Racial Disparities Exist in Outcomes After Major Fragility Fractures.

BACKGROUND Fractures associated with postmenopausal osteoporosis (PMO) are associated with pain, disability, and increased mortality. A recent, nationwide evaluation of racial difference in outcomes after fracture has not been performed. OBJECTIVE To determine if 1‐year death, debility, and destitution rates differ by race. DESIGN Observational cohort study. SETTING US Medicare data from 2010 to 2016. PARTICIPANTS Non‐Hispanic black and white women with PMO who have sustained a fragility fracture of interest: hip, pelvis, femur, radius, ulna, humerus, and clinical vertebral. MEASUREMENTS Outcomes included 1‐year: (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. RESULTS: Among black and white women with PMO (n = 4,523,112), we identified 399,000 (8.8%) women who sustained a major fragility fracture. Black women had a higher prevalence of femur (9.0% vs 3.9%; P <.001) and hip (30.7% vs 28.0%; P <.001) fractures and lower prevalence of radius/ulna (14.7% vs 17.0%; P <.001) and clinical vertebral fractures (28.8% vs 33.5%; P <.001) compared with white women. We observed racial differences in the incidence of 1‐year outcomes after fracture. After adjusting for age, black women had significantly higher risk of mortality 1 year after femur, hip, humerus, and radius/ulna fractures; significantly higher risk of debility 1 year after femur and hip fractures; and significantly higher risk of destitution for all fractures types. CONCLUSIONS: In a sample of Medicare data from 2010 to 2016, black women with PMO had significantly higher rates of mortality, debility, and destitution after fracture than white women. These findings are a first step toward understanding and reducing disparities in PMO management, fracture prevention, and clinical outcomes after fracture. J Am Geriatr Soc 68:1803‐1810, 2020. [ABSTRACT FROM AUTHOR]