Underrecognized: Osteoporosis in African-American Women

Based on content from the NIH publication, “Osteoporosis and African American Women.”

Although African American women tend to have higher bone mineral density (BMD) than white women throughout life, they are still at significant risk of developing osteoporosis.

The misperception that osteoporosis is only a concern for white women can delay prevention and treatment in African American women who do not believe they are at risk for the disease.

What is osteoporosis?

Osteoporosis is a metabolic bone disease characterized by low bone mass, which makes bones fragile and susceptible to fracture. Osteoporosis is known as a silent disease because symptoms and pain do not appear until a fracture occurs. Without prevention or treatment, osteoporosis can progress painlessly until a bone breaks, typically in the hip, spine, or wrist. A hip fracture can limit mobility and lead to a loss of independence, and vertebral fractures can result in a loss of height, stooped posture, and chronic pain.

What are the risk factors for osteoporosis?

Risk factors for developing osteoporosis include:

•     a thin, small-boned frame
•     previous fracture or family history of osteoporotic fracture
•     estrogen deficiency resulting from early menopause (before age 45), either naturally, from surgical removal of the ovaries, or as a result of prolonged amenorrhea (abnormal absence of menstruation) in younger women
•     advanced age
•     a diet low in calcium
•     Caucasian and Asian ancestry (African American and Hispanic women are at lower but significant risk)
•     cigarette smoking
•     excessive use of alcohol
•     prolonged use of certain medications, such as those used to treat lupus, asthma, thyroid deficiencies, and seizures

Are there special issues for African American women regarding bone health?

Many scientific studies highlight the risk that African American women face with regard to developing osteoporosis and fracture.

•     Osteoporosis is underrecognized and undertreated in African American women.
•     As African American women age, their risk for hip fracture doubles approximately every 7 years.
•     African American women are more likely than white women to die following a hip fracture.
•     Diseases more prevalent in the African American population, such as sickle cell anemia and lupus, can increase the risk of developing osteoporosis.
•     African American women consume 50 percent less calcium than the Recommended Dietary Allowance. Adequate intake of calcium plays a crucial role in building bone mass and preventing bone loss.
•     African Americans may be at increased risk for lactose intolerance. Lactose intolerance can hinder optimal calcium intake. People with lactose intolerance often may avoid milk and other dairy products that are excellent sources of calcium because they have trouble digesting lactose, the primary sugar in milk.

How can osteoporosis be prevented?

Osteoporosis prevention begins in childhood. The recommendations listed below should be followed throughout life to lower your risk of osteoporosis.

•     Eat a well-balanced diet adequate in calcium and vitamin D.
•     Exercise regularly, with an emphasis on weight-bearing activities such as walking, jogging, dancing, and weight training.
•     Live a healthy lifestyle. Avoid smoking and, if you drink alcohol, do so in moderation.

Talk to your doctor if you have a family history of osteoporosis or other risk factors that may put you at increased risk for the disease. Your doctor may suggest that you have your bone density measured to determine your risk for fractures (broken bones), and measure your response to osteoporosis treatment. The most widely recognized bone mineral density test is called a dual-energy x-ray absorptiometry, or DXA test. It is safe and painless, a bit like having an x ray, but with much less exposure to radiation. This test can measure bone density at your hip and spine.

What treatments are available?

Although there is no cure for osteoporosis, several medications are available for the prevention and/or treatment of the disease, including: bisphosphonates; estrogen agonists/antagonists (also called selective estrogen receptor modulators or SERMS); parathyroid hormone; estrogen therapy; hormone therapy; and a recently approved RANK ligand (RANKL) inhibitor.

Resources

For more information on osteoporosis, including lactose intolerance, nutrition, exercise, treatment, and fall prevention for the elderly, visit the National Institutes of Health Osteoporosis and Related Bone Diseases ~ National Resource Center website.

For more information on minority health, visit the Office of Minority Health Resource Center website.

By National Institutes of Health

The National Institutes of Health, a part of the U.S. Department of Health and Human Services, is the nation's medical research agency — making important discoveries that improve health and save lives. NIH is the largest single source of financing for medical research in the world, seeking new ways to cure disease, alleviate suffering and prevent illness. By providing the evidence base for health decisions by individuals and their clinicians, NIH is empowering Americans to embrace healthy living through informed decision-making. NIH is made up of 27 institutes and centers, each with a specific research agenda, focusing on stages of life, like aging or child health, or particular diseases or body systems.