---
title: 'Race and Age Impact Osteoporosis Screening Rates in Women Prior to Hip Fracture'
type: 'lecture'
url: 'https://doc.social/lectures/race-and-age-impact-osteoporosis-screening-rates-in-women-prior-to-hip-fracture'
published: '2022-05-27'
author: 'Gregory Benes, LSUHSC School of Medicine in New Orleans, Class of 2023'
transcript: 'yes'
---

# Race and Age Impact Osteoporosis Screening Rates in Women Prior to Hip Fracture

## Summary

A presentation by Gregory Benes, a third year medical student at LSU School of Medicine in New Orleans, about a recent publication in the Archives of Osteoporosis (PMID: 35150320).

## Transcript

1,162 words · 7 min · automatically transcribed (aws-transcribe) and not checked by a person; it may contain errors, particularly in names, drugs and dosages. The recording is the source.

[0:00] Hi, my name is Greg Bennis, and I'm currently a 3rd-year medical student at LSU in New Orleans, and I'm going to be presenting on our study which was recently published in the Archives of Osteoporosis. Before I begin, I'd like to thank my co-authors who helped me bring this project to the finish line.
[0:16] What's the significance of osteoporotic fractures and bone mineral density screening? Well, osteoporotic fractures place a substantial burden on the US healthcare system, with nearly 2 million fractures occurring each year, which leads to significant morbidity and mortality.
[0:31] Specifically, about 25% of patients with a Hip fracture die within 1 year of that Fracture. And despite surgical advances, this rate has remained constant for the past 30 years. Bone mineral density screening with a DEXA scan is recommended in all females above age 65 and postmenopausal females below this age with additional Risk factors. Yet studies have shown that less than 30% of eligible females undergo bone mineral density screening.
[0:57] To address these problems, our study wanted to answer the following two questions. First, how many patients presenting with Hip fracture had been screened within 2 years of that Hip fracture? And second, were there any disparities between those patients that did and did not receive prior screening?
[1:15] We selected female patients from the ReachNet database, which consists of multiple healthcare systems throughout Louisiana and Texas. We included females older than 65 years old because in addition to the national guideline recommendations that I discussed, Health Insurance covers DEXA scans after this age. This helps negate access to screening as a confounder for our results.
[1:38] Individuals who had any of the following more than 2 years prior to Hip fracture were excluded from our study, with that being a DEXA scan, treatment for diagnosis of osteoporosis, and a history of Hip fracture.
[1:51] It's left us with a study population of just over 1100 females who all sustained a Hip fracture with no history of osteoporotic disease or treatment, who are all eligible for screening under insurance and national recommendations. So why do we remove patients with a DEXA scan or osteoporosis diagnosis in the past?
[2:12] Well, we wanted to capture the group of patients who essentially slipped through the healthcare cracks regarding preventative measures such as a bone mineral density screening or osteoporosis treatment, who all went on to sustain a life-altering event of a Hip fracture. It's important to identify disparities in an already, in an already um vulnerable population.
[2:33] So to answer question number 1, how many patients were screened within 2 years of the Hip fracture?
[2:39] Our study found that only 223 individuals were screened, roughly 20% of our cohort.
[2:48] And of those that were screened, 187 were diagnosed with osteoporosis or osteopenia after their screening.
[2:57] But only 15 of these patients were actually treated with bisphosphonates.
[3:03] So now on to question number 2. We looked at um any disparities between patients that did and did not receive screening. And after multivariate logistic regression, we found that individuals were less likely to be screened, if they're a black race or older age. And age squared, age squared means that there's a quadratic relationship which um between age and screening, which I'll go into more detail in a few slides.
[3:31] Because of the significance of age and race with relation to screening before Hip fracture, we wanted to take a deeper dive into this. So we looked at the screening probability differences between white patients, um, charted as the top line and black patients being the red bottom line based on agent Hip fracture with the dotted lines between the two being the respective 95% confidence intervals.
[3:55] We found that across all age groups, white females were more likely to be screened prior to Hip fracture than their black counterparts, and this was statistically significant until the age of 97. We only had 20 patients older than 97, of which one was black, so we may not have enough data in this age range to see differences by racial groups.
[4:16] As I had mentioned, we found a quadratic relationship between age and screening rates, indicating that the screening rate increases in age until age 72 and then decreases significantly in both racial groups after that age group.
[4:33] To our knowledge, our study was the first study published to examine otherwise orthopedically healthy females who slipped through the healthcare cracks and all went on to sustain a Hip fracture.
[4:45] There are several limitations of our study, secondary to the retrospective nature and use of a large database. Um, I wanted to discuss that.
[4:53] Our racial disparity findings could be limited by a low percentage of black patients. Roughly 8% of our study cohort were black patients, which, um, however, this is consistent with a large Medicare study that investigated the national trends in the incidence of Hip fractures, and the cohort of that study also consisted of 8% being black patients.
[5:15] So, because of the similarities between our studies, we think it's possible to draw conclusions based on our racial disparity findings.
[5:23] So what's to take away from our study?
[5:26] First, among an even more vulnerable cohort of those who slipped through the healthcare system, black females were still less likely to be screened prior to Fracture.
[5:36] Clinicians should recommend more screening to otherwise healthy black patients after the age of 65.
[5:42] Second, if individuals do not have a baseline bone mineral density screening around the recommended age of 65, it is unlikely that they will undergo screening prior to Hip fracture, especially after the age of 72. The average age of Hip fracture in our study was 82 years old, so strategies need to be implemented to support DEXA scan occurrence prior to the age of 80.
[6:06] Lastly, the overall lack of treatment, even if individuals were diagnosed with bone mineral disease, certainly warrants future studies because um our study had such a small sample size of those that were actually treated with bisphosphonates.
[6:21] In conclusion, I hope you can agree with me that optimal screening and treatment are essential to increase the quality of life in our aging population.
[6:30] If there are any disparities, clinicians should aim to improve quality of care and treatment by targeting those. In particular, our study contributes to the literature by further emphasizing the presence of racial disparities. Clinicians should continue to recommend more screening to otherwise healthy black patients.
[6:47] And lastly, it's difficult to conclude if individuals had a DEXA scan or if they had bisphosphonate treatment. Would that have changed their, their outcomes, or would they have eventually, um, gone on to sustain a Hip fracture. It's difficult to say. However, we can conclude the benefits to a multifactorial Approach with a combination of bone mineral density measurements, clinical Risk factors, as well as assessment tools to predict future Fracture risk.
[7:15] Thank you for listening to my presentation, and please check out our published study within the Archives of Osteoporosis for the full paper and please reach out to me by email if you have any questions or comments.