INTRODUCTION

The epidemiologic literature has consistently shown that black women and men have a higher bone mineral density (BMD) and a lower incidence of osteoporotic fracture compared to age- and sex-matched whites. The lower rate of fractures among blacks has been attributed to their higher BMD levels, but other factors could contribute. Furthermore, the relationship between BMD and fractures may not be the same for different racial groups. Older Gambian women experience a low rate of osteoporotic fracture despite low bone mineral content. Regardless of the exact magnitude of the association between BMD and osteoporotic fracture, it is well-established from studies, such as NHANES III, that BMD is higher in African Americans than Caucasian Americans and that the rates of osteoporosis and osteopenia are lower.

Despite a higher mean BMD and a lower incidence of osteoporotic fractures compared to older whites, older blacks do sustain hip fractures, and large numbers have been identified with low BMD. The literature provides scant information on the correlates of low BMD in blacks that might help to identify those at greater risk of fracture. When risk factors associated with low BMD and/or fractures are reported, they are usually limited to white women. Prior studies have not been population-based, some have examined recent immigrants from Africa, and all have been limited to small numbers of women. A case control study looked at African-American women hospitalized for hip fracture and compared them to similar hospitalized control patients without fracture. Comparisons of Gambians and Caucasians living in England are available. Aspray et al. compared dual X-ray absorptiometry (DXA) measurements in Gambian and English women but had few other potential risk factors to include in the models. Melton et al. looked at younger African Americans and recent immigrants from Somalia and compared them to Caucasians. The Somalian immigrant women had BMDs that fell between those of white Americans and those we traditionally call African Americans. When the BMDs were adjusted for bone size, the Somalian immigrants’ BMDs where more similar to those of white Americans. They found weight to be the only major predictor of BMD in both populations of African Americans, while age, weight, height, diuretic use, gravidity and parity all contributed to the prediction of lumbar spine size adjusted BMD in the white women.
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Asian or Caucasian race has been identified as a risk factor for osteoporosis and included in recommendations for screening. There is no consensus on the screening of older blacks. This paper examines correlates of lower BMD in older African-American men and women, in order to inform clinicians in their decision-making regarding osteoporosis screening in this population.