Background: Fractures are associated with pain, disability, and increased mortality. Osteoporosis screening and treatment are lower in Blacks, potentially related to racial differences in fracture outcomes. A comprehensive evaluation of racial differences in fracture outcomes has not been performed; thus, the goal of our study was to estimate one-year post fracture outcomes by race.
Methods: This descriptive, observational cohort study used 2010-2015 Medicare data from all Black and White women with postmenopausal osteoporosis (PMO). We identified major fragility fractures (hip, pelvis, femur, radius/ulna, humerus, clinical spine) using a validated fracture episode algorithm. Our outcomes of interest included: 1) mortality - identified by date of death in Medicare vital status information, 2) debility - identified as new placement in long-term nursing facilities, and 3) destitution - identified as becoming newly eligible for Medicaid. We calculated one-year post fracture age-adjusted incidence rates of each outcome overall, and by fracture site and race.
Results: We identified 377,981 (27.6%) women with PMO with a major fragility fracture [Black: 10,657 (2.8%); White: 367,324 (97.2%)]. Black women were younger, had a greater proportion of women from the South, and had a larger proportion of women with a Charlson score ≥2. Overall, the age-adjusted one-year mortality (95% CI) rates per 1,000 person-years ranged from 68.8 (66.7, 70.9) in radius/ulna fractures to 242.8 (234.0, 251.7) in femur fractures. The age-adjusted one-year debility rates ranged from 37.0 (35.4, 38.8) in hip fractures to 53.0 (51.6, 54.4) in clinical vertebral fractures. The overall age-adjusted one-year destitution rates ranged from 15.2 (14.1, 16.4) in radius/ulna fractures to 40.8 (38.8, 42.8) in hip fractures. On average Black women had 34.3%, 19.6%, and 190.2% significantly higher mortality, debility, and destitution, respectively, with a 52.5% higher mortality and 332.4% higher destitution in humerus, and 87.6% higher debility in femur fractures (Table).
Conclusions: Although fracture incidence in women with PMO in 2010-1015 Medicare data was relatively equal by race, we found thatBlack women had significantly higher rates of mortality, debility, and destitution post fracture than rates in White women. This comprehensive evaluation of fracture events and outcomes post fracture by race is the first step to mitigating and reducing disparities in PMO management and outcomes.