Racial disparities, FRAX, and the care of patients with osteoporosis

A recent publication in a prestigious medical journal, released June 17, 2020, reviewed race-based adjustments in selected clinical algorithms and described their “potential dangers” [1]. The USA adaption of the fracture risk assessment tool, FRAX [2], was cited as an example of an algorithm with the potential “to perpetuate or even amplify race-based health inequities.” The concern was that Asian, Black, and Hispanic women are estimated to have a 10-year probability of major osteoporotic fracture that is one-half or less than White women, which might lead to a delay of treatment in non-Whites. The same day as the journal publication, a companion article appeared in the New York Times with the title “Many Medical Decision Tools Disadvantage Black Patients” [3]. Here, it was stated that the use of the FRAX USA calculator would result in Black women being less likely to be treated than “similar” White women, implying that women in need of treatment are being deprived of it because of their race. Considering the tremendous importance of addressing racial disparities in healthcare, the need for accurate information on which to base health policy and clinical decisions, and the many challenges in efforts to reduce the osteoporosis treatment gap, we offer the following thoughts on race and osteoporosis care.

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