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

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.