Skeletal Health Outcomes among US Asian Women

项目总结/摘要 随着美国人口老龄化，种族多样性和骨质疏松症的负担都有所增加。亚洲人现在 占美国人口的7%，占加州人口的17%，在加州，近三分之一的美国亚裔人口 居住。2002年，美国预防服务工作组更新了骨质疏松症筛查的建议 所有65岁及以上的妇女。因为亚洲人的骨密度比白人低， 更大的可能性被诊断为骨质疏松症的基础上，他们的骨密度筛查测试 结果，但他们有较低的风险髋部骨折。现有的骨折风险计算器考虑了种族/民族， 估计骨折风险，但固有的假设仍然在很大程度上未经检验。使用最广泛的计算器 是FRAX，它提供了10年的风险估计髋关节和任何一个四个主要的腰椎骨折， 白色、黑色、西班牙裔和亚裔。对于美国亚裔，在以下期间应用调整因子（女性为0.5） 骨折风险计算，基于流行病学研究表明，美国亚洲妇女有40-50%的低， 髋部骨折发病率高于白色女性。然而，亚洲人除髋关节外的骨折数据有限， 亚洲人种亚组的人口断裂数据在很大程度上缺乏。美国亚洲人组成一个 祖先主要来自东亚、南亚和东南亚的异质人群; 在加州，最大的两个亚群是菲律宾人和中国人。值得注意的是，使用相同的年龄，性别， 骨密度和临床特征，FRAX计算器对美国亚裔与亚裔产生不同的结果， 香港和台湾（均较高），中国（相似）和菲律宾（较低）。这些差异可能 源于这些国家骨折流行病学的差异。更准确地理解骨折 在美国亚洲人的风险是最重要的定制他们的骨折预防咨询和护理。 使用来自Kaiser Permanente北方加州的数据，Kaiser Permanente是一个大型综合医疗保健提供系统， 在整个北方加州，特别是在旧金山弗朗西斯科湾区和萨克拉门托地区的成员 （大量亚洲人居住的地方），这项拟议的研究将进行第一次大规模评估， 美国亚裔和亚裔少数民族的骨密度和骨折结局。我们的三个主要目标 比较白色和亚洲男性和女性的髋部骨折和主要股骨骨折的发生率 和亚洲少数民族;（2）描述骨密度和骨折风险之间的关系， 亚洲妇女与观察到的白色妇女结果的关系;和（3）检查 骨折风险工具，以确定是否更换现有的亚洲妇女骨折的基础人口 与亚洲人特有的骨折数据相结合的数据对亚洲人的骨折风险预测更准确。的结果 这项研究将提供一种更准确的方法来计算美国亚洲人的骨折风险， 使数百万亚裔美国人能够获得针对其种族特征的骨折风险数据。

PROJECT SUMMARY/ABSTRACT Both ethnic diversity and the burden of osteoporosis have increased with the aging US population. Asians now comprise 7% of the US and 17% of California’s population, the state in which nearly one third of all US Asians reside. In 2002, the US Preventive Services Task Force updated recommendations for osteoporosis screening to all women age 65 years and older. Because Asians have lower bone density than whites, they have a greater likelihood of being diagnosed with osteoporosis on the basis of their bone density screening test results, yet they have a lower risk of hip fracture. Existing fracture risk calculators consider race/ethnicity in estimating fracture risk, but the inherent assumptions remain largely untested. The most widely used calculator is FRAX, which provides 10-year risk estimates of hip and any one of four major osteoporotic fractures for white, black, Hispanic, and Asian race. For US Asians, an adjustment factor (0.5 for women) is applied during fracture risk calculation, based on epidemiologic studies indicating that US Asian women have a 40-50% lower incidence of hip fracture than white women. However, data for fractures other than hip are limited for Asians, and population fracture data by Asian ethnic subgroups are largely lacking. US Asians comprise a heterogeneous population whose ancestry originates primarily from East, South, and Southeast Asia; in California, the two largest subgroups are Filipino and Chinese. It is notable that using the same age, gender, bone density, and clinical profile, FRAX calculators produce different results for US Asian versus Asians in Hong Kong and Taiwan (both higher), China (similar), and the Philippines (lower). These differences could stem from differences in fracture epidemiology in these countries. A more precise understanding of fracture risk in US Asians is paramount for tailoring their fracture prevention counseling and care. Using data from Kaiser Permanente Northern California, a large integrated healthcare delivery system with membership across Northern California and especially in the San Francisco Bay Area and Sacramento regions (where large numbers of Asians reside), this proposed study will conduct the first large-scale assessment of bone density and fracture outcomes among US Asians and Asian ethnic minorities. Our three primary aims are: (1) to compare the incidence of hip and major osteoporotic fractures for white and Asian men and women and by Asian ethnic minorities; (2) to characterize the association between bone density and fracture risk for Asian women in relation to findings observed for white women; and (3) to examine the predictive accuracy of fracture risk tools for Asian women and to determine whether replacement of existing base population fracture data with Asian-specific fracture data yields more accurate fracture risk prediction for Asians. Findings from this study will provide a more accurate way to calculate fracture risk in US Asians and, in the future, could enable millions of Asian Americans to obtain fracture risk data tailored to their ethnic profile.