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Minority women more likely to developlow bone density that predicts osteoporosis
Tuesday, February 16, 1999 By Diana Block, Post-Gazette Staff Writer
People with osteoporosis suffer more than 300,000 hip fractures a year. And 24 percent of these people die within 12 months of the fracture, according to the National Osteoporosis Foundation. The problem will only grow as the population ages.
Although doctors once thought osteoporosis mostly affected white women, that's no longer the case.
One of the largest bone health studies has found that more Asian, Native American, and Hispanic women have low bone density than Caucasian women. Scientists have known that Asian women tend to have poorer bone health than other American minorities, but the National Osteoporosis Risk Assessment study was among the first to look at Native American and Hispanic women.
"This is the most extensive database available to date with information on the relative bone health of women of color," said Dr. Ethel Siris, professor of clinical medicine at Columbia University, and the study's medical director.
Preliminary results from the first 48,000 postmenopausal women were released late last year.
Factors that predict bone density tend to vary by minority. For example, Asian women may have lower bone density because they often have a smaller bone structure and consume less calcium than other populations.
Siris said that although she knew more Asian women would be at risk for bone loss, she was not expecting such a high number to have low bone mass. Sixty-five percent of the Asian participants had low bone mineral density, density more than one standard deviation below that of healthy young adults.
"The Hispanic data were a little surprising," too, Siris said. Researchers did not expect as many as 55 percent of the women to have low bone density.
"Native American data were of interest because I don't think anybody had ever looked," Siris said.
Low bone density predicts osteoporosis, a state of bone deterioration that is 2.5 standard deviations below normal, healthy bones. Healthy bones constantly slough off dead cells and replenish them with new ones. Young bones add more than they discard, building bone mass until people are somewhere in their 30s. Then new construction slows, and the bones lose mass about a rate of about 1 percent a year. This deterioration occurs in everyone, but women are more at risk for osteoporosis after menopause when their levels of bone-protecting estrogen decrease. Women frequently lose up to half of their bone density in the seven years after menopause, according to the foundation.
Although at least half of every group except black women had low bone density, the percentages of women with osteoporosis were much smaller, ranging from 9.5 to 4 percent.
Having low bone density "doesn't mean that you're going to crumble as you exit my door," Siris said. "It means you're at increased risk. I don't think it should alarm us, I think it should inform us."
Other risk factors range from age, gender, and genetics to behaviors. People can protect their bone mass through a diet rich in calcium, weight-bearing exercise such as walking, and avoidance of nicotine and alcohol.
Not enough younger people take steps to maintain bone strength, said Dr. Cynthia Napier Rosenberg, chief of geriatrics at The Western Pennsylvania Hospital.
"The women who talk to me about it tend to be ones who are older. I think that younger women, i.e. women in their 30s, 40s and 50s, need to have a better understanding about what osteoporosis is, because that's the age when prevention will have the most benefits," Rosenberg said. "All women should take preventative measures and make lifestyle changes to prevent osteoporosis." They should also talk with their doctors, she said.
Siris said the study would help doctors better serve minority women.
"Some doctors today say, we don't know what to do about African-Americans, we don't know what to do about Hispanics, so we're not going to do anything," Siris said. "I hope [this study] is going to lead to guidelines about what to do for minority women that's based on data and not guesswork."
By the time the study concludes in five years, it will have involved almost 5,000 doctors and more than 130,000 women.
Siris hopes that within a year, the study will show that in spite of different degrees of deterioration, every woman will follow similar patterns of bone loss, and will respond similarly to preventive measures.
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