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. Measuremens: 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.