Racial Disparities Exist in Outcomes After Major Fragility Fractures

Abstract

Background: Fractures associated with postmenopausal osteoporosis (PMO) are associated with pain, disability, and increased mortality. A recent, nationwide evaluation of racial difference in outcomes after fracture has not been performed.

Objective: To determine if 1-year death, debility, and destitution rates differ by race.

Design: Observational cohort study.

Setting: US Medicare data from 2010 to 2016.

Participants: Non-Hispanic black and white women with PMO who have sustained a fragility fracture of interest: hip, pelvis, femur, radius, ulna, humerus, and clinical vertebral.

Measurements: Outcomes included 1-year: (1) mortality, identified by date of death in Medicare vital status information, (2) debility, identified as new placement in long-term nursing facilities, and (3) destitution, identified as becoming newly eligible for Medicaid.

Results: Among black and white women with PMO (n = 4,523,112), we identified 399,000 (8.8%) women who sustained a major fragility fracture. Black women had a higher prevalence of femur (9.0% vs 3.9%; P < .001) and hip (30.7% vs 28.0%; P < .001) fractures and lower prevalence of radius/ulna (14.7% vs 17.0%; P < .001) and clinical vertebral fractures (28.8% vs 33.5%; P < .001) compared with white women. We observed racial differences in the incidence of 1-year outcomes after fracture. After adjusting for age, black women had significantly higher risk of mortality 1 year after femur, hip, humerus, and radius/ulna fractures; significantly higher risk of debility 1 year after femur and hip fractures; and significantly higher risk of destitution for all fractures types.

Conclusions: In a sample of Medicare data from 2010 to 2016, black women with PMO had significantly higher rates of mortality, debility, and destitution after fracture than white women. These findings are a first step toward understanding and reducing disparities in PMO management, fracture prevention, and clinical outcomes after fracture. J Am Geriatr Soc 68:1803-1810, 2020.

Keywords: disparities; epidemiology; fractures; osteoporosis.

Figure 1.

Identification of white and black postmenopausal osteoporosis (PMO) with fractures by outcome.

Figure 2.

Incidence rate ratio of postfracture outcomes by fracture type in black women compared to white women with postmenopausal osteoporosis. To the right of the line of unity (1), a higher incidence rate of postfracture outcomes in black women compared with white women; to the left of the line, a lower incidence rate of postfracture outcomes in black women compared with white women. If the confidence interval (CI) crosses the line the unity, then no difference in risk is observed between black and white women.