women, the standardized annual incidence fell by 0.6% (4.0 fractures per 100,000) per year. Annual incidence among Hispanic women increased 4.9% (11.1 fractures per 100,000) per year. Annual incidence among Hispanic men increased by 4.2% (4.5 fractures per 100,000) per year and among NHW men by 0.5% (1.2 fractures per 100,000) per year. No significant change occurred among black or Asian women or men. CONCLUSIONS Among California women, hip fracture incidence has doubled among Hispanics since 1983, while remaining unchanged or declining in other groups. Greater attention should be given to identification of individuals at risk for hip fracture and initiation of preventive measures in Hispanic populations.
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Affiliation(s)
- David S Zingmond
- Division of General Internal Medicine, The David Geffen School of Medicine at UCLA, 911 Broxton Plaza, Los Angeles, CA 90095-1736, USA.
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