Skip to main content
Journal of the National Medical Association logoLink to Journal of the National Medical Association
. 2004 Apr;96(4):461–467.

Osteoporosis screening is unjustifiably low in older African-American women.

Consuelo H Wilkins 1, Jason S Goldfeder 1
PMCID: PMC2595016  PMID: 15101666

Abstract

BACKGROUND: More than one million Americans suffer osteoporotic fractures yearly, resulting in a marked increase in morbidity and mortality. Despite a decrease in bone mineral density with increasing age in all ethnic groups and both genders, preventative and therapeutics efforts in osteoporosis have been focused on caucasian and Asian women. This study assesses the osteoporosis screening practices and the frequency of low bone density in a primarily African-American population of older women. METHODS: Medical records of 252 women at risk for osteoporosis were reviewed for the diagnosis of osteoporosis, prior osteoporosis screening, prior breast cancer screening, and the use of calcium, vitamin D or estrogen. Subsequently, 128 women were assessed for risk factors for osteoporosis, and their bone mineral density was measured using a peripheral bone densitometer. RESULTS: Osteoporosis screening had been performed in 11.5% of the subjects. Of the women evaluated by peripheral bone densitometry, 44.5% of all women, 40.4% of African-American women, and 53.3% of caucasian women had abnormally low bone density measurements. The frequency of abnormal bone density increased with both increasing age and decreasing body mass index. CONCLUSIONS: Although few women in this population were previously screened for osteoporosis, low bone density occurred in African-American women at substantial rates. Increasing age and low body mass are important risk factors for low bone density in African-American women. Ethnicity should not be used as an exclusion criterion for screening for osteoporosis.

Full text

PDF
467

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aloia J. F., Vaswani A., Yeh J. K., Flaster E. Risk for osteoporosis in black women. Calcif Tissue Int. 1996 Dec;59(6):415–423. doi: 10.1007/BF00369203. [DOI] [PubMed] [Google Scholar]
  2. Bohannon A. D. Osteoporosis and African American women. J Womens Health Gend Based Med. 1999 Jun;8(5):609–615. doi: 10.1089/jwh.1.1999.8.609. [DOI] [PubMed] [Google Scholar]
  3. Frazier E. L., Jiles R. B., Mayberry R. Use of screening mammography and clinical breast examinations among black, Hispanic, and white women. Prev Med. 1996 Mar-Apr;25(2):118–125. doi: 10.1006/pmed.1996.0037. [DOI] [PubMed] [Google Scholar]
  4. Huff M., Sadler C. African American women and osteoporosis. ABNF J. 1997 May-Jun;8(3):48–50. [PubMed] [Google Scholar]
  5. Keating N. L., Cleary P. D., Rossi A. S., Zaslavsky A. M., Ayanian J. Z. Use of hormone replacement therapy by postmenopausal women in the United States. Ann Intern Med. 1999 Apr 6;130(7):545–553. doi: 10.7326/0003-4819-130-7-199904060-00002. [DOI] [PubMed] [Google Scholar]
  6. Kellie S. E., Brody J. A. Sex-specific and race-specific hip fracture rates. Am J Public Health. 1990 Mar;80(3):326–328. doi: 10.2105/ajph.80.3.326. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Kleerekoper M., Nelson D. A., Peterson E. L., Flynn M. J., Pawluszka A. S., Jacobsen G., Wilson P. Reference data for bone mass, calciotropic hormones, and biochemical markers of bone remodeling in older (55-75) postmenopausal white and black women. J Bone Miner Res. 1994 Aug;9(8):1267–1276. doi: 10.1002/jbmr.5650090817. [DOI] [PubMed] [Google Scholar]
  8. Kurahara K., Aoyagi K., Nakamura S., Kuwano Y., Yamamoto C., Iida M., Fujishima M. Treatment of herpes simplex esophagitis in an immunocompetent patient with intravenous acyclovir: a case report and review of the literature. Am J Gastroenterol. 1998 Nov;93(11):2239–2240. doi: 10.1111/j.1572-0241.1998.00623.x. [DOI] [PubMed] [Google Scholar]
  9. Lindsay R., Cosman F., Herrington B. S., Himmelstein S. Bone mass and body composition in normal women. J Bone Miner Res. 1992 Jan;7(1):55–63. doi: 10.1002/jbmr.5650070109. [DOI] [PubMed] [Google Scholar]
  10. Lindsay R. Risk assessment using bone mineral density determination. Osteoporos Int. 1998;8 (Suppl 1):S28–S31. [PubMed] [Google Scholar]
  11. Looker A. C., Johnston C. C., Jr, Wahner H. W., Dunn W. L., Calvo M. S., Harris T. B., Heyse S. P., Lindsay R. L. Prevalence of low femoral bone density in older U.S. women from NHANES III. J Bone Miner Res. 1995 May;10(5):796–802. doi: 10.1002/jbmr.5650100517. [DOI] [PubMed] [Google Scholar]
  12. Looker A. C., Orwoll E. S., Johnston C. C., Jr, Lindsay R. L., Wahner H. W., Dunn W. L., Calvo M. S., Harris T. B., Heyse S. P. Prevalence of low femoral bone density in older U.S. adults from NHANES III. J Bone Miner Res. 1997 Nov;12(11):1761–1768. doi: 10.1359/jbmr.1997.12.11.1761. [DOI] [PubMed] [Google Scholar]
  13. Marshall D., Johnell O., Wedel H. Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ. 1996 May 18;312(7041):1254–1259. doi: 10.1136/bmj.312.7041.1254. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy Osteoporosis prevention, diagnosis, and therapy. JAMA. 2001 Feb 14;285(6):785–795. doi: 10.1001/jama.285.6.785. [DOI] [PubMed] [Google Scholar]
  15. Nelson Heidi D., Helfand Mark, Woolf Steven H., Allan Janet D. Screening for postmenopausal osteoporosis: a review of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2002 Sep 17;137(6):529–541. doi: 10.7326/0003-4819-137-6-200209170-00015. [DOI] [PubMed] [Google Scholar]
  16. Ravn P., Cizza G., Bjarnason N. H., Thompson D., Daley M., Wasnich R. D., McClung M., Hosking D., Yates A. J., Christiansen C. Low body mass index is an important risk factor for low bone mass and increased bone loss in early postmenopausal women. Early Postmenopausal Intervention Cohort (EPIC) study group. J Bone Miner Res. 1999 Sep;14(9):1622–1627. doi: 10.1359/jbmr.1999.14.9.1622. [DOI] [PubMed] [Google Scholar]
  17. Riggs B. L., Khosla S., Melton L. J., 3rd A unitary model for involutional osteoporosis: estrogen deficiency causes both type I and type II osteoporosis in postmenopausal women and contributes to bone loss in aging men. J Bone Miner Res. 1998 May;13(5):763–773. doi: 10.1359/jbmr.1998.13.5.763. [DOI] [PubMed] [Google Scholar]
  18. Romans M. C., Marchant D. J., Pearse W. H., Gravenstine J. F., Sutton S. M. Utilization of screening mammography--1990. Womens Health Issues. 1991 Winter;1(2):68–73. doi: 10.1016/s1049-3867(05)80018-0. [DOI] [PubMed] [Google Scholar]
  19. Rossouw Jacques E., Anderson Garnet L., Prentice Ross L., LaCroix Andrea Z., Kooperberg Charles, Stefanick Marcia L., Jackson Rebecca D., Beresford Shirley A. A., Howard Barbara V., Johnson Karen C. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial. JAMA. 2002 Jul 17;288(3):321–333. doi: 10.1001/jama.288.3.321. [DOI] [PubMed] [Google Scholar]
  20. Siris E. S., Miller P. D., Barrett-Connor E., Faulkner K. G., Wehren L. E., Abbott T. A., Berger M. L., Santora A. C., Sherwood L. M. Identification and fracture outcomes of undiagnosed low bone mineral density in postmenopausal women: results from the National Osteoporosis Risk Assessment. JAMA. 2001 Dec 12;286(22):2815–2822. doi: 10.1001/jama.286.22.2815. [DOI] [PubMed] [Google Scholar]
  21. Sweeney Ann T., Malabanan Alan O., Blake Michael A., Weinberg Janice, Turner Adrian, Ray Patricia, Holick Michael F. Bone mineral density assessment: comparison of dual-energy X-ray absorptiometry measurements at the calcaneus, spine, and hip. J Clin Densitom. 2002 Spring;5(1):57–62. doi: 10.1385/jcd:5:1:057. [DOI] [PubMed] [Google Scholar]
  22. U.S. Preventive Services Task Force Screening for osteoporosis in postmenopausal women: recommendations and rationale. Ann Intern Med. 2002 Sep 17;137(6):526–528. doi: 10.7326/0003-4819-137-6-200209170-00014. [DOI] [PubMed] [Google Scholar]

Articles from Journal of the National Medical Association are provided here courtesy of National Medical Association

RESOURCES