Osteoporosis Screening in Postmenopausal Women 50 to 64 Years Old: Comparison of US Preventive Services Task Force Strategy and Two Traditional Strategies in the Women's Health Initiative

Abstract

The U.S. Preventive Services Task Force (USPSTF) recommends osteoporosis screening for women younger than 65 years whose 10-year predicted risk of major osteoporotic fracture is ≥ 9.3%. For identifying screening candidates among women aged 50-64 years, it is uncertain how the USPSTF strategy compares with the Osteoporosis Self-Assessment Tool (OST) and the Simple Calculated Osteoporosis Risk Estimate (SCORE). We examined data (1994-2012) from 5165 Women's Health Initiative participants aged 50-64. For the USPSTF (FRAX major fracture risk ≥ 9.3% calculated without BMD), OST (score <2), and SCORE (score >7) strategies, we assessed sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) to discriminate between those with and without femoral neck (FN) T-score ≤ −2.5. Sensitivity, specificity, and AUC for identifying FN T-score ≤ −2.5 were 34.1%, 85.8%, and 0.60 for USPSTF (FRAX), 74.0%, 70.8%, and 0.72 for SCORE, and 79.8%, 66.3%, and 0.73 for OST. The USPSTF strategy identified about 1/3rd of women aged 50-64 with FN T-scores ≤ −2.5. Among women aged 50-64 years, the USPSTF strategy was modestly better than chance alone and inferior to conventional SCORE and OST strategies in discriminating between women with and without FN T-score ≤ −2.5.

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

“…However, they did not evaluate the sensitivities and specificities of the various tools to identify osteoporosis at the lumbar spine. The investigators noted that the currently recommended USPSTF FRAX threshold of 9.3% for screening only identified about one third of women in this age group with osteoporosis at the femoral neck, 8 which is similar to our finding for identifying osteoporosis at the femoral neck and/or lumbar spine.…”

“…Similarly, in a study of women ages 50 to 64 years, Crandall et al 8 found that both OST and SCORE (ORAI was not evaluated) had higher sensitivity to detect osteoporosis at the femoral neck than the current FRAX threshold of 9.3%. However, they did not evaluate the sensitivities and specificities of the various tools to identify osteoporosis at the lumbar spine.…”

“…Previous investigations suggest that the USPSTF FRAX threshold score of an MOF of Ն9.3% to perform DXA in this age group has a low sensitivity for detecting densitometric osteoporosis. 8,9 Clinical prediction rules that were created and validated to assess the likelihood of osteoporosis include the Osteoporosis Risk Assessment Instrument (ORAI), Osteoporosis Self-Assessment Tool (OST), and the Simple Calculated Osteoporosis Risk Estimation (SCORE). 10 -12 The purpose of our study is to evaluate the ability of these 4 clinical prediction rules to identify women with osteoporosis among a cohort of women ages 50 to 64 years, and to compare the sensitivity and specificity of the current USPSTF FRAX score threshold of an MOF of 9.3% with the validated ORAI, OST, and SCORE clinical prediction rules for osteoporosis detection.…”

Fracture risk assessment tool (FRAX) and for the diagnosis of osteoporosis in Japanese middle-aged and elderly women: Chiba bone survey

“…5). We previously mentioned that there are two reports to use FRAX for screening of osteoporosis [9,10]. However, these two reports do not check accuracy of cutoff value to diagnose osteoporosis.…”

“…FRAX was used for screening of osteoporosis in two reports [9,10]. However, the subjects were postmenopausal or women older than 55 years.…”