Disparities in osteoporosis screening between at-risk African-American and white women.
BACKGROUND
Despite a lower prevalence of osteoporosis in African-American women, they remain at risk and experience a greater mortality than white women after sustaining a hip fracture. Lack of recognition of risk factors may occur in African-American women, raising the possibility that disparities in screening practices may exist.


OBJECTIVE
To determine whether there is a difference in physician screening for osteoporosis in postmenopausal, at-risk African-American and white women.


METHODS
We conducted a retrospective chart review at an urban academic hospital and a suburban community hospital. Subjects included 205 African-American and white women, age > or = 65 years and weight < or = 127 pounds, who were seen in Internal Medicine clinics. The main outcome was dual-energy x-ray absorptiometry (DXA) scan referral. We investigated physician and patient factors associated with referral. Secondary outcomes included evidence of discussion of osteoporosis and prescription of medications to prevent osteoporosis.


RESULTS
Significantly fewer African-American than white women were referred for a DXA scan (OR 0.39%, 95% confidence interval (CI): 0.22 to 0.68). Physicians were also less likely to mention consideration of osteoporosis in medical records (0.27, 0.15 to 0.48) and to recommend calcium and vitamin D supplementation for this population (0.21, 0.11 to 0.37). If referred, African-American women had comparable DXA completion rates when compared with white women. No physician characteristics were significantly associated with DXA referral patterns.


CONCLUSIONS
Our study found a significant disparity in the recommendation for osteoporosis screening for African-American versus white women of similar risk, as well as evidence of disparate osteoporosis prevention and treatment, confirming results of other studies. Future educational and research initiatives should target this inequality.
Miller
Redonda G
RG
The Division of General Internal Medicine, The Johns Hopkins School of Medicine, Baltimore, MD, USA. rgmiller@jhmi.edu
Ashar
Bimal H
BH
Cohen
Jennifer
J
Camp
Melissa
M
Coombs
Carmen
C
Johnson
Elizabeth
E
Schneyer
Christine R
CR
D015502:Absorptiometry, Photon; D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007388:Internal Medicine; D008403:Mass Screening / Q000706:statistics & numerical data*; D010024:Osteoporosis / Q000208:ethnology / Q000517:prevention & control*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D044465:White People