Osteoporotic fragility fractures in African Americans: under-recognized and undertreated

Abstract

Purpose: To determine the frequency of diagnosing and treating osteoporosis in patients with fragility fractures.

Methodology: Retrospective review of medical records from January 1992 to December 2002 at Howard University Hospital, an urban tertiary care teaching hospital with a predominantly African-American population. Men 50 years old and women 45 years old with fractures caused by low impact falls (fragility fractures) were included. The diagnosis of osteoporosis was based on history, x-rays and pathology reports as indicated by ICD-9 codes (733.00-733.09) and review of medical records.

Main findings: Of 58,841 patients who were admitted during the study period, 1,248 patients (2.1%) had fractures. There were 323 patients (65%) who had fractures secondary to low-impact falls. However, only 29 (8.9%) of these had a diagnosis of osteoporosis. Of these, only five (19%) patients were discharged on antiosteoporotic medications, and only one patient was discharged with a bisphosphonate therapy. No patient had DXA scans.

Conclusions: In the population studied, osteoporosis was missed in the majority of the patients as an underlying cause for fragility fractures in African Americans. These results strongly suggest that physicians should be more aware of osteoporosis as an essential cause of fragility fractures. Early recognition and treatment in African Americans and other ethnic groups can significantly decrease the morbidity, mortality and the healthcare costs.