Biology or Management: Understanding Racial Differences in Post Fracture Outcomes

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ABSTRACT Fragility fractures related to osteoporosis are associated with high rates of morbidity and mortality. Up to a third of patients die in the year after sustaining a hip fracture, 20% require extended time nursing facilities, and one in ten require additional financial assistance from Medicaid post fracture. Preliminary data among Medicare beneficiaries indicate that there are significant racial differences in hip fracture mortality; specifically, a higher mortality rate among Black women, suggesting either biological differences in bone health, disparities in osteoporosis and post fracture management, or both. A current evaluation of racial differences in post fracture outcomes has not been performed. Similarly, there has not been a comprehensive evaluation of factors that if intervened upon, could reduce the disparity in these post-fracture outcomes. Many factors that prevent and/or reduce the adverse sequelae of fractures have been reported from large national osteoporosis cohorts. However, these cohorts had a relatively small proportion of Blacks, and these factors may have different associations in the Black population. Currently, Blacks comprise the largest racial minority group in the United States, thus highlighting the need to evaluate factors potentially mediating these disparities and designing studies targeting these factors to reducing the mortality disparity in the Black population. To further my journey as an independent osteoporosis outcomes and disparities researcher, I propose a project titled “Biology or Management: Understanding Racial Differences in Post-Fracture Outcomes.” The specific aims for this study are: 1) To determine current racial differences in post fracture outcomes, 2) To identify the patient, health care utilization, and hospital-related factors that mediate the association between race and post- fracture outcomes, and 3) To examine if psychosocial, cultural, and lifestyle factors mediate the association between race and mobility among patients with hip fracture. To achieve these aims, I have proposed training and career development activities around health disparities research, mediation analysis, and pragmatic clinical trial design and intervention development with complementary osteoporosis and hip fracture clinical rotations. With completion of my training activities and research aims, I will successfully transition into an independent researcher, and be one step closer to my overall goal of reducing the racial disparity in fracture outcomes.