# Skeletal Health Outcomes among US Asian Women

> **NIH NIH R01** · KAISER FOUNDATION RESEARCH INSTITUTE · 2021 · $555,289

## Abstract

PROJECT SUMMARY/ABSTRACT
Both ethnic diversity and the burden of osteoporosis have increased with the aging US population. Asians now
comprise 7% of the US and 17% of California’s population, the state in which nearly one third of all US Asians
reside. In 2002, the US Preventive Services Task Force updated recommendations for osteoporosis screening
to all women age 65 years and older. Because Asians have lower bone density than whites, they have a
greater likelihood of being diagnosed with osteoporosis on the basis of their bone density screening test
results, yet they have a lower risk of hip fracture. Existing fracture risk calculators consider race/ethnicity in
estimating fracture risk, but the inherent assumptions remain largely untested. The most widely used calculator
is FRAX, which provides 10-year risk estimates of hip and any one of four major osteoporotic fractures for
white, black, Hispanic, and Asian race. For US Asians, an adjustment factor (0.5 for women) is applied during
fracture risk calculation, based on epidemiologic studies indicating that US Asian women have a 40-50% lower
incidence of hip fracture than white women. However, data for fractures other than hip are limited for Asians,
and population fracture data by Asian ethnic subgroups are largely lacking. US Asians comprise a
heterogeneous population whose ancestry originates primarily from East, South, and Southeast Asia; in
California, the two largest subgroups are Filipino and Chinese. It is notable that using the same age, gender,
bone density, and clinical profile, FRAX calculators produce different results for US Asian versus Asians in
Hong Kong and Taiwan (both higher), China (similar), and the Philippines (lower). These differences could
stem from differences in fracture epidemiology in these countries. A more precise understanding of fracture
risk in US Asians is paramount for tailoring their fracture prevention counseling and care.
Using data from Kaiser Permanente Northern California, a large integrated healthcare delivery system with
membership across Northern California and especially in the San Francisco Bay Area and Sacramento regions
(where large numbers of Asians reside), this proposed study will conduct the first large-scale assessment of
bone density and fracture outcomes among US Asians and Asian ethnic minorities. Our three primary aims
are: (1) to compare the incidence of hip and major osteoporotic fractures for white and Asian men and women
and by Asian ethnic minorities; (2) to characterize the association between bone density and fracture risk for
Asian women in relation to findings observed for white women; and (3) to examine the predictive accuracy of
fracture risk tools for Asian women and to determine whether replacement of existing base population fracture
data with Asian-specific fracture data yields more accurate fracture risk prediction for Asians. Findings from
this study will provide a more accurate way to calculate fracture risk in US Asia...

## Key facts

- **NIH application ID:** 10096288
- **Project number:** 1R01AG069992-01
- **Recipient organization:** KAISER FOUNDATION RESEARCH INSTITUTE
- **Principal Investigator:** Joan C Lo
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $555,289
- **Award type:** 1
- **Project period:** 2021-09-15 → 2026-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10096288

## Citation

> US National Institutes of Health, RePORTER application 10096288, Skeletal Health Outcomes among US Asian Women (1R01AG069992-01). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10096288. Licensed CC0.

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