This investigation provides new insight into the correlates of BMD among older African Americans. As might be expected, female gender was highly associated with lower BMD. Of importance, however, is the substantial contribution of weight to the explained variability, while age diminishes in importance after adjustment for covariates. The association of weight with BMD or fractures has been reported previously in white women. In a case control study comparing African-American and white women hospitalized for hip fractures to other hospitalized patients, Pruzansky et al. showed a comparable effect of weight in both groups. Because of the case control methodology using a comparison group of patients hospitalized for other conditions, it is impossible to estimate the effect of weight on the risk of hip fracture from that study. A report from Rochester, MN looking at a smaller, younger population of African Americans, Caucasians and recent immigrants from Somalia similarly found that weight was the major predictor of bone density in all races.

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The participants ranged in age from 67 to 97, with a mean age of 75.3. Men comprised 37.5% of the sample. The participants were relatively well-educated, reporting an average of 13.1 years of education. The average family had an annual income between $16,000 and $24,999. Based on their reported physical activity, African-American participants in CHS expended about 1,500 kcals per day above basal metabolic rate. Only 12% of African-American women were taking estrogen. Few of the participants screened positive for depression. Five-to 6% of the participants reported difficulty with more than one ADL or IADL, and 63.5% reported their health as good or better. Seventy-five percent of the cohort was overweight, defined as a BMI >25.0 kg/m².

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As part of the Cardiovascular Health Study (CHS), DXA scans were preformed on 1,591 older men and women, including 302 African Americans. CHS is a longitudinal, population-based cohort study of men and women over the age of 64 recruited from four geographically distinct sites in the United States. Additionally, other medical, functional and psychosocial data were gathered on these individuals. A more complete description of the CHS is provided elsewhere. Two sites, Pittsburgh, PA and Sacramento, CA, obtained DXA during 1995-1996, using a protocol similar to that used in the Study of Osteoporotic Fractures and the Fracture Intervention Trial. Scans were acquired using the medium array mode on Hologic QDR-2000 densitometers (Hologic Inc., Waltham, MA) and read by individuals blinded to other information about the participants at the University of California, San Francisco Reading Center using Hologic software version 7.10. The coefficient of variation for hip BMD measurements was <0.75%.

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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.

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Kawasaki disease is an acute febrile illness, also known as mucocutaneous lymph node syndrome. It predominantly affects children between the ages of six months and two years, and usually less than five years of age. Asian children are at higher risk due to genetic predisposition. The male-female ratio is 1.5:1. Males are more frequently affected and are also at a greater risk of developing coronary artery aneurysms.

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Initial Presentation and History

A 21-year-old gravida 3 para 1111 African-American female returned to a community hospital emergency department one week postdischarge after having been hospitalized for five days with the working diagnosis of toxic shock syndrome, but she never fulfilled the criteria of multisystem involvement. At the time of initial presentation, she was four weeks postpartum, having experienced a normal vaginal delivery without complications. She presented with complaints of a one-week history of nausea, persistent fever, and a generalized painfiil, pruritic rash. Subsequently, the rash spread to her neck, arms, hands, abdomen, back, buttocks, and thighs.

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SECTION THREE: MODES OF IMPLEMENTATION

This essay has examined diversity rights claims within the medical profession systemically—especially in its manner of training and admitting new practitioners to orthopedic surgery. If the above argument is correct, increasing diversity among African Americans, Latinos, Native Americans, and women in orthopedic surgery is necessary for moral and prudential reasons. In order to effect this vision, the following are a few first-steps that may bring us closer to this goal.
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