Comparison of Clinical Risk Tools for Predicting Osteoporosis in Women Ages 50-64

Abstract

Objective: The objective of this study was to compare the performance of the US Preventive Services Task Force (USPSTF) recommended WHO Fracture Risk Assessment Tool (FRAX) threshold score of 9.3% (calculated without femoral neck bone density) with the Simple Calculated Osteoporosis Risk Estimate (SCORE), Osteoporosis Self-Assessment Tool (OST), and the Osteoporosis Risk Assessment Instrument (ORAI) to identify osteoporosis in younger women.Methods: We conducted a retrospective review of women ages 50 to 64 years who underwent dualenergy radiographic absorptiometry (DXA) at our institution over a 6-month period. Scores for the FRAX, ORAI, OST, and SCORE tools were calculated using various thresholds: FRAX >9.3%, SCORE >6, OST <2, and ORAI >9. Sensitivity, specificity, and area under the receiver-operating characteristic curve for detection of densitometric osteoporosis by DXA for each tool were compared.Results: A total of 290 women were identified. Of these, 284 (97.9%) were white, and the mean ؎ standard deviation age was 56.6 ؎ 3.4 years. Fifty (17.2%) had osteoporosis of the lumbar spine and/or femoral neck on DXA. Sensitivity, specificity, and area under the receiver-operating characteristic curve for identifying densitometric osteoporosis at the femoral neck and/or spine were 36%, 73%, and 0.55 for FRAX; 74%, 42%, and 0.58 for SCORE; 56%, 69%, and 0.63 for the OST; and 52%, 67%, and 0.60 for the ORAI, respectively.Conclusions: DXA screening based on the USPSTF-recommended FRAX threshold score of 9.3% has a low sensitivity to identify densitometric osteoporosis in women ages 50 to 64. Lowering the threshold score would increase sensitivity but would also increase the number of women sent for screening DXA. Use of the validated SCORE tool would improve sensitivity to identify osteoporosis in this age group.

Performance of osteoporosis self-assessment tool in detecting low bone mineral density in menopausal women

“…The Osteoporosis Risk Assessment Instrument (ORAI) incorporates only the use of estrogens. (8,10) Several studies have been conducted to compare the efficacy of these tools. The study by Pecina et al (8) showed that the sensitivity and AUC were 36% and 55% respectively for FRAX, 74% and 58% for SCORE, 56% and 63% for OST, and 52% and 60% for ORAI.…”

“…(8,10) Several studies have been conducted to compare the efficacy of these tools. The study by Pecina et al (8) showed that the sensitivity and AUC were 36% and 55% respectively for FRAX, 74% and 58% for SCORE, 56% and 63% for OST, and 52% and 60% for ORAI. (8) The study by Rubin et al, (10) comparing FRAX and other tools, found that the performance of FRAX and the other tools were not much different, with the AUC ranging between 70.3%-72.2%.…”

“…The OST scores were categorized with the cut-off value of 2; the BMD was normal if the OST score was ≥2, and low if the OST score was <2. (8,11,12) …”

“…(11) The osteoporosis screening tools take only body weight and age into account. (8)(9)(10) There are several other tools that incorporate more risk factors, eg. the Simple Calculated Osteoporosis Risk Estimation (SCORE), Osteoporosis Risk Assessment Instrument (ORAI), Osteoporosis Index of Risk (OSIRIS), and WHO Fracture Risk Assessment (FRAX).…”

“…The most frequent risk factors used in those tools are among others body weight, age, use of estrogens, and fractures. (8)(9)(10) One of the most easily used tools that nevertheless has relatively high sensitivity (up to 90%) is the osteoporosis self-assessment tool (OST). (11) The osteoporosis screening tools take only body weight and age into account.…”