A risk assessment tool (OsteoRisk) for identifying latin American women with osteoporosis

Abstract

OBJECTIVE: To develop a simple and easy-to-use tool for identifying osteoporotic women (femoral neck bone mineral density [BMD] Tscores À 2.5) in Latin America. DESIGN:Retrospective study involving review of medical records.SETTING: Osteoporosis clinics in 6 Latin American countries. PATIENTS:Postmenopausal women ages ! 50 in Latin America who had femoral neck BMD measurements. MEASUREMENTS AND MAIN RESULTS:A risk index was developed from 1,547 patients based on least square regression using age, weight, history of fractures, and other variables as predictors for BMD T-score. The final model was simplified by reducing the number of predictors; sensitivity and specificity were evaluated before and after reducing the number of predictors to assess performance of the index. The final model included age, weight, country, estrogen use, and history of fractures as significant predictors for T-score. The resulting scoring index achieved 91% sensitivity and 47% specificity. Simplifying the index by using only age and weight yielded similar performance (sensitivity, 92%; specificity, 45%). Three risk categories were identified based on OsteoRisk, the index using only age and body weight: high-risk patients (index o =À 2; 65.6% were osteoporotic), moderate-risk patients ( À 2o index o =1; 26.7% were osteoporotic), and low-risk patients (index41; 8% were osteoporotic). Similar results were seen in a validation sample of 279 women in Brazil.CONCLUSION: Age and weight alone performed well for predicting the risk of osteoporosis among postmenopausal women. The OsteoRisk is an easy-to-use tool that effectively targets the vast majority of osteoporotic patients in Latin America for evaluation with BMD. Although patients with fracture should automatically be considered for treatment for osteoporosis, and assessment of bone mineral density (BMD) using dual energy x-ray absorptiometry (DXA) is the standard for diagnosing osteoporosis prior to fracture, facilities for DXA measurements remain limited in Latin America and certain other parts of the world, and this poses a serious challenge for diagnosing osteoporosis in patients without prior fracture.Some researchers have examined the relationship between clinical variables and bone mass in the hope of targeting BMD measurements to patients who are more likely to have osteoporosis.14-20 Lydick et al. 17 developed a model that accurately identifies 90% of subjects with low bone mass and 40% of subjects with normal bone mass. Recently, Koh et al. 18 developed an index, the Osteoporosis Self-assessment Tool for Asians (OSTA), for identifying women at increased risk of osteoporosis in a population of Asian patients other than Japanese. The OSTA is based only on age and weight and achieved a sensitivity of 91% for identifying women with osteoporosis; it was further validated in a cohort of Japanese women, with a sensitivity of 98%. 19 The Osteoporosis Self-assessment Tool (OST) was derived from the OSTA by altering the risk category ranges, and performed well in identifying women at...

Accuracy study on "Osteorisk": a new osteoporosis screening clinical tool for women over 50 years old

“…[1][2][3] Estrogen deficiency is responsible for 30 to 50% of the bone loss observed during women's lives. 3 In Brazil, it has been estimated that 10 million individuals are affected by osteoporosis 4 and that, because of the greater ages attained by the population, the number of hip fractures among men and women between 50 and 60 years old will increase by 400% by 2050, in comparison with the prevalence in 1950. 4 This signifies a major public health problem with enormous financial cost relating to caring for this morbid condition.…”

“…3 In Brazil, it has been estimated that 10 million individuals are affected by osteoporosis 4 and that, because of the greater ages attained by the population, the number of hip fractures among men and women between 50 and 60 years old will increase by 400% by 2050, in comparison with the prevalence in 1950. 4 This signifies a major public health problem with enormous financial cost relating to caring for this morbid condition. [5][6][7][8][9][10] It has become important to achieve early identification of individuals at greater risk of this disease, in order to implement preventive measures.…”

“…17 Osteorisk has been validated in Asia, Europe, the United States and Latin America, undergoing adjustments in accordance with each population studied. 4 According to Sen et al, the sensitivity of this method reaches 94% and the specificity, 45%. 4 Osteorisk is based on a series of statistical calculations and, using age and body weight variables allocated in a defined table, it allows the risk of osteoporosis to be classified as high, moderate or low.…”

“…4 According to Sen et al, the sensitivity of this method reaches 94% and the specificity, 45%. 4 Osteorisk is based on a series of statistical calculations and, using age and body weight variables allocated in a defined table, it allows the risk of osteoporosis to be classified as high, moderate or low. On the basis of these results, doctors can identify patients who are at greater risk of low bone mass and request examinations of higher complexity, and even begin therapy if it is impossible to undertake such examinations.…”

“…On the basis of these results, doctors can identify patients who are at greater risk of low bone mass and request examinations of higher complexity, and even begin therapy if it is impossible to undertake such examinations. 4,5,[11][12][13] The aim of Osteorisk is not to diagnose osteoporosis or osteopenia, but to identify women with a greater likelihood of developing low BMD, so that they can be advised to undergo bone densitometry examination. In this manner, the effectiveness of detecting patients with osteoporosis and osteopenia is increased and the wastage of unnecessary examinations is avoided.…”