Project Summary / Abstract
Some Caucasian-based clinical guidelines have become the systematic underpinnings of racial and ethnic dis-
parities in healthcare. A prime example is the T-score osteoporosis diagnosis criteria, which the WHO initially
proposed only for postmenopausal Caucasian women in epidemiological research. However, the T-score diag-
nosis criteria are currently used to help with osteoporosis diagnosis for all patients. The T-score approach defines
the reference range (RR) of bone mineral density (BMD). Nonetheless, Caucasians-based RRs cannot account
for normal variability in race/ethnicity. As a result, applying these Caucasian-based RRs to racial/ethnic minorities
often causes errors in diagnosis and risk assessment. With a growing and increasingly diverse minority popula-
tion in the US, Caucasian-based clinical guidelines run the risk of exacerbating racial and ethnic healthcare
disparities. The existing RRs of BMD are incredibly controversial because many patients who sustain fragility
fractures have a “normal” BMD as defined by the conventional T-score approach. This clinically utilized, Cauca-
sian-based approach is flawed and, as such, causes systematic healthcare disparities. There is no empirical
approach specifically designed to define the RRs of BMD for racial/ethnic minorities. Subsequent race/ethnicity-
adjusted T-score thresholds remain controversial because they are not empirically validated, so consequently,
their performance has been unsatisfactory on racial/ethnic minorities. Hispanic women have a similarly high
fracture risk as Caucasian women; however, Hispanic women, as the most heterogeneous group, have a higher
osteoporosis misclassification rate with the T-score diagnosis criteria. With the rapid growth of an increasingly
diverse and aging Hispanic population, osteoporotic fractures in Hispanic women are rapidly becoming a signif-
icant public health issue. Hence, this application aims to create precise RRs of BMD for Hispanic women to
address this pressing issue. This application's central hypothesis is that new precise RRs will classify osteopo-
rosis in Hispanic women more accurately than conventional thresholds. This hypothesis will be tested by pursu-
ing three specific aims: 1) developing the best-performing model for normative BMD in Hispanic women; 2)
determining the precise thresholds of BMD; and 3) evaluating the new RRs in Hispanic women. By replacing the
conventional Caucasian-based threshold, the novel, precise RRs will fundamentally shift the current research
and clinical care paradigm in RR from one fixed range for every patient to more precise thresholds that account
for many individual differences. This application will leverage large samples of Hispanic women and innovative
data-driven approaches in creating race/ethnicity-specific, precise RRs of BMD, thus systematically eliminating
the corresponding root cause of healthcare disparities for Hispanic women. Of increased significance, the
knowledge gained herein can be utilized to generate many other types of precise RRs for various minority groups.
The new generation of RRs will directly contribute to improving minority health and reducing healthcare dispari-
ties by eliminating such systematic bias in the healthcare system.
