Osteoporosis Screening Disparities among Ethnic and Racial Minorities: A Systematic Review
Table 2
Characteristics of included studies.
Author and publication year
Study setting and recruitment
Sample size at pretest
Age (years)
N Female (percentage)
N Male (percentage)
Race or ethnicity minority (percentage)
Race or ethnicity nonminority (percentage)
Measured outcomes
Follow-up duration (years)
Results
Amarnath, 2015
United States, USPSTF
50,995
40–85
50,995 (100)
0
Hispanic 3,278 (6.4) Black 3,021 (5.9) Asian 2,574 (5.0) Other 2,865 (5.6)∗ Unknown 13, 826 (27.1)
White 25,431 (49.9)
DXA screening
Average 4.4
Compared to White women, DXA screening was significantly less common among Black women. 15% of eligible Black women received a DXA screen, 19.2% of eligible Hispanic women received a DXA screen, and 25% of eligible White women received a DXA screen
Becker, 2006
United States, Columbia University Medical Center
185
48–99
155 (83)
30 (16)
Hispanic 39 (21) Black 30 (16) Other 2 (1)
White 114 (62)
DXA screening
2
The ethnic distribution of patients receiving DXA scans mirrored the ethnic composition of the entire study population. 37% of eligible Black women received a DEXA scan, 28% of Hispanic women received a DXA scan, and 33% of White women received a DXA scan
Curtis, 2008
United States, Medicare claims data
25,783,720
≥65
15,142,440 (58.7)
10,641,280 (41.3)
Black 1,966,800 (7.6) Other 1,162,400 (4.5)
White 22,654,520 (87.9)
DXA screening
6
Using data from all 7 years observed (1999–2005), the proportion ever tested was 31.3% for White women compared with 15.3% for Black women (). For men, the respective proportions were 4.6% and 1.9% ()
Even after accounting for socioeconomic status, health status, and healthcare utilization patterns, non-Hispanic Asian and Hispanic women in the 50–64 and 65–79-year age groups had the highest odds of screening, whereas non-Hispanic Black women had the lowest odds across all age groups in our cohort. Among women 50–64 years of age, screening odds for non-Hispanic Blacks were 18% lower compared with non-Hispanic Whites
Gourlay, 2007
United States, North Carolina family medicine research network
400
≥45
400 (100)
0
Black 80 (20)
White 190 (47.5)
DXA screening
—
White women were more likely than Black women to receive DXA. 21.3% of eligible Black women received DXA, while 56.8% of eligible White women received a DXA screen
Hamrick, 2006
Southeastern United States, multiple primary care clinics
739
≥50
546 (100)
0
Black 79 (45.9)
White 452 (51.7)
DXA screening
4
In women 65 years and older with universal screening recommendations, 19.4% (n = 46) of the screened women were African American, and 80.6% (n = 191) were white. The prevalence of osteoporosis was similar in both populations, 21.5% and 20.1% for African American and White women, respectively
Hamrick, 2012
United States, multiple primary care clinics
1000
≥60
1000 (100)
0
Black 500 (50.0)
White 500 (50.0)
DXA referral, DXA screening
—
Among the initial 1000 women, only 29.8% African American women were referred to DXA compared to 38.4% White women (), and 20.8% African American vs. 27.0% White () women completed the test
Lee, 2019
United States, Department of Orthopedic surgery in Virginia Commonwealth University
191
≥50
71 (37.1)
119 (62.3)
Black 65 (34.0) Other 5 (2.6)
White 121 (63.4)
DXA screening
3
Only 13 (6.8%) of all people who underwent hip fracture surgery received DXA screening. Of eligible White patients, 11 (9.1%) received DXA screening while 2 (3.1%) of eligible Black patients received DXA screen
Mikuls, 2005
Unites States, 6 preselected countries in Alabama
251
≥45
251 (100.0)
0
Black 73 (29.0)
White 178 (71.0)
DXA screening
—
Caucasians were substantially more likely (46%) than African Americans patients (19%, ) to have received a DEXA examination
Miller, 2005
United States, 2 outpatient clinics in Baltimore Maryland
205
≥65
205 (100.0)
0
Black 103 (50.2)
White 102 (49.8)
DXA referral, DXA screening
1
Eighty-nine (43%) of the at-risk women were referred for a DXA scan. Of the 102 White women, 56 (55%) were referred for DXA, while 33 (32%) of the 103 African American women were referred. If referred, African American women had comparable DXA completion rates when compared with White women
Mudano, 2003
United States, Alabama
8,909
≥50
8,909 (100.0)
0
Black 1,960 (22.0)
White 6949 (78.0)
DXA screening
—
Black participants had approximately two-thirds lower odds of receiving BMD testing compared to White participants. 10% of eligible Black women received DXA screening while 25% of eligible, White women received DXA screening
Neuner, 2007
United States, Illinois, Florida, New York
35,681
65–89
35,681 (100.0)
0
Black 1,044 (2.9) Hispanic 598 (1.7)
White 34,039 (95.4)
DXA screening
4
Women of Black race were about half as likely (RR0.52 [0.43, 0.62]) and Hispanic women about 2/3 as likely (RR 0.66 [0.54, 0.80]) as White women to undergo testing before their fracture. They remained less likely (RR 0.66 [0.50, 0.88] and 0.58 [0.39, 0.87], respectively) to undergo testing after fracture
Solimeo, 2019
United States, US Department of Veterans Affairs
7,371
≥65
0
7,371 (100.0)
Black 750 (10.2) “All other” 522 (7.1)
White 5476 (74.8)
DXA screening
7
Age and race were not significantly associated with the receipt of osteoporosis care
Tandeter, 2007
Israel, 3 primary care clinics of Clalit Health Services
347
50–75
347 (100.0)
0
Ethiopian 121 (34.9)
Non-Ethiopian 296 (85.3)
DXA referral, DXA screening
—
The general population received more preventive recommendations and treatment than did Jewish Ethiopian women, including bone density scans. 8% of Ethiopian women received a DXA referral or screen, with 48% of non-Ethiopian women received a DXA referral or screen
Werner, 2005
Israel, a large tertiary medical center
261
≥45
261 (100.0)
0
Arab 79 (30.3)
Jewish 182 (69.7)
DXA screening
—
Compared with Jewish participants, a lower percentage of Arab women had bone density examinations. 10.1% of Arab women received DXA screen, while 67.6% of Jewish women received DXA screen
Yoo, 2012
United States, US Urban Area Health System
1,398
≥65
1398 (100.0)
0
Black 825 (59.0)
White 573 (41.0)
DXA screening
3
Significantly fewer Black than White female Medicare beneficiaries received the DXA screening. 26% of Black women received screening, while 33% of White women received screening
includes native American, Alaska native, native Hawaiian, other pacific Islander, North African, Iran, other Asian/Mideastern, or others.
