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Fracture Risk in African Americans


Compared with Caucasians and other ethnic groups, African Americans have a lower risk of breaking a bone in their lifetime.1-3  The best explanations are genetic differences in bone size, bone density, bone structure and possibly differences in calcium regulation.

Despite the general statement of lower risk, there are two areas of growing concern for African Americans: 1) fracture risk may be rising4 and, 2) fractures increase dramatically after age 75.

Ethnic differences in fracture risk

Many studies dating as far back as 1965 have shown that individuals of African descent have much lower rates of osteoporosis and fractures than Caucasians.5-9  More recently, the Women’s Health initiative (WHI) found that African American women have less than half of the number of fractures compared to Caucasian women.

In the WHI, the ethnic differences in the number of fractures were less dramatic when the researchers looked at the groups by bone density.  Women with greater bone density do not have as many fractures, regardless of ethnicity.  Typically, African American women have greater bone density.4

The long bones that make up our arm and legs, have a tubular shape in the middle and a bulbous shape at either end.  African Americans have long bones that are wider in the middle than other ethnic groups—and that gives the bones considerable more strength to resist breaking.  At the ends of the long bones, the bone network structure is thicker and more connected—again more strength to resist breaking.10-13  These structural differences in the bones of African Americans begin to appear early in life.  African Americans build larger and denser bones in puberty, accounting for fewer fractures later in life.14,15,16,17,18

Current research is looking at genetic reasons for ethnic differences in fracture risk.  One study has shown that African Americans have a gene that regulates calcium, increasing the amount that is reabsorbed by the kidneys rather than eliminated from the body.  Since calcium is the principal mineral that makes bones stronger, this efficiency may explain why and how the bone mass is built and maintained.

Factors that increase fracture risk in African Americans

Although for most African Americans the risk of breaking a bone is low, the occurrence of fractures seems to be on the rise.  Women who are at increased risk are taller, have already broken a bone, have a tendency to fall or have a family history of fractures. Other factors that increase risk are medical conditions such as diabetes, heart attacks, arthritis and the use of certain medications including nonsteroidal anti-inflammatory drugs (NSAIDs), steroids (for more than two years) and sedatives.4

Bone health is important for people of all ethnicities.  Having a balanced diet with sufficient calcium and vitamin D and being physically activity goes a long way to ensure healthy bones for life.  If you have any of the medical conditions or take medications that increase your risk of breaking a bone, talk with your doctor.


  1. Farmer ME, White LR, Brody JA, Bailey KR 1984 Race and sex differences in hip fracture incidence. Am J Public Health 74:1374–1380.
  2. Baron JA, Karagas M, Barrett J, Kniffin W, Malenka D, Mayor M, Keller RB 1996 Basic epidemiology of fractures of the upper and lower limb among Americans over 65 years of age. Epidemiology 7:612–618.
  3. Baron JA, Barrett J, Malenka D, Fisher E, Kniffin W, Bubolz T, Tosteson T 1994 Racial differences in fracture risk. Epidemiology 5:42–47.
  4. Cauley JA, Wu L, Wampler NS, Barnhart JM, Allison M, Chen Z, Jackson R, John Robbins J 2007 Clinical risk factors for fractures in multi-ethnic women: The Women’s Health Initiative. J Bone Miner Res 22:1816-1826.
  5. Baron JA, Barrett J, Malenka D, et al 1994 Racial differences in fracture risk. Epidemiology 5:42–47.
  6. Farmer ME, White LR, Brody JA, et al. 1984 Race and sex differences in hip fracture incidence. Am J Public Health 74:1374–1380.
  7. Moldawer M, Zimmerman SJ, Collins LC 1965 Incidence of osteoporosis in elderly whites and elderly Negroes. JAMA 194:859–862.
  8. Silverman SL, Madison RE 1988 Decreased incidence of hip fracture in Hispanics, Asians, and blacks: California Hospital Discharge Data. Am J Public Health 78:1482–1483.
  9. Barrett-Connor E, Siris ES, Wehren LE, et al. 2005 Osteoporosis and fracture risk in women of different ethnic groups. J Bone Miner Res 20:185–194.
  10. Aloia JF, Vaswani A, Ma R, et al. 1997 Comparison of body composition in black and white premenopausal women. J Lab Clin Med 129:294–299.
  11. Bachrach LK, Hastie T, Wang MC, et al. 1999 Bone mineral acquisition in healthy Asian, Hispanic, black, and Caucasian youth: a longitudinal study. J Clin Endocrinol Metab 84:4702–4712.
  12. Nelson DA, Jacobsen G, Barondess DA, et al. 1995 Ethnic differences in regional bone density, hip axis length, and lifestyle variables among healthy black and white men. J Bone Miner Res 10:782–787.
  13. Pollock NK, Laing EM, Taylor RG, et al. 2011 Comparisons of trabecular and cortical bone in late adolescent black and white females. J Bone Miner Metab 29:44–53.
  14. Gilsanz V, Skaggs DL, Kovanlikaya A, et al. 1998 Differential effect of race on the axial and appendicular skeletons of children. J Clin Endocrinol Metab 83:1420–1427.
  15. Wetzsteon RJ, Hughes JM, Kaufman BC, et al. 2009 Ethnic differences in bone geometry and strength are apparent in childhood. Bone 44:970–975.
  16. Leonard MB, Elmi A, Mostoufi-Moab S, et al. 2010 Effects of sex, race, and puberty on cortical bone and the functional muscle bone unit in children, adolescents, and young adults. J Clin Endocrinol Metab 95:1681–1689.
  17. Wetzsteon RJ, Hughes JM, Kaufman BC, et al. 2009 Ethnic differences in bone geometry and strength are apparent in childhood. Bone 44:970–975.
  18. Peacock M, Buckwalter KA, Persohn S, et al. 2009 Race and sex differences in bone mineral density and geometry at the femur. Bone 45:218–225.


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What to know about bone health
and fracture prevention during COVID-19

  • Remove fall dangers in your home.
  • Stay physically active, and at least 6 feet away from others.
  • Eat for proper nutrition, and take a supplement if needed to get enough calcium and vitamin D.
  • Stick with your osteoporosis medicines and ask your doctor for extra if you’re unable to go to the pharmacy.
  • If you are due for Reclast, there is little concern about delaying for a few weeks or months.
  • If you take Prolia or Evenity injections, don’t miss your appointment.  Some facilities offer “drive-through” injections. Check with your doctor.
  • Bone density testing can be postponed, if necessary.
  • Speak with your doctor about the possibility of telephone and video visits.

The Centers for Disease Control and Prevention has a page with steps you can take to reduce your risk of catching the virus if you have a chronic illness.

Be well. We are here for you if you have any questions.