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Wright NC, Follis S, Larson JC, Crandall CJ, Stefanick ML, Ing SW, Cauley JA. Fractures by race and ethnicity in a diverse sample of postmenopausal women: a current evaluation among Hispanic and Asian origin groups. J Bone Miner Res 2024; 39:1296-1305. [PMID: 39142704 PMCID: PMC11371897 DOI: 10.1093/jbmr/zjae117] [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] [Received: 02/08/2024] [Revised: 06/05/2024] [Accepted: 07/05/2024] [Indexed: 08/16/2024]
Abstract
Using 1998-2022 Women's Health Initiative (WHI) data, our study provides contemporary fracture data by race and ethnicity, specifically focusing on Hispanic and Asian women. Fractures of interest included any clinical, hip, and major osteoporotic fractures (MOFs). We utilized the updated race and ethnicity information collected in 2003, which included seven Asian and five Hispanic origin groups. We computed crude and age-standardized fracture incidence rates per 10 000 woman-years across race and ethnic categories and by Asian and Hispanic origin. We used Cox proportional hazards model, adjusting for age and WHI clinical trial arm, to evaluate the risk of fracture (1) by race compared to White women, (2) Asian origin compared to White women, (3) Hispanic compared to non-Hispanic women, and (4) Asian and Hispanic origins compared the most prevalent origin group. Over a median (interquartile range) follow-up of 19.4 (9.2-24.2) years, 44.2% of the 160 824 women experienced any clinical fracture, including 36 278 MOFs and 8962 hip fractures. Compared to White women, Black, Pacific Islander, Asian, and multiracial women had significantly lower risk of any clinical and MOFs, while only Black and Asian women had significantly lower hip fracture risk. Within Asian women, Filipina women had 24% lower risk of any clinical fracture compared to Japanese women. Hispanic women had significantly lower risk of any clinical, hip, and MOF fractures compared to non-Hispanic women, with no differences in fracture risk observed within Hispanic origin groups. In this diverse sample of postmenopausal women, we confirmed racial and ethnic differences in fracture rates and risk, with novel findings among within Asian and Hispanic subgroups. These data can aid in future longitudinal studies evaluate contributors to racial and ethnic differences in fractures.
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Affiliation(s)
- Nicole C Wright
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35294, United States
| | - Shawna Follis
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Palo Alto, CA 94304, United States
| | - Joseph C Larson
- Fred Hutchinson Cancer Center, Seattle, WA 98109, United States
| | - Carolyn J Crandall
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA 98109, United States
| | - Marcia L Stefanick
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Palo Alto, CA 94304, United States
| | - Steven W Ing
- Division of Endocrinology, Diabetes & Metabolism, Department of Internal Medicine, College of Medicine, Ohio State University, Columbus, OH 43203, United States
| | - Jane A Cauley
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, United States
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Lee DR, Lo JC, Chandra M, Lee C, Gilsanz P. Racial and Ethnic Variation in Dementia Prevalence in a Diverse Cohort of Adults with Hip Fracture. J Gen Intern Med 2024; 39:716-719. [PMID: 38142461 PMCID: PMC10973300 DOI: 10.1007/s11606-023-08578-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/08/2023] [Indexed: 12/26/2023]
Affiliation(s)
- David R Lee
- Department of Hospital Medicine, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA
- The Permanente Medical Group, Oakland, CA, USA
- UCLA Multicampus Program in Geriatric Medicine and Gerontology, Los Angeles, CA, USA
| | - Joan C Lo
- The Permanente Medical Group, Oakland, CA, USA.
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
| | - Malini Chandra
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Catherine Lee
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Paola Gilsanz
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
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Lo JC, Lee DR, Chandra M, Zeltser DW, Chu CE, Gordon NP, Darbinian JA, Lee C. Differences in proximal humerus and wrist fracture incidence among US Asian subgroups. J Am Geriatr Soc 2023; 71:3303-3306. [PMID: 37224407 PMCID: PMC10592629 DOI: 10.1111/jgs.18408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 04/17/2023] [Indexed: 05/26/2023]
Affiliation(s)
- Joan C Lo
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
- The Permanente Medical Group, Oakland, California, USA
| | - David R Lee
- The Permanente Medical Group, Oakland, California, USA
- Department of Hospital Medicine, Kaiser Permanente Oakland Medical Center, Oakland, California, USA
- Division of Geriatrics, University of California Los Angeles, Los Angeles, California, USA
| | - Malini Chandra
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - David W Zeltser
- The Permanente Medical Group, Oakland, California, USA
- Department of Orthopedic Surgery, Kaiser Permanente South San Francisco Medical Center, South San Francisco, California, USA
| | - Clarence E Chu
- Department of Adult and Family Medicine, Kaiser Permanente Oakland Medical Center, Oakland, California, USA
| | - Nancy P Gordon
- 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
| | - Catherine Lee
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
- The Permanente Medical Group, Oakland, California, 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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