Racial and Socioeconomic Disparities in Bone Density Testing Before and After Hip Fracture

BACKGROUND Racial and socioeconomic disparities have been identified in osteoporosis screening. OBJECTIVE To determine whether racial and socioeconomic disparities in osteoporosis screening diminish after hip fracture. DESIGN Retrospective cohort study of female Medicare patients. SETTING Entire states of Illinois, New York, and Florida. PARTICIPANTS Female Medicare recipients aged 65–89 years old with hip fractures between January 2001 and June 2003. MEASUREMENTS Differences in bone density testing by race/ethnicity and zip-code level socioeconomic characteristics during the 2-year period preceding and the 6-month period following a hip fracture. RESULTS Among all 35,681 women with hip fractures, 20.7% underwent bone mineral density testing in the 2 years prior to fracture and another 6.2% underwent testing in the 6 months after fracture. In a logistic regression model adjusted for age, state, and comorbidity, women of black race were about half as likely (RR 0.52 0.43, 0.62]) and Hispanic women about 2/3 as likely (RR 0.66 0.54, 0.80]) as white women to undergo testing before their fracture. They remained less likely (RR 0.66 0.50, 0.88] and 0.58 0.39, 0.87], respectively) to undergo testing after fracture. In contrast, women residing in zip codes in the lowest tertile of income and education were less likely than those in higher-income and educational tertiles to undergo testing before fracture, but were no less likely to undergo testing in the 6 months after fracture. CONCLUSIONS Racial, but not socioeconomic, differences in osteoporosis evaluation continued to occur even after Medicare patients had demonstrated their propensity to fracture. Future interventions may need to target racial/ethnic and socioeconomic disparities differently.