Racial disparity in treatment of osteoporosis after diagnosis.

INTRODUCTION: Racial disparities have been identified in a number of areas in clinical medicine. Patients diagnosed with osteoporosis should be treated similarly regardless of race. However, limited data are available on the relative frequency of treatment by race after diagnosis of osteoporosis. METHODS: We analyzed all 739 dual-energy X-ray absorptiometry (DXA) results obtained of women 50 years old and older between 1998 and 2002 at our medical center. Our study sample was 82% Caucasian and 15% African American. Of 353 women who had low bone mineral density on first DXA, we abstracted the electronic and paper medical records to compare treatment rates by race. RESULTS: Of the women diagnosed with osteoporosis or osteopenia, 80.0% and 68.3%, respectively, were started on antiresorptive medications. Of the African American women, 61.9% diagnosed with osteoporosis were started on antiresorptive treatment compared with 83.3% of Caucasian women (p<0.05). African American women with low bone mass were less likely than Caucasian women to be smokers (p<0.05) and use alcohol (p<0.01) but were more likely to be on corticosteroids (p<0.05). No other significant differences were found among treated and nontreated groups that might explain the disparity in treatment. CONCLUSION: A smaller proportion of African American than Caucasian women with osteoporosis received antiresorptive medications after a DXA diagnosis. This significant disparity requires further study in a larger population.

The physical functioning inventory: a procedure for assessing physical function in adults.

The Physical Functioning Inventory, an instrument designed to assess changes in how and how often activities are performed in persons reporting difficulty with a task as well as in those who do not, is described. The measure is designed for adults. Interrater and test-retest reliability were assessed with active participants in the Baltimore Longitudinal Study of Aging (BLSA). Percentage agreement ranged from 63% to 100%. The instrument was also given to 392 inactive BLSA participants as part of a follow-up telephone interview. Fifty-eight percent of the respondents reported no difficulty in performing a task, yet reported a change in how often they performed that task. The results indicate that the instrument is reliable and effective in detecting early stages of disability in activities of daily living, instrumental activities of daily living, and mobility. The instrument is somewhat less reliable for moderate and strenuous physical activities.

Inhibition, contextual segregation, and subject strategies in list method directed forgetting.

This experiment tested alternative explanations of list method directed forgetting effects. Two word lists were studied by 135 subjects. Between lists, subjects were instructed to remember both lists (remember group), remember both lists as well as in which list words were studied (segregate group), or to forget the first list and remember the second (forget group). All subjects took both recall and recognition tests with test order varied between subjects. Among subjects who took the recall test first, the forget group showed a directed forgetting effect (poorer performance on List 1 than List 2) with both recall accuracy, recall typing time, and recognition reaction time measures. Contextual segregation of List 1 words by forget subjects was ruled out as a sufficient cause of the effect. Limited support was obtained for a differential rehearsal explanation of the effect. Within-group comparisons and findings of release from directed forgetting support inhibitory processes as the major cause of the directed forgetting effect.