Abstract / Summary
Abstract Background Osteoporosis is a chronic skeletal disease characterized by low bone mass and micro-architectural deterioration that leads to increased fracture risk. The economic and social impact of osteoporosis and associated fractures is quite significant, with one in three women as well as one in five men over the age of 50 experiencing an osteoporosis-related fracture. Hip fractures are particularly devastating with significant disability which can be permanent. We aimed to investigate whether community health fairs could provide a unique opportunity to screen individuals in underserved areas, and specifically whether primary care engagement had an impact on an individual’s fracture risk based on FRAX-estimated fracture probability. Methods This cross-sectional study examined FRAX-estimated 10-year fracture probability among 132 adults aged 45 to 89 years (M = 62.7 years; 91.7% female) recruited voluntarily at community health fairs in South Florida from 2021 through 2026. Volunteers responsible for participant recruitment during health fairs were medical students trained in osteoporosis risk screening/counseling. Participants were asked to complete a structured survey assessing medical history, dietary patterns, supplement use, smoking, alcohol consumption, and primary care visit frequency. Ten-year fracture probabilities for major osteoporotic fracture (MOF) and hip fracture were calculated using the WHO FRAX tool (US reference population). Analyses included one-way ANOVA, independent samples t-tests, and hierarchical linear regression. Results Participants seen by a primary care provider every few months had significantly higher FRAX MOF and hip scores than those not seen regularly, a pattern consistent with clinical selection of higher-risk individuals into more frequent care. Hierarchical regression demonstrated that lifestyle and behavioral variables alone explained negligible variance in FRAX scores, while the addition of medical history variables produced significant models explaining 28.1% and 33.5% of variance in hip and MOF outcomes respectively. Osteoporosis history, prior fracture, and cancer history were the strongest positive predictors of fracture risk. Conclusions These findings suggest that community health fair screening captures a medically complex, high-risk population, and that individuals without regular primary care contact may represent an underserved group whose fracture risk is under characterized by self-report alone.