Skeletal Health Outcomes among US Asian Women

美国亚裔女性的骨骼健康状况

• 批准号: 10096288
• 负责人: Joan C Lo
• 金额: $ 55.53万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-15 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10096288
• 关键词: Address; Advisory Committees; Age; Aging; Area; Asian Americans; Asians; Bone Density; California; Caring; Caucasians; China; Chinese People; Clinical; Clinical Management; Counseling; Country; Data; Databases; Diagnosis; Diagnostic; Electronic Health Record; Epidemiology; Ethnic Origin; Event; Femoral Fractures; Filipino; Fracture; Future; Gender; Health; Healthcare; Hip Fractures; Hip region structure; Hispanics; Home; Hong Kong; Incidence; Integrated Delivery of Health Care; Integrated Health Care Systems; Japanese Population; Knowledge; Koreans; Neck; Online Systems; Osteoporosis; Outcome; Pharmaceutical Preparations; Philippines; Population; Population Heterogeneity; Prevention; Preventive service; Probability; Race; Recommendation; Reporting; Risk; Risk Assessment; Risk Estimate; San Francisco; South Asian; Southeastern Asia; Subgroup; System; Taiwan; Test Result; Testing; Update; Variant; Woman; Wrist; base; bisphosphonate; epidemiology study; ethnic diversity; ethnic minority population; fracture risk; hazard; health plan; human old age (65+); humerus; member; men; older patient; osteoporosis with pathological fracture; overtreatment; population based; predictive tools; risk prediction; screening; skeletal; southeast Asian; spine bone structure; stem; tool; treatment optimization

PROJECT SUMMARY/ABSTRACT Both ethnic diversity and the burden of osteoporosis have increased with the aging US population. Asians now comprise 7% of the US and 17% of California’s population, the state in which nearly one third of all US Asians reside. In 2002, the US Preventive Services Task Force updated recommendations for osteoporosis screening to all women age 65 years and older. Because Asians have lower bone density than whites, they have a greater likelihood of being diagnosed with osteoporosis on the basis of their bone density screening test results, yet they have a lower risk of hip fracture. Existing fracture risk calculators consider race/ethnicity in estimating fracture risk, but the inherent assumptions remain largely untested. The most widely used calculator is FRAX, which provides 10-year risk estimates of hip and any one of four major osteoporotic fractures for white, black, Hispanic, and Asian race. For US Asians, an adjustment factor (0.5 for women) is applied during fracture risk calculation, based on epidemiologic studies indicating that US Asian women have a 40-50% lower incidence of hip fracture than white women. However, data for fractures other than hip are limited for Asians, and population fracture data by Asian ethnic subgroups are largely lacking. US Asians comprise a heterogeneous population whose ancestry originates primarily from East, South, and Southeast Asia; in California, the two largest subgroups are Filipino and Chinese. It is notable that using the same age, gender, bone density, and clinical profile, FRAX calculators produce different results for US Asian versus Asians in Hong Kong and Taiwan (both higher), China (similar), and the Philippines (lower). These differences could stem from differences in fracture epidemiology in these countries. A more precise understanding of fracture risk in US Asians is paramount for tailoring their fracture prevention counseling and care. Using data from Kaiser Permanente Northern California, a large integrated healthcare delivery system with membership across Northern California and especially in the San Francisco Bay Area and Sacramento regions (where large numbers of Asians reside), this proposed study will conduct the first large-scale assessment of bone density and fracture outcomes among US Asians and Asian ethnic minorities. Our three primary aims are: (1) to compare the incidence of hip and major osteoporotic fractures for white and Asian men and women and by Asian ethnic minorities; (2) to characterize the association between bone density and fracture risk for Asian women in relation to findings observed for white women; and (3) to examine the predictive accuracy of fracture risk tools for Asian women and to determine whether replacement of existing base population fracture data with Asian-specific fracture data yields more accurate fracture risk prediction for Asians. Findings from this study will provide a more accurate way to calculate fracture risk in US Asians and, in the future, could enable millions of Asian Americans to obtain fracture risk data tailored to their ethnic profile.

项目概要/摘要 随着美国亚洲人口的老龄化，种族多样性和骨质疏松症的负担都在增加。 占美国人口的 7% 和加利福尼亚州人口的 17%，该州居住着近三分之一的美国亚裔 2002 年，美国预防服务工作组更新了骨质疏松症筛查建议。 对于所有 65 岁及以上的女性，由于亚洲人的骨密度低于白人，因此她们的骨密度较低。 根据骨密度筛查测试诊断骨质疏松症的可能性更大 结果，但他们的髋部骨折风险较低，现有的骨折风险计算器考虑了种族/民族。 估计骨折风险，但其内在假设在很大程度上尚未经过测试。 FRAX，它提供髋部和四种主要骨质疏松性骨折中任何一种的 10 年风险评估 白人、黑人、西班牙裔和亚洲人种，在此期间应用调整系数（女性为 0.5）。 骨折风险计算基于流行病学研究，表明美国亚裔女性的骨折风险要低 40-50% 亚洲人髋部骨折的发生率高于白人女性，但髋部以外骨折的数据有限。 美国亚裔亚裔群体的人口分布数据也很缺乏。 血统主要来自东亚、南亚和东南亚的异质人群； 加利福尼亚州最大的两个亚群体是菲律宾人和华人，值得注意的是，使用相同的年龄、性别。 FRAX 计算器在骨密度和临床特征方面为美国亚裔与亚裔提供了不同的结果 香港和台湾（均较高）、中国（类似）和菲律宾（较低）。 源于这些国家骨折流行病学的差异。 对于美国亚洲人来说，风险对于定制骨折预防咨询和护理至关重要。 使用北加州 Kaiser Permanente 的数据，这是一个大型综合医疗保健服务系统， 北加州的会员资格，特别是旧金山湾区和萨克拉门托地区的会员资格 （大量亚洲人居住的地方），这项拟议的研究将对 美国亚裔和亚洲少数族裔的骨密度和骨折结果我们的三个主要目标。 是：（1）比较白人和亚洲男性和女性的髋部和主要骨质疏松性骨折的发生率 以及亚洲少数民族；(2) 描述骨密度与骨折风险之间的关系 亚洲女性与白人女性的观察结果相关；(3) 检查预测的准确性 亚洲女性骨折风险工具并确定是否替换现有骨折人群 结合亚洲特定骨折数据的数据可以为亚洲人提供更准确的骨折风险预测。 这项研究将提供一种更准确的方法来计算美国亚洲人的骨折风险，并且在未来可以 使数百万亚裔美国人能够获得适合其种族特征的骨折风险数据。