Fracture risk lower for black women than white women at all bone mineral density levels

May 03, 2005

Black women have a lower risk of fracture than white women at every level of bone mineral density, according to an article in the May 4 issue of JAMA.

"The recently released U.S. surgeon general's report on bone health and osteoporosis noted that one in two individuals older than 50 years will be at risk for fractures from osteoporosis," according to background information in the article. Despite lower fracture rates among black women, the report stressed that osteoporosis is a risk for any aging man or woman, with low bone mineral density (BMD) being an important predictor for fracture risk. However, it is unknown how BMD is associated with fracture in older black women.

Jane A. Cauley, Dr.P.H., from the University of Pittsburgh, and colleagues examined nonspinal fractures in older women as part of the Study of Osteoporotic Fractures. Data was collected for 1986-1990 from 7,334 white women aged 67-99 years, and for 1996-1998 from 636 black women aged 65-94 years, with an average 6.1 years of follow-up. Bone mineral content (BMC; amount of bone mineral in grams) and bone mineral density (amount in grams of BMC divided by the region of interest in centimeters squared) of the hip and the femoral neck were measured.

Researchers found that black women in the study had a lower risk of fracture than white women at every level of BMD. Fifty-eight black women had a total of 61 fractures, while 1,606 white women had a total of 1,712 fractures. At the beginning of the study, black women had a nine percent higher total hip BMD and a 15 percent higher femoral neck BMD than white women. The association between BMD and fracture was weakened when adjusted for body weight and other risk factors, especially among black women. The absolute incidence of fracture across the pooled BMD distribution was 30 percent to 40 percent lower among black women at every BMD tertile.

"We have demonstrated that reduced BMD of the hip and femoral neck is associated with an increased risk of all nonspinal fractures in older black women in age-adjusted models, a relationship largely mitigated by other risk factors," the researchers write. "Our results suggest that low BMD is useful to identify blacks at risk of experiencing an osteoporotic fracture and those who may benefit from therapy and other preventive measures."

(JAMA. 2005; 293: 2102-2108. Available post-embargo at

Editor's Note: This study was supported in part by Public Health Service research grants from the National Institutes of Health. Dr. Cauley has received honoraria from Eli Lilly & Co., Merck & Co., and Novartis and has served on the speaker's bureau for Eli Lilly & Co. and Merck & Co.

Editorial: Should Treatment Thresholds Vary by Race?

In an accompanying editorial, Louise S. Acheson, M.D., M.S., from Case Western Reserve University, Cleveland, discusses the use of race in determining fracture risk.

Dr. Acheson writes: "Middle-aged and older black men and women have higher bone mass and substantially lower fracture rate than whites. Partly because of their reduced risk, blacks have only recently been included in prospective studies of osteoporosis with measurements of bone mineral density (BMD) and fracture incidence."

"An important issue is whether evidence about ethnic differences ... indicates a different threshold for treating patients with the same BMD based on differences in skin color, facial features, or self-identified racial groups. This approach is fallible to the extent that race is a nonbiological category, an extremely crude surrogate for biological, environmental, cultural, and behavioral differences among individuals and human populations."

"If, besides BMD, bone geometry, body composition, bone metabolism, physical capacity, fall risk, and eventually genotype are race-related variables determining fracture risk, measurements related to these factors could be evaluated clinically. Research will be needed to test their value. This step will be more appropriate than using race as a variable to determine treatment threshold," Dr. Acheson concludes.

(JAMA. 2005; 293: 2151-2153. Available post-embargo at

The JAMA Network Journals

Related Osteoporosis Articles from Brightsurf:

New opportunities for detecting osteoporosis
Osteoporosis can be detected through low dose computed tomography (LDCT) imaging tests performed for lung cancer screening or other purposes.

Oxytocin can help prevent osteoporosis
In a laboratory experiment with rats, Brazilian researchers succeeded in reversing natural processes associated with aging that lead to loss of bone density and strength.

New strategy against osteoporosis
An international research team has found a new approach that may be able to reduce bone loss in osteoporosis and maintain bone health.

New review on management of osteoporosis in premenopausal women
An IOF and ECTS Working Group have published an updated review of literature published after 2017 on premenopausal osteoporosis.

Cardiac CT can double as osteoporosis test
Cardiac CT exams performed to assess heart health also provide an effective way to screen for osteoporosis, potentially speeding treatment to the previously undiagnosed, according to a new study.

Osteoporosis treatment may also protect against pneumonia
A recent study published in the Journal of Bone and Mineral Research found that nitrogen-containing bisphosphonates (N-BPs) such as alendronate, which are widely used to treat postmenopausal osteoporosis, are linked with lower risks of pneumonia and of dying from pneumonia.

New pharmaceutical target reverses osteoporosis in mice
Biomedical engineers at Duke University have discovered that an adenosine receptor called A2B can be pharmaceutically activated to reverse bone degradation caused by osteoporosis in mouse models of the disease.

A link between mitochondrial damage and osteoporosis
In healthy people, a tightly controlled process balances out the activity of osteoblasts, which build bone, and osteoclasts, which break it down.

Many stroke patients not screened for osteoporosis, despite known risks
Many stroke survivors have an increased risk of osteoporosis, falls or breaks when compared to healthy people.

Many postmenopausal women do not receive treatment for osteoporosis
The benefits of treating osteoporosis in postmenopausal women outweigh the perceived risks, according to a Clinical Practice Guideline issued today by the Endocrine Society.

Read More: Osteoporosis News and Osteoporosis Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to