Ethnic disparity in the treatment of women with established low bone mass

To assess the extent of bone-health treatment and to test for racial differences in that treatment among black and white women with documented low bone mass.

All women who underwent central dual-energy X-ray absorptiometry testing at the Washington, DC Veterans Affairs Medical Center (VAMC) from January 1, 1998 through October 15, 2001 were identified via the VAMC's computerized patient record system. Self-administered questionnaires measuring patient demographics, fracture history, and presence of appropriate bone-health treatments were mailed to those with T scores < or = -1.0 (n=110).

Seventy-five women (68%) completed the survey (mean 61 years old, 55% white and 35% black). There were no statistically significant differences between black and white women in smoking (71% nonsmokers), avoiding excess alcohol (95%), or exercising regularly (68%). Eighty-one percent reported taking calcium supplements, 71% vitamin D supplements, and 56% antiresorptive medications; whites were significantly more likely than blacks to be taking calcium supplements (90% v 69%, p=.048) and antiresorptive drugs (71% v 35%, p=.004). The racial difference in antiresorptive medication use remained significant after adjusting for bone loss severity and prior fractures (odds ratio 3.71; 95% confidence interval 1.24, 11.0).

Women with low bone mass treated at the Washington, DC VAMC reported high rates of bone-building behaviors and the use of calcium and vitamin D supplements and somewhat lower rates of antiresorptive drug use. Whites were more likely than blacks to be taking calcium supplements and antiresorptive drugs. The causes of these disparities should be identified in future studies.