The impact of race and ethnicity on the etiology and management of musculoskeletal conditions requires more extensive investigation. The influence of race and ethnicity on the incidence of musculoskeletal conditions may be due to genetics along with difference in activities participated in. Genetic differences, however, have not been well defined in the vast majority of conditions. Clarifying this may lead to advancements in the management of certain conditions including osteoporosis, multiple myeloma, and spinal deformities.

The difference in incidence is also largely influenced by the lower rate of presentation by ethnic minorities to a physician. We also need to enhance awareness of any disparities in the management of musculoskeletal conditions. Race-based differences in the treatment of certain conditions may indicate an inherent bias. They may also be related to access issues and patient perception. The treatment of disabling osteoarthritis is a good example. Osteoarthritis has been found to be as prevalent in AA and Hispanic populations as in non-Hispanic white populations. Several studies, however, have shown that minorities undergo joint replacement procedures at a significantly lower rate. Ethnic minorities are less familiar with certain surgical procedures. Also, certain primary care physicians are less likely to refer patients to surgeons for consultations depending on their access to these services or their perception of what their patient's insurance may allow for. Unfortunately, AAs may have a higher rate of adverse outcomes.1 The reasons for this disparity are multifactorial but include less familiarity and lower expectations with the procedure in minority populations. Also, minorities tend to have procedures at lower volume hospitals which may contribute to more adverse outcomes.

Lastly, access to adequate postoperative care should be considered in adverse outcomes, be it from another family member that can afford to miss workdays or certain ancillary services provided to the patient.

• 1. Zhang W, Lyman S, Boutin-Foster C, et al. Racial and ethnic disparities in utilization rate, hospital volume, and perioperative outcomes after total knee arthroplasty. J Bone Joint Surg Am. 2016 Aug 3;98(15):1243-52. doi: 10.2106/JBJS.15.01009.