Comparison of different screening tools (FRAX®, OST, ORAI, OSIRIS, SCORE and age alone) to identify women with increased risk of fracture. A population-based prospective study

Abstract

Comparison of FRAX® and simpler screening tools (OST, ORAI, OSIRIS, SCORE) in predicting fractures indicate that FRAX® did not perform better in fracture risk prediction compared with the simpler tools or even age alone in a screening scenario without bone mineral density assessment.

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

“…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%. (10) These studies have demonstrated that the increase in added risk factors in these tools did not add to the performance in evaluating the risk of low bone mass.…”

“…(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%. (10) These studies have demonstrated that the increase in added risk factors in these tools did not add to the performance in evaluating the risk of low bone mass. Age and body weight are the most influential risk factors for osteoporosis (4,5,19) so that the other factors added to these screening tools could not much increase their performance.…”

“…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.…”

“…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.…”

“…(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).…”