Racial disparities, FRAX, and the care of patients with osteoporosis
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EDITORIAL
Racial disparities, FRAX, and the care of patients with osteoporosis E.M. Lewiecki 1
&
N.C. Wright 2 & A.J. Singer 3
Received: 17 August 2020 / Accepted: 22 September 2020 # International Osteoporosis Foundation and National Osteoporosis Foundation 2020
A recent publication in a prestigious medical journal, released June 17, 2020, reviewed race-based adjustments in selected clinical algorithms and described their “potential dangers” [1]. The USA adaption of the fracture risk assessment tool, FRAX [2], was cited as an example of an algorithm with the potential “to perpetuate or even amplify race-based health inequities.” The concern was that Asian, Black, and Hispanic women are estimated to have a 10-year probability of major osteoporotic fracture that is one-half or less than White women, which might lead to a delay of treatment in non-Whites. The same day as the journal publication, a companion article appeared in the New York Times with the title “Many Medical Decision Tools Disadvantage Black Patients” [3]. Here, it was stated that the use of the FRAX USA calculator would result in Black women being less likely to be treated than “similar” White women, implying that women in need of treatment are being deprived of it because of their race. Considering the tremendous importance of addressing racial disparities in healthcare, the need for accurate information on which to base health policy and clinical decisions, and the many challenges in efforts to reduce the osteoporosis treatment gap, we offer the following thoughts on race and osteoporosis care. We fully acknowledge that there are racial disparities in the care of osteoporosis. A study of women meeting the US Preventive Services Task Force recommendation for a screening bone mineral density (BMD) test [4] (women age 65 years and older and younger women at high fracture risk), found that Black women were 40% less likely than their White counterparts to have an incident screening dual-energy X-ray absorptiometry (DXA), with hazard ratio (95% confidence * E.M. Lewiecki [email protected] 1
New Mexico Clinical Research & Osteoporosis Center, 300 Oak St. NE, Albuquerque, NM 87106, USA
2
Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
3
MedStar Georgetown University Hospital, Washington, DC, USA
interval) = 0.60 (0.54–0.65) [5]. Black women are also less likely to have a DXA study after having a hip fracture [6]. Several studies have shown that Black women are less likely to be treated for osteoporosis than White women overall [7] and in the presence of fractures [8, 9]. There are also disparities in outcomes after an osteoporotic fracture, as shown in an analysis of 399,000 Black and White women with a major osteoporotic fracture (MOF) identified from Medicare claims data [10]. After adjusting for age, Black women had a significantly higher risk of death, disability, and destitution than Whites for most fracture types. These disparities must be fully recognized by the healthcare community, and aggressive e
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