Underrepresentation of Non-White Participants in the American Academy of Orthopaedic Surgeons Guidelines for Symptomatic Spinal Compression Fractures

Introduction: Annually, compression fractures affect more than 1.5 million individuals. In response to this healthcare burden, the American Academy of Orthopedic Surgeons (AAOS) released the Clinical Practice Guideline on the Treatment of Osteoporotic Spinal Compression Fractures in 2011, aiming to improve care. However, the utility of this guideline is contingent on the evidence with which it can be applied to the population at large. We aimed to assess the racial and ethnic composition of patients enrolled in the studies cited in the AAOS Clinical Practice Guideline on the Treatment of Osteoporotic Spinal Compression Fractures.

Methods: We reviewed full-text articles cited in the 2010 American Academy of Orthopaedic Surgeons Clinical Practice Guideline on Treatment of Osteoporotic Spinal Compression Fractures, which represents the most recent AAOS guideline published. Inclusion criteria consisted of RCTs or prospective studies reporting patient data. Race reporting was defined as any explicit listing of participants’ race or ethnicity. Primary outcomes were the proportion of studies that reported race and that referenced race without reporting data.

Results: In AAOS guidelines, 76 studies were cited, of which 50 met inclusion criteria. Of these, 13(26%) studies reported race. Two(4%) studies referenced race without reporting the breakdown of race included in the study. The majority of patients included across all studies were female and white. Notably, none of the 50 studies enrolled Black or Hispanic patients. The majority of studies reported on osteoporosis medication recommendations while 3(6%) assessed Kyphoplasty vs Vertebroplasty, 3(6%) assessed Kyphoplasty vs conservative treatment, and 5(10%) assessed Vertebroplasty vs conservative treatment.

Conclusion : There is a substantial lack of racial diversity in clinical trial enrollment of studies
cited by the current AAOS guidelines for osteoporotic spinal compression fractures. This underscores the need for more inclusive research practices and updated orthopaedic guidelines to ensure that practice guidelines apply to the population at large.