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A critical review of racial/ethnic variables in osteoporosis and bone density research

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Abstract

Summary

Racial and ethnic variables are common in research on variation in bone density. This literature review describes some of the common flaws associated with the use of these variables and provides some suggestions for how bone density research may be able to better document and address skeletal health disparities.

Introduction

Racial/ethnic differences in bone density have been commonly documented in the research literature. While effective identification of the specific factors underlying these trends might go a long way in informing treatment and screening for osteoporosis, this would require careful consideration of exactly what these variables are capturing. However, the basis and implications of what racial/ethnic variables represent have not carefully been examined in bone density research.

Methods

For this paper, we systematically reviewed 55 articles that included bone density and race/ethnicity as key variables. Our analysis reveals that racial/ethnic terminology in these articles is highly variable, and discussion of how race/ethnicity is determined is often vague and idiosyncratic. Racial/ethnic variables are being used for a wide range of analytical purposes in statistical tests, which may not be appropriate for such a complex and poorly defined variable.

Results

Many articles attribute racial/ethnic differences in bone mass/bone density to genetic causes, although few studies actually examine genetic data.

Conclusion

This analysis indicates that more rigorous examination of what race/ethnicity actually captures, more careful definitions of group labels and the procedures for assigning them, and attention to the limitations of how such variables can reliably be used in data analyses is needed to help address the problems and issues outlined in this review.

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Notes

  1. Race and ethnicity are routinely used interchangeably in health research, and in this paper, we will treat them as a single construct, “race/ethnicity.”

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Acknowledgments

This project was supported, in part, by the National Institute of Health National Center for Human Genome Research through Grant #HG2299-05, and by the Food, Nutrition, and Chronic Disease Fellowship from the Graduate School of Michigan State University. An earlier draft of portions of this paper was presented at the 2008 Society for Applied Anthropology Meetings, Memphis, TN. Thanks to Dr. Dorothy Nelson and Lynne Slagh, both from Wayne State University, for their many technical insights about osteoporosis and its diagnosis. We would also like to thank Dr. Norman Sauer (Michigan State University) for his sound advice throughout the development of this project.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Joint POW/MIA Accounting Command, Central Identification Laboratory, 310 Worchester Ave. Bldg. 45, Hickam AFB, HI, 96853-5530, USA

    M. S. Megyesi

  2. Department of Anthropology, Michigan State University, East Lansing, MI, 48824, USA

    L. M. Hunt

  3. Department of Family Medicine, University of Texas Medical Branch, Galveston, TX, 77555, USA

    H. Brody

  4. Institute for the Medical Humanities, University of Texas Medical Branch, Galveston, TX, 77555, USA

    H. Brody

Authors
  1. M. S. Megyesi
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  2. L. M. Hunt
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  3. H. Brody
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Corresponding author

Correspondence to M. S. Megyesi.

Appendix A

Appendix A

List of articles included in review

Alekel, D.L., C.T. Peterson, R.K. Werner, E. Mortillaro, N. Ahmed, and S.C. Kukreja 2002Frame size, ethnicity, lifestyle, and biologic contributors to areal and volumetric lumbar spine bone mineral density in Indian/Pakistani and American Caucasian premenopausal women. J Clin Densitom 5(2):175–186.

Alver, K., H.E. Meyer, J.A. Falch, and A.J. Sogaard 2005 Bone mineral density in ethnic Norwegians and Pakistani immigrants living in Oslo—The Oslo Health Study. Osteoporos Int 16(6):623–630.

Andersen, S., E. Boeskov, and P. Laurberg 2005 Ethnic differences in bone mineral density between Inuit and Caucasians in north Greenland are caused by differences in body size. J Clin Densitom 8(4):409–414.

Barondess, D.A., M. Singh, S.L. Hendrix, and D.A. Nelson 2002 Radiographic measurements, bone mineral density, and the Singh Index in the proximal femur of white and black postmenopausal women. Dis Mon 48(10):637–646.

Barrett-Connor, E., E.S. Siris, L.E. Wehren, P.D. Miller, T.A. Abbott, M.L. Berger, A.C. Santora, and L.M. Sherwood 2005 Osteoporosis and fracture risk in women of different ethnic groups. J Bone Miner Res 20(2):185–194.

Bass, M., M.A. Ford, B. Brown, A. Mauromoustakos, and R.S. Keathley 2006 Variables for the prediction of femoral bone mineral status in American women. Southern Med J 99(2):115–122.

Bonilla, C., M.D. Shriver, E.J. Parra, A. Jones, and J.R. Fernandez 2004 Ancestral proportions and their association with skin pigmentation and bone mineral density in Puerto Rican women from New York city. Hum Genet 115(1):57–68.

Carbone, L.D., A.J. Bush, K.D. Barrow, and A.H. Kang 2003a The relationship of sodium intake to calcium and sodium excretion and bone mineral density of the hip in postmenopausal African-American and Caucasian women. J Bone Miner Metab 21(6):415–420.

Carbone, L.D., F.A. Tylavsky, J.A. Cauley, T.B. Harris, T.F. Lang, D.C. Bauer, K.D. Barrow, and S.B. Kritchevsky 2003b Association between bone mineral density and the use of nonsteroidal anti-inflammatory drugs and aspirin: impact of cyclooxygenase selectivity. J Bone Miner Res 18(10):1795–1802.

Castro, J.P., L.A. Joseph, J.J. Shin, S.K. Arora, J. Nicasio, J. Shatzkes, I. Raklyar, I. Erlikh, V. Pantone, G. Bahtiyar, L. Chandler, L. Pabon, S. Choudhry, N. Ghadiri, P. Gosukonda, R. Muniyappa, H. von-Gicyzki, and S.I. McFarlane 2005 Differential effect of obesity on bone mineral density in White, Hispanic, and African American women: a cross-sectional study. Nutr Metab 2:2–9.

Cauley, J.A., R.L. Fullman, K.L. Stone, J.M. Zmuda, D.C. Bauer, E. Barrett-Connor, K.E. Ensrud, E.M. Lau, and E.S. Orwoll 2005a Factors associated with the lumbar spine and proximal femur bone mineral density in older men. Osteoporos Int 16(12):1525–1537.

Cauley, J.A., L.Y. Lui, K.E. Ensrud, J.M. Zmuda, K.L. Stone, M.C. Hochberg, and S.R. Cummings 2005b Bone mineral density and the risk of incident nonspinal fractures in black and white women. JAMA 293(17):2102–2108.

Cauley, J.A., L.Y. Lui, K.L. Stone, T.A. Hillier, J.M. Zmuda, M. Hochberg, T.J. Beck, and K.E. Ensrud 2005c Longitudinal study of changes in hip bone mineral density in Caucasian and African-American women. J Am Geriatr Soc 53(2):183–189.

Cobb, K.L., J.L. Kelsey, S. Sidney, B. Ettinger, and C.E. Lewis 2002 Oral contraceptives and bone mineral density in white and black women in CARDIA. Osteoporos Int 13(11):893–900.

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Deng, F.Y., S.F. Lei, M.X. Li, C. Jiang, V. Dvornyk, and H.W. Deng 2006 Genetic determination and correlation of body mass index and bone mineral density at the spine and hip in Chinese Han ethnicity. Osteoporos Int 17(1):119–124.

Duan, Y., X.F. Wang, A. Evans, and E. Seeman 2005 Structural and biomechanical basis of racial and sex differences in vertebral fragility in Chinese and Caucasians. Bone 36(6):987–998.

Dvornyk, V., P.Y. Liu, J.R. Long, Y.Y. Zhang, S.F. Lei, R.R. Recker, and H.W. Deng 2005 Contribution of genotype and ethnicity to bone mineral density variation in Caucasians and Chinese: a test for five candidate genes for bone mass. Chinese Med J 118(15):1235–1244.

Evans, E.M., K.M. Ross, K.L. Heinrichs, E. McAuley, and K.S. Rosengren 2005 Ultrasound of the calcaneus and bone mineral density differs in older black and white women but is not impacted by current physical activity. Osteoporos Int 16(12):1755–1760.

Fielding, K.T., L.K. Backrach, M.L. Hudes, P.B. Crawford, and M.C. Wang 2002 Ethnic differences in bone mass of young women vary with method of assessment. J Clin Densitom 5(3):229–238.

Finkelstein, J.S., M.L. Lee, M.R. Sowers, B. Ettinger, R.M. Neer, J.L. Kelsey, J.A. Cauley, M.H. Huang, and G.A. Greendale 2002 Ethnic variation in bone density in premenopausal and early perimenopausal women: effects of anthropometric and lifestyle factors. J Clin Endocrinol Metab 87(7):3057–3067.

George, A., J.K. Tracy, W.A. Meyer, R.H. Flores, P.D. Wilson, and M.C. Hochberg 2003 Racial differences in bone mineral density in older men. J Bone Miner Res 18(12):2238–2244.

Goh, J.C., S.L. Low, and S. DasDe 2004 Bone mineral density and hip axis length in Singapore's multiracial population. J Clin Densitom 7(4):406–412.

Greendale, G.A., J. Chu, R. Ferrell, J.F. Randolph, Jr., J.M. Johnston, and M.R. Sowers 2006 The association of bone mineral density with estrogen receptor gene polymorphisms. Am J Med 119(9 suppl):S79–S86.

Hamson, C., L. Goh, P. Sheldon, and A. Samanta 2003 Comparative study of bone mineral density, calcium, and vitamin D status in the Gujarati and white populations of Leicester. Postgraduate Med J 79(931):279–283.

Holm, K., A. Dan, J. Wilbur, S. Li, and J. Walker 2002 A longitudinal study of bone density in midlife women. Health Care Women Int 23(6–7):678–691.

Jen, K.L., A. Buison, L. Darga, and D.A. Nelson 2005 The relationship between blood leptin level and bone density is specific to ethnicity and menopausal status. J Lab Clin Med 146(1):18–24.

Lauderdale, D.S., and P.J. Rathouz 2003 Does bone mineralization reflect economic conditions? An example using a national US sample. Econ Hum Biol 1(1):91–104.

Lenchik, L., F.C. Hsu, T.C. Register, K.K. Lohman, B.I. Freedman, C.D. Langefeld, D.W. Bowden, and J.J. Carr 2004 Heritability of spinal trabecular volumetric bone mineral density measured by QCT in the Diabetes Heart Study. Calcif Tissue Int 75(4):305–312.

Leslie, W.D., C.J. Metge, H.A. Weiler, M. Doupe, S.P. Wood, and J.D. O’Neil 2006 Bone density and bone area in Canadian aboriginal women: the First Nations Bone Health Study. Osteoporos Int 17(12):1755–1762.

Li, S., R. Wagner, K. Holm, J. Lehotsky, and M.J. Zinaman 2004 Relationship between soft tissue body composition and bone mass in perimenopausal women. Maturitas 47(2):99–105.

McCabe, L.D., B.R. Martin, G.P. McCabe, C.C. Johnston, C.M. Weaver, and M. Peacock 2004 Dairy intakes affect bone density in the elderly. Am J Clin Nutr 80(4):1066–1074.

Melton, L.J., 3rd, M.A. Marquez, S.J. Achenbach, A. Tefferi, M.K. O’Connor, W.M. O’Fallon, and B.L. Riggs 2002 Variations in bone density among persons of African heritage. Osteoporos Int 13(7):551–559.

Morris, M.S., P.F. Jacques, and J. Selhub 2005 Relation between homocysteine and B-vitamin status indicators and bone mineral density in older Americans. Bone 37(2):234–242.

Morton, D.J., E. Barrett-Connor, D. Kritz-Silverstein, D.L. Wingard, and D.L. Schneider 2003 Bone mineral density in postmenopausal Caucasian, Filipina, and Hispanic women. Int J Epidemiol 32(1):150–156.

Nelson, D.A., J.M. Pettifor, D.A. Barondess, D.D. Cody, K. Uusi-Rasi, and T.J. Beck 2004 Comparison of cross-sectional geometry of the proximal femur in white and black women from Detroit and Johannesburg. J Bone Miner Res 19(4):560–565.

Opotowsky, A.R., and J.P. Bilezikian 2003 Racial differences in the effect of early milk consumption on peak and postmenopausal bone mineral density. J Bone Miner Res 18(11):1978–1988.

Pescatello, L.S., D.M. Murphy, D. Anderson, D. Costanzo, L. Dulipsingh, and M.J. De Souza 2002 Daily physical movement and bone mineral density among a mixed racial cohort of women. Med Science Sports Exercise 34(12):1966–1970.

Quandt, S.A., J.G. Spangler, L.D. Case, R.A. Bell, and A.E. Belflower 2005 Smokeless tobacco use accelerates age-related loss of bone mineral density among older women in a multi-ethnic rural community. J Cross Cult Gerontol 20(2):109–125.

Robbins, J., C. Hirsch, and J.A. Cauley 2004 Associates of bone mineral density in older African Americans. J Natl Med Assoc 96(12):1609–1615.

Roy, D., C. Swarbrick, Y. King, S. Pye, J. Adams, J. Berry, A. Silman, and T. O’Neill 2005 Differences in peak bone mass in women of European and South Asian origin can be explained by differences in body size. Osteoporos Int 16(10):1254–1262.

Ryder, K.M., R.I. Shorr, A.J. Bush, S.B. Kritchevsky, T. Harris, K. Stone, J.A. Cauley, and F.A. Tylavsky 2005 Magnesium intake from food and supplements is associated with bone mineral density in healthy older white subjects. J Am Geriatr Soc 53(11):1875–1880.

Schwartz, A.V., D.E. Sellmeyer, E.S. Strotmeyer, F.A. Tylavsky, K.R. Feingold, H.E. Resnick, R.I. Shorr, M.C. Nevitt, D.M. Black, J.A. Cauley, S.R. Cummings, and T.B. Harris 2005 Diabetes and bone loss at the hip in older black and white adults. J Bone Miner Res 20(4):596–603.

Shepherd, J.A., M. Meta, J. Landau, Y.S. Sherrer, D.H. Goddard, M.I. Ovalle, A. Rosholm, and H.K. Genant 2005 Metacarpal index and bone mineral density in healthy African-American women. Osteoporos Int 16(12):1621–1626.

Sowers, M.R., J.S. Finkelstein, B. Ettinger, I. Bondarenko, R.M. Neer, J.A. Cauley, S. Sherman, and G.A. Greendale 2003 The association of endogenous hormone concentrations and bone mineral density measures in pre- and perimenopausal women of four ethnic groups: SWAN. Osteoporos Int 14(1):44–52.

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Taaffe, D.R., E.M. Simonsick, M. Visser, S. Volpato, M.C. Nevitt, J.A. Cauley, F.A. Tylavsky, and T.B. Harris 2003b Lower extremity physical performance and hip bone mineral density in elderly black and white men and women: cross-sectional associations in the Health ABC Study. J Gerontol 58(10):934–942.

Tracy, J.K., W.A. Meyer, R.H. Flores, P.D. Wilson, and M.C. Hochberg 2005 Racial differences in rate of decline in bone mass in older men: the Baltimore men’s osteoporosis study. J Bone Miner Res 20(7):1228–1234.

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Megyesi, M.S., Hunt, L.M. & Brody, H. A critical review of racial/ethnic variables in osteoporosis and bone density research. Osteoporos Int 22, 1669–1679 (2011). https://doi.org/10.1007/s00198-010-1503-z

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