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Osteoporosis often goes undiagnosed and untreated in black patients with fragility fractures

Fragility fractures, the result of low-impact falls that would ordinarily not fracture healthy bones, are the hallmark of osteoporosis (decreased bone mass). They affect all U.S. racial and ethnic groups, but blacks suffer more complications and deaths from these fractures than whites. This may be because the diagnosis of osteoporosis is often missed as the underlying cause of fragility fractures among black patients, according to a recent study.

The study found that for 91 percent of black patients with low-impact fragility fractures, osteoporosis was not recognized, diagnosed, or treated before or after hospitalization. This increases the risk of future fractures and the likelihood of disability or even nursing home entry, caution the researchers. Their work was supported in part by the Agency for Healthcare Research and Quality (HS11673).

For the study, the researchers reviewed the medical records of middle-aged men and women with fragility fractures who had been seen at Howard University Hospital—a teaching hospital that treats predominantly black patients—from 1992 through 2002. Of the 58,841 patients who were admitted during the study period, 2.1 percent had fractures. Of these, 65 percent had fractures secondary to low-impact falls, but only 9 percent were diagnosed with osteoporosis.

Of those diagnosed with osteoporosis, only five (19 percent) were discharged on antiosteoporotic medications, and only one was discharged with a bisphosphonate therapy for bone loss. None of the patients had bone density scans to diagnose osteoporosis, which is recommended for patients with fragility fractures.

See "Osteoporotic fragility fractures in African Americans: Under-recognized and undertreated," by Neelofar M. Alam, M.D., Juanita A. Archer, M.D., and Euni Lee, Pharm.D., Ph.D., in the December 2004 Journal of the National Medical Association 96(12), pp. 1640-1645.

Editor's Note: Another study on a related topic found that rates of adherence to local osteoporosis guidelines for patients at risk of fragility fractures vary by patient, physician, and practice site characteristics. For more details, see Solomon, D.H., Brookhart, A., Gandhi, T.K., and others (2004, December). "Adherence with osteoporosis practice guidelines: A multilevel analysis of patient, physician, and practice setting characteristics." (AHRQ grant HS11046). American Journal of Medicine 117, pp. 919-924.

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