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In a diverse sample of postmenopausal women, white women had the highest rates of fractures, but other groups were not far behind, according to data from the Women's Health Initiative (WHI).

Over a nearly 20-year period, Black, Pacific Islander, Asian, and multiracial women had significantly lower risks for any clinical fracture compared with white women, reported Nicole Wright, PhD, MPH, of the University of Alabama at Birmingham at the time of the study (now at Tulane University in New Orleans), and colleagues:

• Black: HR 0.58 (95% CI 0.56-0.60)
• Pacific Islander: HR 0.69 (95% CI 0.50-0.95)
• Asian: HR 0.68 (95% CI 0.64-0.72)
• Multiracial: HR 0.92 (95% CI 0.86-0.99)

In addition, all women with the exception of those who were American Indian/Alaskan Native had significantly lower risks for major osteoporotic fractures -- such as those in the hip, clinical spine, forearm, and shoulder -- compared with white women, the group detailed in the .

The findings were not surprising and largely in line with prior studies that used data from the , the largest cohort of racially and ethnically diverse postmenopausal women evaluating fractures, said Wright.

"Although not surprising per se, I was intrigued by the different fracture incidence within Hispanic and Asian women, especially higher incidence rates in Asian Indian women compared to the other Asian groups [and] differences between Cuban and the other Hispanic groups in our study," she told 番茄社区app.

Wright and team found that Asian Indian women had the highest age-standardized incidence rate for any fracture (comparable to white women), while Filipina women had the lowest (47% lower than white women). This was also true for major osteoporotic fractures.

As for Hispanic women, Cuban women had the highest fracture incidence rate (comparable to non-Hispanic women), while women of unspecified Hispanic origin had the lowest (22% lower than non-Hispanic women). While rates of major osteoporotic fractures were similar across women of Hispanic origin, Cuban women ranked the highest.

Patterns also held true when it came to hip fractures. Compared with white women, there was a significantly lower rate of hip fractures among Black (71% lower), Asian (51% lower), and Hispanic women (43% lower). Rates weren't significantly different between white women and American Indian/Alaskan Native or Cuban women. There were too few hip fractures among Asian Indian women to measure this outcome.

"The biggest take-away is that in addition to non-Hispanic white women, fracture prevention should be an emphasis in American Indian and Alaskan Native, Asian Indian, and Cuban women who are at higher risk," Wright advised. "Given recent changes in the demographics of the U.S. -- particularly in older adults -- it was important to provide information on fracture incidence in other race and ethnic categories, especially the Hispanic community, as it is now the largest racial and ethnic minority group in the U.S."

Bone health management in all women and men "is vital" to primary and secondary fracture prevention, she added.

"Such data can aid in the development of future longitudinal studies evaluating the contributors to these racial and ethnic differences in fracture, which in turn could be used to develop interventions aimed at minimizing known racial and ethnic disparities in osteoporosis management and fracture outcomes," the authors wrote.

The study included 160,824 women enrolled in the WHI from 1998 to 2022. Mean age was 63.6, and 85.2% were white. Of these women, 71,124 (44.2%) experienced a clinical fracture, including 36,278 major osteoporotic fractures and 8,962 hip fractures.

Among this cohort, white women tended to be older (mean age 63.9), and made up the highest proportions of those who consumed 7 or more drinks per week (12.9%) and those who had a fracture after age 55 (15.1%). Black women had the highest average BMI (mean 31.2) and the lowest mean metabolic-equivalent hours/week of physical activity (9.6). American Indian and Alaskan Native women made up the highest proportion with an income under $20,000 (30.1%) and three or more falls in the past year (6.2%).

Comparisons were adjusted for age, WHI time period, WHI Hormone Trial arm, and WHI Calcium/Vitamin D trial arm. Other factors like education level, income, acculturation, nutrition, lifestyle, bone mineral density, and bone geometry were not adjusted for, which was a limitation to the study.

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