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Applying ethnic-specific bone mineral density T-scores to Chinese women in the USA

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Abstract

Summary

Caucasian reference data are used to classify bone mineral density in US women of all races. However, use of Chinese American reference data yields lower osteoporosis prevalence in Chinese women. The reduction in osteoporosis labeling may be relevant for younger Chinese women at low fracture risk.

Introduction

Caucasian reference data are used for osteoporosis classification in US postmenopausal women regardless of race, including Asians who tend to have lower bone mineral density (BMD) than women of white race. This study examines BMD classification by ethnic T-scores for Chinese women.

Methods

Using BMD data in a Northern California healthcare population, Chinese women aged 50–79 years were compared to age-matched white women (1:5 ratio), with femoral neck (FN), total hip (TH), and lumbar spine (LS) T-scores calculated using Caucasian versus Chinese American reference data.

Results

Comparing 4039 Chinese and 20,195 white women (44.8 % age 50–59 years, 37.5 % age 60–69 years, 17.7 % age 70–79 years), Chinese women had lower BMD T-scores at the FN, TH, and LS (median T-score 0.29–0.72 units lower across age groups, p < 0.001) using Caucasian reference data. Using Chinese American BMD reference data resulted in an average +0.47, +0.36, and +0.48 units higher FN, TH, and LS T-scores, respectively, reducing the prevalence of osteoporosis (T-score ≤ −2.5) in Chinese women at the FN (16.7 to 6.6 %), TH (9.8 to 3.2 %), and LS (23.2 to 8.9 %); osteoporosis prevalence at any one of three sites fell from 29.6 to 12.6 % (22.4 to 8.1 % for age 50–64 years and 43.2 to 21.0 % for age 65–79 years).

Conclusion

Use of Chinese American BMD reference data yields higher (ethnic) T-scores by 0.4–0.5 units, with a large proportion of Chinese women reclassified from osteoporosis to osteopenia. The reduction in osteoporosis labeling with ethnic T-scores may be relevant for younger Chinese women at low fracture risk.

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Author information

Authors and Affiliations

  1. Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA

    J. C. Lo, M. Chandra & B. Ettinger

  2. Department of Medicine, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA

    J. C. Lo & S. Kim

Authors
  1. J. C. Lo
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  2. S. Kim
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  3. M. Chandra
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  4. B. Ettinger
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Corresponding author

Correspondence to J. C. Lo.

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Conflicts of interest

Joan Lo has received past research funding from Amgen and current research funding from Sanofi unrelated to the current study. Malini Chandra has received past research funding from Amgen unrelated to the current study. Bruce Ettinger has previously received payments for serving as an expert witness in litigation involving Fosamax. Stephanie Kim has no conflict of interests to report.

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Lo, J.C., Kim, S., Chandra, M. et al. Applying ethnic-specific bone mineral density T-scores to Chinese women in the USA. Osteoporos Int 27, 3477–3484 (2016). https://doi.org/10.1007/s00198-016-3673-9

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  • DOI: https://doi.org/10.1007/s00198-016-3673-9

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