Ethnic Differences in the Risk of Fracture and Vascular Disease

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DESCRIPTION (provided by applicant): The career objective of the K23 candidate is to become a rheumatic disease epidemiologist. In the context of mentored research, Dr. Curtis will examine the incidence, risk factors, and outcomes related to osteoporosis, with an emphasis on African Americans and men. To achieve this objective, Dr. Curtis has designed a didactic training program to augment his methodologic skills in analytic techniques relevant to large longitudinal studies. With supervision of experienced mentors, Dr. Curtis will obtain hands-on training in the conduct and analysis of an ancillary study to the 4 year R01 "Reasons for Geographic and Racial Differences in Stroke" study funded by the NINDS enrolling 30,000 African Americans and Caucasians. Although typically at lower risk for fractures than Caucasian women, African Americans and men suffer greater post-fracture morbidity and mortality. The ability to estimate absolute fracture risk among men and non-Caucasians is limited since these persons are relatively underrepresented in osteoporosis cohorts. Prior fracture appears to be an independent risk for subsequent stroke and myocardial infarction (Ml), but the association between bone and vascular disease in high risk, understudied populations is poorly understood. The specific aims of the K23 project are 1) Define ethnic/racial differences in relative and absolute fracture incidence over 4 years in 3 high risk groups (prevalent fracture; prior stroke; glucocorticoid use) compared to the overall cohort; 2) Determine ethnic/racial differences in stroke and Ml risk among those with prevalent fracture. Survival analysis will compare rates and risk factors for first and recurrent fractures and vascular events by ethnicity/race and gender. Shared risk factors for both bone and vascular disease will be examined in several secondary hypotheses based on an ancillary questionnaire sent to the entire cohort. Data generated from this project will provide a framework for future research proposals. Better understanding of the absolute and relative hazards associated with risk factors for fracture and associated vascular events in African Americans and men may lead to improved understanding of the underlying biology and help reduce ethnic/racial and gender-related disparities in osteoporosis care. Beyond the training objective of this award, the ultimate goal is better prevention through improved identification of those at highest risk for poor outcomes from osteoporotic fractures and associated vascular disease.