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Osteoporosis, low bone mass prevalence high among Puerto Rican adults
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Puerto Rican men are three times more likely to have osteoporosis than non-Hispanic white or non-Hispanic black men, but the rates of low bone mass are similar among the groups, whereas estimated osteoporosis prevalence among Puerto Rican women is comparable to that of non-Hispanic white women, but their prevalence of low bone mass is lower, according to findings published in the Journal of Bone and Mineral Research.
“Puerto Rican adults living on the U.S. mainland are at greater risk for osteoporosis and low bone mass than most people realize,” Sabrina E. Noel, PhD, RD, assistant professor in the department of biomedical and nutritional sciences at the University of Massachusetts Lowell, told Endocrine Today. “This is of public health importance, as this increases the risk for fracture, which can lead to disability and increase risk of mortality. Doctors, health professionals and the Puerto Rican community need to be aware of this health problem and seek out opportunities to learn more about how to maintain their bone health and prevent fracture.”
Puerto Ricans make up the second largest Hispanic subgroup in the United States (more than 9%) after Mexican-Americans, but little is known about their skeletal health and whether interventions to improve bone health would benefit this population, Noel and colleagues wrote in the study background. Additionally, the largest increase in fracture-related health care costs is expected to occur among Hispanics — from $754 million in 2005 to $2 billion by 2025, according to a study cited by the researchers.
Noel and colleagues analyzed data from 953 participants from the Boston Puerto Rican Osteoporosis Study (BPROS), an ancillary study to the Boston Puerto Rican Health Study, a longitudinal investigation of health disparities among Puerto Rican adults aged 45 to 75 years living in the greater Boston area (mean age of men, 58 years; mean age of women, 59 years). Participants completed interviews and questionnaires; bone mineral density measurements at the hip and lumbar spine were assessed via DXA. Osteoporosis was defined as a T-score of –2.5 or less; low bone mass was defined as a T-score between –1 and –2.5. Participants also provided blood samples to measure 25-hydroxyvitamin D, serum parathyroid hormone and bone turnover markers. Researchers compared BPROS results with 4,244 adults aged at least 50 years and valid BMD data participating in the 2005-2006, 2007-2008 and 2009-2010 cycles of the National Health and Nutrition Examination Survey.
Within the cohort, 10.5% had osteoporosis and 43.3% had low bone mass. Additionally, 40% of participants had diabetes, and 22% to 24% reported having heart disease; 44% of men and 68% of women reported having arthritis, and the cohort tended to have low vitamin D (mean for men, 18.6 ng/mL; mean for women, 20.1 ng/mL).
Compared with men, women had a higher prevalence of osteoporosis (11.2% vs. 8.8%) and low bone mass (46.9% vs. 34.4%), but only the higher rate of low bone mass rose to statistical significance (P < .001). Among women, the prevalence of osteoporosis increased with age, rising from 3.8% among women aged 45 to 49 years to 24.3% among women aged 70 to 79 years. Among Puerto Rican men, the trend was different — osteoporosis prevalence was highest among men aged 50 to 59 years and lowest among men aged at least 70 years. Low bone mass prevalence, however, increased with age for both sexes, before decreasing at age 70 years.
The rate of osteoporosis was significantly higher among Puerto Rican men (8.6%) compared with non-Hispanic white (2.3%) and non-Hispanic black men (1.3%). Similar prevalence estimates of low bone mass were reported among Puerto Rican (34.6%), Mexican-American (38.3%) and non-Hispanic white men (34.5%).
Among women, age-adjusted prevalence of osteoporosis was similar between Puerto Rican (10.7%) and non-Hispanic white women (10.1%). The highest prevalence was among Mexican-American women, estimated at 16%, although researchers noted the CI overlapped between Mexican-American and Puerto Rican women. The prevalence of low bone mass among Puerto Rican women was lower (46.7%) vs. Mexican-American (50.1%) and non-Hispanic white women (51.5%).
“This work contributes to a growing body of literature that indicates Hispanics, particularly Puerto Ricans, are at risk for osteoporosis and [low bone mass],” the researchers wrote. “This is contrary to current public health standards that do not address the need for intervention for bone among Hispanic subgroups that have different lifestyle, acculturation and sociodemographic influences. The current study indicates a need for additional research on the ethnic-specific factors contributing to osteoporosis in this high-risk and understudied population.” – by Regina Schaffer
For more information:
Sabrina Noel, PhD, RD, can be reached at the Department of Biomedical and Nutritional Sciences, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, 883 Broadway St., Dugan 110L, Lowell, MA 01854; email: sabrina_feldeisen@uml.edu.
Disclosures: One study author reports she is the vice president and serves on the board of trustees for the International Osteoporosis Foundation; another reports she has received research contracts from Amgen and serves as a consultant for Pfizer Canada.
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