Race, Ethnicity, and Mortality Following Major Osteoporotic Fracture: Results from the Women's Health Initiative Study.

Juels M, Larson JC, Ensrud KE, Stefanick ML, Shadyab AH, Garcia L, Nassir R, Schnatz PF, Nelson R, Crandall CJ. Race, Ethnicity, and Mortality Following Major Osteoporotic Fracture: Results from the Women's Health Initiative Study. Journal of general internal medicine. 2025 Aug 1; 40(11):2583-2592, DOI: 10.1007/s11606-025-09506-6.

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Abstract:

BACKGROUND: Major osteoporotic fracture (MOF) is associated with increased mortality; however, few studies in postmenopausal women have examined racial and ethnic differences in 1-year and 5-year mortality following MOF. OBJECTIVE: To assess 1-year and 5-year mortality following MOF by race and ethnicity. DESIGN: This prospective cohort study included postmenopausal women enrolled in the Women''s Health Initiative (WHI), a population-based, multisite US study. Participants were followed from September 1994 to February 2023. Data were analyzed between August 2023 and November 2023. PARTICIPANTS: Postmenopausal women aged 50 to 79 years old who experienced a MOF (N? = 32,675 in 1 year and 29,506 in 5 years following MOF). MAIN MEASURES: Self-reported race and ethnicity. All-cause mortality was determined by death certificates, reports of surrogates, and the National Death Index Search. KEY RESULTS: The baseline mean age of participants was 77.0 [SD? = 8.5] years with 31,223 [95.6%] White participants in the 1-year mortality analysis, and 76.3 [SD? = 8.5] years with 28,212 [95.6%] White participants in the 5-year mortality analysis. In fully adjusted models, compared to White women, Black women had a higher risk of mortality (adjusted odds ratio (aOR)? = 1.42, 95% CI [1.06, 1.90], while Asian women had a lower risk of mortality (aOR? = 0.48 95% CI [0.27, 0.88]), within 1 year following MOF. Compared to White women, the mortality risk within 5 years after MOF was significantly higher among American Indian/Alaska Native (aOR? = 3.30, 95% CI [1.65, 6.60]) and lower among Asian (aOR? = 0.58, 95% CI [0.42,0.80]) women. While there were no mortality differences by ethnicity 1 year following MOF, Hispanic/Latina women were less likely to die 5 years following MOF (aOR? = 0.74, [95% CI 0.57-0.96]) compared to Non-Hispanic/Latina women. CONCLUSIONS: In this large prospective study, mortality following MOF differed by race. Future research is needed to delineate the mechanism behind these associations.