Fracture risk among Asian, Hispanic postmenopausal women may differ by origin subgroup
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Key takeaways:
- White women have higher incidence rates for any clinical fracture than other racial-ethnic groups.
- Providers should focus on preventing fractures for Native American, Asian Indian and Cuban women.
The risk for fractures among postmenopausal women may vary between ethnic origin groups, according to findings from the Women’s Health Initiative published in The Journal of Bone and Mineral Research.
“Given the small body of literature out there, we were glad to provide more data highlighting the different fracture rates in multiple racial and ethnic groups,” Nicole C. Wright, PhD, MPH, associate professor formerly in the department of epidemiology at the University of Alabama at Birmingham and currently in the Center for Health Outcomes, Implementation and Community-Engaged Sciences at Tulane University School of Medicine, told Healio. “The most intriguing findings were the higher incidence rates in Asian Indian women compared to the other Asian groups. Likewise, there were differences between Cuban and other Hispanic groups.”
Wright and colleagues analyzed data from 160,824 postmenopausal women aged 50 to 79 years who enrolled in the observation study or the clinical trials of the WHI from 1993 to 1998 (mean age, 63.6 years; 85.2% white). Participants reported their race and ethnicity at baseline. In 2003, race and ethnicity was expanded to include origin subgroups. Hispanic women specified their subgroup as Puerto Rican, Mexican/Mexican American/Chicano, Cuban or other Spanish heritage. Asian and Pacific Islander women were permitted to specify their origin subgroup as Asian Indian, Chinese, Filipina, Japanese, Korean, Vietnamese, other Asian heritage, Native Hawaiian, Guamanian or Chamorro, Samoan, other Pacific Islander or other race. Any clinical fractures, hip fractures and major osteoporotic fractures were collected.
Of Hispanic participants, 37.7% stated they were Mexican. Japanese women was the most common origin subgroup identified for Asian women with a prevalence of 49.1%.
Any clinical fractures
Over a median follow-up of 19.4 years, 44.2% of all participants had a clinical fracture. Age-standardized incidence rates were higher among white women than all other racial-ethnic groups.
Among Asian women, the highest incidence rates were observed for Asian Indian participants and the lowest rates were found for Filipina women. Compared with white women, Chinese women (adjusted HR = 0.67; 95% CI, 0.59-0.76), Filipina women (aHR = 0.53; 95% CI, 0.42-0.67) and Japanese women (aHR = 0.7; 95% CI, 0.65-0.76) had a lower risk for any fracture. Filipina women had a lower risk for any clinical fracture than Japanese women (aHR = 0.76; 95% CI, 0.6-0.97).
Mexican women (aHR = 0.89; 95% CI, 0.82-0.96) and those of other Spanish heritage (aHR = 0.91; 95% CI, 0.84-0.98) had a lower risk for any fracture than white women. No difference in any fracture risk was observed between Mexican women and other Hispanic origin subgroups.
Major osteoporotic fractures
Major osteoporotic fractures occurred among 22.6% of women. White women had a higher incidence rate for major osteoporotic fractures than other racial-ethnic groups.
Among Asian women, those who were Indian had a higher incidence rate for major osteoporotic fractures than other Asian origin subgroups. A lower risk for major osteoporotic fractures was observed among Chinese women (aHR = 0.59; 95% CI, 0.48-0.71), Filipina women (aHR = 0.55; 95% CI, 0.39-0.76) and Japanese women (aHR = 0.65; 95% CI, 0.58-0.73) compared with white women. Compared with Japanese women, Indian women had a higher risk for major osteoporotic fractures (aHR = 1.74; 95% CI, 1.03-2.93).
Hispanic women were less likely to have a major osteoporotic fracture than non-Hispanic women (aHR = 0.89; 95% CI, 0.83-0.95). Among Hispanic subgroups, women of other Spanish heritage had a lower major osteoporotic fracture risk than non-Hispanic women (aHR = 0.84; 95% CI, 0.75-0.94). No differences in major osteoporotic fracture risk were observed between Mexican women and other Hispanic origin subgroups.
Hip fractures
Of the study group, 5.6% sustained a hip fracture during follow-up. White women had a higher hip fracture incidence rate than other racial-ethnic groups.
There were too few hip fractures to compare incidence rates between Asian origin subgroups. Compared with white women, Chinese women (aHR = 0.37; 95% CI, 0.23-0.61) and Japanese women (aHR = 0.51; 95% CI, 0.4-0.67) had a lower risk for hip fractures.
Hispanic women were less likely to have a hip fracture than non-Hispanic women (aHR = 0.57; 95% CI, 0.48-0.68). The risk for hip fractures was lower for all Hispanic origin subgroups except for Cuban women compared with non-Hispanic women.
Fracture prevention essential
Wright noted the study found Native American and Alaska Native women had a similar risk for all three types of fractures as white women. She said providers should pay particularly attention to preventing fractures among Native American, Asian Indian and Cuban women based on the study’s findings, though she emphasized that fracture prevention is important for all older adults.
“The main take-home message of our study is that fractures are experienced by every race, ethnic, nationality and cultural group,” Wright said. “Bone health management in all populations, men and women, is vital for primary and secondary fracture prevention.”
Future studies should focus race- or ethnic-specific factors contributing to fracture rates, which could help develop targeted interventions in the future, according to Wright.
For more information:
Nicole C. Wright, PhD, MPH, can be reached at ncwright@uab.edu.
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