title: Osteoporosis healthcare disparities in postmenopausal women.
abstract: BACKGROUND
  Previous studies in referral populations have shown that fewer African American women complete dual-energy x-ray absorptiometry (DXA) screening and are prescribed medications for osteoporosis. This study examines if these disparities exist in primary care practices.
  
  
  METHODS
  Of 4748 eligible women ≥60 years of age in primary care practices, we randomly selected 500 African American and 500 Caucasian women. We compared the DXA screening referral rate and results, follow-up rate, and medication prescribing for low bone mineral density (BMD) between African American and Caucasian women and analyzed provider demographics. We used logistic regression analysis to control confounding variables, such as age and BMI.
  
  
  RESULTS
  Among the initial 1000 women, only 29.8% African American Women were referred to DXA compared to 38.4% Caucasian women (p<0.05), and 20.8% African American vs. 27.0% Caucasian (p<0.05) women completed the test. Among women with a diagnosis of osteoporosis, African Americans were less likely to receive medication (79.6% vs. 89.2%, p<0.05), without a difference in follow-up visit pattern between races. Female providers were more likely to refer women for DXA (27.7%) than male providers (21.7%) (p=0.035), and this gender difference in referral was more pronounced for African American patients.
  
  
  CONCLUSIONS
  Not enough eligible women are being screened and treated for osteoporosis in primary care. Even fewer African American women receive DXA screenings and are treated for osteoporosis. Controlling for age and BMI attenuated but did not eliminate the difference. Female providers were more likely than male providers to refer women for DXA.
authors.affiliation: Department of Family Medicine, University of Wisconsin, Madison, Wisconsin, USA. ihamrick@wisc.edu
authors.forename: Irene
authors.initials: I
authors.lastname: Hamrick
authors.forename: Qing
authors.initials: Q
authors.lastname: Cao
authors.forename: Dorothy
authors.initials: D
authors.lastname: Agbafe-Mosley
authors.forename: Doyle M
authors.initials: DM
authors.lastname: Cummings
mesh_terms: D015502:Absorptiometry, Photon; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D015519:Bone Density; D003695:Delivery of Health Care / Q000208:ethnology; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D016015:Logistic Models; D008403:Mass Screening / Q000706:statistics & numerical data; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000175:diagnosis* / Q000188:drug therapy / Q000208:ethnology; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D044465:White People / Q000706:statistics & numerical data