title: Clinical risk factors for fractures in multi-ethnic women: the Women's Health Initiative.
abstract: To identify risk factors for fractures in multi-ethnic women, we studied 159,579 women enrolled in the Women's Health Initiative. In general, risk factors for fractures were similar across ethnic groups. However, irrespective of their ethnicity, women with multiple risk factors have a high risk of fracture. Targeting these high-risk women for screening and intervention could reduce fractures.
  
  
  BACKGROUND
  Fracture rates tend to be lower in minority women, but consequences may be greater. In addition, the number of fractures is expected to increase in minority women because of current demographic trends. There are limited prospective data on risk factors for fractures in minority women.
  
  
  METHODS
  We studied 159,579 women 50-79 yr of age enrolled in the Women's Health Initiative. Information on risk factors was obtained by questionnaire or examination. Nonspine fractures that occurred after study entry were identified over an average follow-up of 8 +/- 2.6 (SD) yr.
  
  
  RESULTS
  Annualized rates (%) of fracture in whites, blacks, Hispanics, Asians, and American Indians were 2.0, 0.9, 1.3, 1.2, and 2.0, respectively. Significant predictors [HR (95% CI)] of fractures by ethnic group were as follows: blacks: at least a high school education, 1.22 (1.0, 1.5); (+) fracture history, 1.7 (1.4, 2.2); and more than two falls, 1.7 (1.9, 2.0); Hispanics: height (>162 cm), 1.6 (1.1, 2.2); (+) fracture history, 1.9 (1.4, 2.5); more than two falls, 1.8 (1.4, 2.3); arthritis, 1.3 (1.1, 1.6); corticosteroid use, 3.9 (1.9, 8.0); and parental history of fracture, 1.3 (1.0, 1.6); Asians: age (per 5 yr), 1.2 (1.0, 1.3); (+) fracture history, 1.5 (1.1, 2.0); current hormone therapy (HT), 0.7 (0.5, 0.8); parity (at least five), 1.8 (1.1, 3.0); more than two falls, 1.4 (1.1, 1.9); American Indian: (+) fracture history, 2. 9 (1.5, 5.7); current HT, 0.5 (0.3, 0.9). Women with eight or more risk factors had more than a 2-fold higher rate of fracture compared with women with four or fewer risk factors. Two ethnicity x risk factor interactions were identified: age and fall history.
  
  
  CONCLUSIONS
  Irrespective of their ethnicity, women with multiple risk factors have a high risk of fracture. Targeting these high-risk women for screening and intervention could reduce fractures.
authors.affiliation: Department of Epidemiology, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania, USA. jcauley@edc.pitt.edu
authors.forename: Jane A
authors.initials: JA
authors.lastname: Cauley
authors.forename: Lieling
authors.initials: L
authors.lastname: Wu
authors.forename: Nina S
authors.initials: NS
authors.lastname: Wampler
authors.forename: Janice M
authors.initials: JM
authors.lastname: Barnhart
authors.forename: Matthew
authors.initials: M
authors.lastname: Allison
authors.forename: Zhao
authors.initials: Z
authors.lastname: Chen
authors.forename: Rebecca
authors.initials: R
authors.lastname: Jackson
authors.forename: John
authors.initials: J
authors.lastname: Robbins
mesh_terms: D000368:Aged; D005006:Ethnicity; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology* / Q000208:ethnology*; D006801:Humans; D008875:Middle Aged; D012307:Risk Factors; D014481:United States / Q000453:epidemiology / Q000208:ethnology