Development and assessment of the Osteoporosis Index of Risk (OSIRIS) to facilitate selection of women for bone densitometry

Abstract

A simple questionnaire would be useful to identify individuals most in need of bone mineral density (BMD) testing. We designed a new predictive model and risk assessment instrument based on an extensive review of the literature evaluating risk factors for osteoporosis, and tested its performance in a large cohort of postmenopausal women in whom BMD was measured by dual x-ray absorptiometry. In total, 1303 postmenopausal women from an outpatient osteoporosis clinic participated in this study. The Osteoporosis Index of Risk (OSIRIS) is based on four variables: age, body weight, current hormone replacement therapy use and history of previous low impact fracture. The sensitivity and specificity for an OSIRIS value of +1 were respectively 78.5% and 51.4%. The AUC under the ROC curve of OSIRIS was 0.71. Three categories were arbitrarily created using OSIRIS, with cutoff of +1 and -3. The low risk category (OSIRIS > +1) represented 41% of all women; only 7% of the women in this category had osteoporosis. The prevalence of osteoporosis was very high (66%) among the group at high risk (OSIRIS < -3 representing 15% of all women). The prevalence of osteoporosis was 39% in the intermediate risk group (-3 < OSIRIS < +1, 44% of all women). In conclusion, OSIRIS is a simple index based on four easy-to-collect variables from postmenopausal women, it shows a high degree of accuracy, and performed well for classifying the degree of risk of osteoporosis in western European women of Caucasian lineage. Based on this instrument it is possible to propose a strategy that would initiate treatment in women with very high risk, postpone BMD measurement in women with low risk and limit BMD measurement to women with intermediate risk of osteoporosis, this would spare more than 55% of the densitometry bill compared with a mass screening scenario.

The role of the dental surgeon in detecting osteoporosis: the OSTEODENT study

“…The Osteoporosis Index of Risk (OSIRIS) is based on four variables: 10 age, body weight, current hormone replacement therapy (HRT) use and history of previ ous low impact fracture. The index is calculated by adding together:…”

“…Hip frac tures, in particular, are associated with significant mortality and morbidity in the elderly, 1 but in one study, less than one fifth (18%) of high risk peo ple had received medical treatment for osteoporosis before the occurrence of hip fracture. 2 The current failure to assess and treat patients at high risk of osteoporosis may be partly due to 1* School of Dentistry, University of Manchester; 2,3,7,8 Im aging Science and Biomedical Engineering, University of Manchester; 4 Oral Imaging Centre, Katholieke Uni versiteit, Belgium; 5 Oral Diagnosis and Radiology, Den tal School of Athens; 6 Faculty of Odontology, Malmo University, Sweden; 9,11 School of Dentistry, University of Manchester; 10 insufficient resources or time, but a failure of health professionals to iden tify risk factors and refer the patient for defi nitive diagnosis using dual-energy X-ray absorptiometry (DXA) is an important contributory factor.…”

Diagnostic Feature Extraction on Osteoporosis Clinical Data Using Genetic Algorithms

“…Apart from one instrument that uses only one parameter (body weight) [12] all other instruments include age and body weight, and some also include hormone replacement therapy [13 -15]. History of fracture is included in two [13,15] while one of them includes also history of rheumatoid arthritis and race [15].…”

Validation of the Dutch guidelines for dual X-ray absorptiometry measurement

“…In Table 5 the construct validity of some of these is shown and compared to that of the current study. [9][10][11][12][13][14][15][16][17][18][19] Although sensitivity of the majority of these instruments is high, most are limited by moderate specificity and PPV. The Dutch case-finding instrument showed the poorest outcomes.…”

“…2,6 To date, several case-finding instruments have been developed and validated. [9][10][11][12][13][14][15][16][17][18] However, there is no universally accepted policy.…”