Osteoporosis Screening - Answer or Problem?

Bone disease detection is lacking for women particularly in the African American community

(RxWiki News) Osteoporosis is a major cause of bone fractures, but not all women are being screened for it. This leaves many women at greater risk for broken bones, especially as they age.

A recent study looked at differences in detection and management of osteoporosis based on race and gender. The study found only one third of eligible women in primary care are referred for osteoporosis screening.

These researchers found significant racial disparities in the test group. Caucasian women are more often prescribed medication and referred to receive bone density screening than women of other races.

"Get enough calcium and exercise often."

Irene Hamrick, MD, of the University of Wisconsin, and colleagues compared the medical care of 500 African American and 500 Caucasian women over the age of 60 in regards to osteoporosis. These 1000 women were chosen from a total of 4748 who came into primary care clinics between 1998 and 2009.

The researchers compared referral rates for dual-energy x-ray absorptiometry (DXA) among the groups. DXA is currently considered the best technique to measure bone density. The researchers also compared the medicine prescribed for women with low density in their bones. Low bone mineral density (BMD) is linked to a higher chance of fracture in older women.

Risk factors including height, weight and tobacco, alcohol and steroid use were also noted.

The study found the number of osteoporosis risk factors between the two groups were about the same.

However, more Caucasian women (38.4 percent) were referred for DXA than African American women (29.8 percent). Of the women referred for the DXA test, not all had the screening. Of the 500 African American women, 20.8 percent had the screening, compared to 27.0 percent of the 500 Caucasian women.

When it came to medication, African American women with osteoporosis were less likely to receive it. Medication was received by 79.6 percent of African American women with osteoporosis compared to 89.2 percent of Caucasian women with the disease.

There was no significant difference in frequency of follow-up visits between the two groups who were diagnosed with osteoporosis.

Referral rates also varied depending on the gender of the medical care provider. Male providers were less likely to refer women for DXA. The difference was more prominent when it came to referring African American women. Referral rates did not vary for any other doctor demographic.

The factors associated with the lack of screening are not simply the cause of racial bias. Osteoporosis is commonly perceived as a disease for older Caucasian women.

The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) reports that the risk of hip fracture for African American women doubles approximately every seven years. Diseases that are more common in the African American population, like sickle cell anemia or lupus, can increase the chances of osteoporosis.

African American women should take special care to consume enough vitamin D and calcium, a vitamin important to bone health. This demographic consumes an average of 50 percent less calcium than the Recommended Dietary Allowance.

Other things that women at risk for osteoporosis can do include eating well balanced diet, exercising regularly and avoiding smoking and alcohol. It’s also a good idea to discuss having your bone density measured to determine your risk for fractures with your doctor.

Some assessment tools for bone health take race into factor while others do not. It is commonly recommended that women over the age of 65 be screened for osteoporosis.

“The notion that being an African American is protective is not the case,” Steven Kussin, MD, FACP, patient advocate and author of Doctor, Your Patient Will See You Now, told dailyRx.

Dr. Kussin points out that factors like lack of insurance or access to medical care can play a role in certain groups not receiving proper care. However, all members of this study had access to screening and insurance coverage and were still not treated adequately.

Dr. Kussin suggests that unconscious bias and stereotypes doctors may lead to overlooking appropriate patient care. He also points out the good news - once these biases are understood and recognized, doctors can take care and start to correct them.

With this information, new strategies for treatment and screening of osteoporosis can be developed with particular attention paid to screening for African American women. The study was published in the Journal of Women’s Health. The authors report no conflicts of interest.

Review Date: 
December 12, 2012