ORIGINAL ARTICLE
Performance of Risk Indices for Identifying Low Bone Density in Postmenopausal Women

https://doi.org/10.4065/77.7.629Get rights and content

Objective

To examine the ability of 4 published osteoporosis risk indices to identify women with low bone density.

Subjects and Methods: Subjects included postmenopausal women 45 years and older consecutively recruited from US clinics, women from general practice centers in the Netherlands (age range, 50-80 years), women in the Rotterdam Study (the Netherlands) 55 years and older, and women aged 55 to 81 years old screened for a clinical trial of alendronate. Bone mineral density (BMD) was measured at the femoral neck or lumbar spine; T scores represent the number of SDs below the mean for young healthy women. One risk index was calculated from age and weight; the other risk indices included up to 4 additional variables obtained by questionnaire. We calculated the sensitivity and specificity for identifying women with BMD T scores of -2.5 or less or -2.0 or less in the US clinic sample and created 3 risk categories, using each of the 4 indices.

Results

Data were available for 1102 women from the US clinic sample, 3374 women in the Rotterdam Study, 23,833 women screened for a clinical trial of alendronate, and 4204 women from general practice centers in the Netherlands. Specificity for identifying BMD T scores of -2.5 or less ranged from 37% to 58% (depending on risk index) when sensitivity was approximately 90%. The prevalence of osteoporosis (defined as T scores ≤-2.5) differed widely across the 3 risk categories, ranging from 2% to 4% for the low-risk category to 47% to 61% for the high-risk category in the US clinic sample. For spine BMD in the US clinic sample, the prevalence of T scores of -2.5 or less ranged from 7% (low risk) to 38% (high risk). The large differences in prevalence across risk categories were consistent across the other 3 samples of postmenopausal women in the United States and the Netherlands for all 4 risk indices.

Conclusions

We recommend measuring BMD in women who are classified as having an increased risk of osteoporosis by using any of these risk indices because all 4 indices appear to predict low bone mass equally well. The Osteoporosis Self-assessment Tool index is easiest to calculate and therefore may be most useful in clinical practice.

Section snippets

Data Collection

The original study to develop the SCORE tool recruited community-dwelling women 45 years and older during the years 1994 to 1995.8 Women were recruited from various offices, including family practice, general medicine, rheumatology, endocrinology, and gynecology offices. In each office, the first 10 to 15 women seen for routine checkup or follow-up were recruited. Patients were excluded if they had anatomy that prevented measurement of spine or hip BMD and if they had metabolic bone disease

RESULTS

The 1102 women from the US clinic sample used in this analysis ranged in age from 45 to 87 years, with a mean of 61 years (Table 1). Other characteristics used in the analyses are shown in Table 1. The prevalence of osteoporosis based on femoral neck BMD increased with age (Figure 1). For example, the proportion of women with T scores of -2.5 or less at the femoral neck increased from approximately 5% (24/527) in those younger than 60 years to 42% (22/52) in those 80 years and older.

The

DISCUSSION

Although most physicians and patients are aware of osteoporosis, it is being diagnosed and appropriately treated in only a small proportion of patients; this is true even for patients who have already had fractures.3, 4, 23, 24 Physicians should consider the evaluation of postmenopausal patients to be a higher priority if we are to curtail the growing tide of fractures that is already a substantial socioeconomic problem in developed countries. Risk indices based on easily obtained information

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