Fragility fractures related to osteoporosis are associated with high rates of morbidity and mortality. Up to a third of patients die in the year after sustaining a hip fracture, 20% require extended time nursing facilities, and one in ten require additional financial assistance from Medicaid post fracture. Preliminary data among Medicare beneficiaries indicate that there are significant racial differences in hip fracture mortality; specifically, a higher mortality rate among Black women, suggesting either biological differences in bone health, disparities in osteoporosis and post fracture management, or both. A current evaluation of racial differences in post fracture outcomes has not been performed. Similarly, there has not been a comprehensive evaluation of factors that if intervened upon, could reduce the disparity in these post-fracture outcomes. Many factors that prevent and/or reduce the adverse sequelae of fractures have been reported from large national osteoporosis cohorts. However, these cohorts had a relatively small proportion of Blacks, and these factors may have different associations in the Black population. Currently, Blacks comprise the largest racial minority group in the United States, thus highlighting the need to evaluate factors potentially mediating these disparities and designing studies targeting these factors to reducing the mortality disparity in the Black population. To further my journey as an independent osteoporosis outcomes and disparities researcher, I propose a project titled ?Biology or Management: Understanding Racial Differences in Post-Fracture Outcomes.? The specific aims for this study are: 1) To determine current racial differences in post fracture outcomes, 2) To identify the patient, health care utilization, and hospital-related factors that mediate the association between race and post- fracture outcomes, and 3) To examine if psychosocial, cultural, and lifestyle factors mediate the association between race and mobility among patients with hip fracture. To achieve these aims, I have proposed training and career development activities around health disparities research, mediation analysis, and pragmatic clinical trial design and intervention development with complementary osteoporosis and hip fracture clinical rotations. With completion of my training activities and research aims, I will successfully transition into an independent researcher, and be one step closer to my overall goal of reducing the racial disparity in fracture outcomes.

Public Health Relevance

It has been reported that Black women have a higher post-hip fracture outcomes, such as mortality, than White women. The goal of this K01 project is to acquire the necessary training to: 1) describe the current post- fracture mortality disparity between Black and White women, and 2) uncover the factors potentially causing the disparity. Potential factors of interest include health-related factors, such as health conditions and health care use, and social factors that must be directly measured from patients. With completion of this project I will not only advance my independent research career but also provide evidence to the field to address key public health questions of relevance to bone health and racial disparities.

National Institute of Health (NIH)
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Research Scientist Development Award - Research & Training (K01)
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Arthritis and Musculoskeletal and Skin Diseases Special Grants Review Committee (AMS)
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Alekel, D Lee
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University of Alabama Birmingham
Public Health & Prev Medicine
Schools of Public Health
United States
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