Selecting men for bone densitometry: performance of osteoporosis risk assessment tools in Portuguese men

Abstract

Summary Clinicians need tools to identify patients most likely to benefit from bone mineral density (BMD) testing, for which cost-effectiveness does not allow generalized screening. This study supports the utility of osteoporosis risk assessment tools in selecting men for BMD testing. Different cutoff values may be appropriate for different countries and/or ethnic origins. Introduction Our aim was to evaluate the utility of three osteoporosis (OP) risk assessment tools in a large group of Portuguese men aged 50 or more and to determine the best cutoff value to be used for selecting men for bone densitometry. Methods We assessed the performance of three simple tools in 202 randomly selected men: body weight criterion (BWC), osteoporosis self-assessment tool for Asians (OSTA), and a modified version of the OSTA equation (OST). Previously published cutoff values (validated in postmenopausal women) and three additional cutoff values were tested. Sensitivity (SE), specificity (SP), predictive values, and area under the receiver operating characteristic (AUROC) curve for correctly selecting men with OP (defined by BMD testing) were determined. Results Mean age of the cohort was 63.8 years. According to the World Health Organization diagnostic categories, 16.8% had osteoporosis. The best performing cutoffs for correctly selecting men with OP for BMD testing were OST<3 (SE= 75.5%, SP=50.0%, AUROC=0.632), OSTA<3 (SE=73.5%, SP=58.3%, AUROC=0.659), and BWC<75 kg (SE=73.5%, SP=61.3%, AUROC=0.674). Conclusions OP risk assessment tools seem to be useful in men aged 50 or more. Best cutoff values are different from those recommended for postmenopausal women. Different cutoff values may be appropriate for different countries and/or ethnic origins.

Association of Osteoporosis Self-Assessment Tool for Asians (OSTA) Score with Clinical Presentation and Expenditure in Hospitalized Trauma Patients with Femoral Fractures

“…Although osteoporosis is less prevalent in men than women, 30% of hip fractures occur in men [26] and comprise around 25% of the total cost burden [2]. Similar supporting correlations have also been reported from OSTA studies in men [17,18,25,27]. In addition, studies on OSTA report strong correlations not only for the Taiwanese population [28,29] but also for populations of the Philippines, Japan, Korea, Malaysia, Thailand, Singapore, and China [16,19,20,21,22,23,24,30].…”

“…The risk of osteoporosis in the high-, medium- and low-risk categories was found to be 61%, 15% and 3%, respectively [16]. A significant positive correlation was found between the OSTA index and T-scores of BMD measured by dual energy X-ray absorptiometry at the femoral neck [24,25]. The probability of a patient with an OSTA score < −4 having osteoporosis is 53.8% [23].…”

Systematic review and meta-analysis of the performance of clinical risk assessment instruments for screening for osteoporosis or low bone density

“…Studies that evaluated OST for women reported performance estimates ranging from a high sensitivity of 99 % and corresponding specificity of 15 % with use of a threshold of <6 to identify perimenopausal and early postmenopausal women in Denmark with osteoporosis [96] to a low sensitivity of 17.7 % (95%CI 16.0–19.5 %) and corresponding specificity of 95.7 % (95%CI 94.8–96.4 %) with use of a threshold of −3 to identify postmenopausal women in Argentina with osteoporosis [100]; AUCs ranged from 0.652 (95%CI 0.604–0.699) [72] to 0.77 [95]. Studies that evaluated OST to identify men with osteoporosis or low BMD at the femoral neck, total hip, or lumbar spine reported performance estimates ranging from a high sensitivity of 93 % and corresponding specificity of 66 % with use of a threshold of 3 to identify US male veterans with osteoporosis [11] to a low sensitivity of 6 % and corresponding specificity of 94 % with use of a threshold of −2 to identify US men with rheumatoid arthritis with osteoporosis [92]; AUCs ranged from 0.590 (95%CI 0.492–0.688) when evaluating OST with a threshold of <4 in Portuguese men aged ≥50 [73] to 0.993 in a subgroup analysis of US male veterans aged ≥80 [11]. …”

“…Reported sensitivities and specificities for OSTA for identifying men with osteoporosis at the femoral neck, total hip, or lumbar spine ranged from a high sensitivity of 87.33 % and corresponding specificity of 56.20 % with use of a threshold of ≤−1 for Chinese men aged ≥50 years [69] to a low sensitivity of 38.2 % and corresponding specificity of 82.1 % with use of a threshold of <1 for Portuguese men aged ≥50 years [73]; AUCs ranged from 0.597 (95%CI 0.497–0.697) [73] to 0.676 (95%CI 0.612–0.732) [117]. …”

Association between the Osteoporosis Self-Assessment Tool for Asians Score and Mortality in Patients with Isolated Moderate and Severe Traumatic Brain Injury: A Propensity Score-Matched Analysis

“…The risk of osteoporosis in the high-, medium- and low- risk patients was found to be 61%, 15% and 3%, respectively [3,6]. The OSTA score has a significant positive correlation with the T-scores of bone mineral density as measured by dual-energy X-ray absorptiometry [7,8], and has been validated as an effective and feasible screening method in many Asian countries [3,6,7,9,10,11,12,13,14] to identify both men and women [4,8,15,16] with low bone mineral density who are at risk for osteoporosis.…”