Skeletal Health Outcomes among US Asian Women

项目摘要/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增加了。现在的亚洲人 占美国7%的人口和加利福尼亚州17%的人口，该州近三分之一的美国亚洲人 住下来。2002年，美国预防服务工作组更新了骨质疏松症筛查的建议 给所有65岁及以上的女性。因为亚洲人的骨密度比白人低，所以他们有一种 根据他们的骨密度筛查测试被诊断为骨质疏松症的可能性更大 结果，但他们髋部骨折的风险较低。现有的骨折风险计算器将种族/民族考虑在内 估计骨折风险，但内在假设在很大程度上仍未得到检验。使用最广泛的计算器 是FRAX，它提供髋部和四种主要骨质疏松性骨折中任何一种的10年风险估计 白人、黑人、西班牙裔和亚裔。对于美国亚洲人，调整系数(女性为0.5)在 骨折风险计算，基于流行病学研究表明，美国亚洲女性的骨折风险低40%-50% 髋部骨折的发生率高于白人女性。然而，髋关节以外的骨折数据对亚洲人来说是有限的， 而按亚裔族群划分的人口分布数据在很大程度上是缺乏的。美国亚洲人包括一个 血统主要来自东亚、南亚和东南亚的异质人口； 加利福尼亚州，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计算器在美国亚洲人和亚洲人中产生不同的结果 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。对骨折有更准确的认识 美国亚洲人的风险对于定制他们的骨折预防、咨询和护理是至关重要的。 使用来自Kaiser Permanente North California的数据，一个大型集成医疗保健提供系统 北加州，特别是旧金山湾区和萨克拉门托地区的会员资格 (大量亚洲人居住的地方)，这项拟议的研究将对 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 以下是：(1)比较白人和亚裔男女髋部和主要骨质疏松性骨折的发生率 和亚裔少数民族；(2)表征骨密度与骨折风险之间的关系 亚洲女性与观察到的白人女性研究结果的关系；以及(3)检查 亚洲妇女的骨折风险工具，并确定是否更换现有的基础人群骨折 具有亚洲特有骨折数据的数据为亚洲人提供了更准确的骨折风险预测。调查结果来自 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，并在未来可能 使数百万亚裔美国人能够获得根据他们的种族特征量身定做的骨折风险数据。

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.