Prescreening tools to determine who needs DXA

Abstract

Clinical decision rules (CDRs) are designed to help physicians practice better. A number of CDRs to assist in identifying women with low bone mass have been developed since the mid 1990s, including SCORE, OST (OSTA), OSIRIS, SOFSURF, NOF, ABONE, pBW, ORAI, and weight-only-EPIDOS (which we have termed WO-E). This review discusses these CDRs in terms of development and validation cohorts and their sensitivity and specificity. The sensitivities of the available CDRs exceed 80% and specificities are about 50%. After much analysis, it appears that most experts prefer OST for its simplicity and SCORE for its flexibility, but there is no consensus on what risk factors to use in the CDRs and what regions of interest (spine, total hip, femoral neck, or a combination) to test with dual-energy x-ray absorptiometry (DXA). Because of the lack of consensus, there are barriers to the clinical application of these CDRs. Agreement on a single CDR for worldwide use is required to optimally fulfill the objective of identifying low bone mass.

Panoramic radiographs for identifying individuals with undetected osteoporosis

“…Several clinical decision-making rules to assist in identifying postmenopausal women with low BMD or osteoporosis have been developed since the mid-1990s. Nevertheless, the clinical application of these rules to determine which patients require DXA is complicated due to a lack of consensus [14].…”

Osteoporosis: are healthcare professionals missing an opportunity

“…The purpose of such tools is to categorize individuals according to their risk status, to select most suitable candidates for bone scan and initiation of therapy according to level of risk e.g. dietary and lifestyle modifications in low to medium risk individuals while pharmacological therapy for one with high risk (Schwartz & Steinberg 2006; Elliott & Meek 2002). Ultimately use of osteoporosis prescreening tools would result in better utilization of bone densitometry, reduce economic burden associated with osteoporosis as well as improved patient quality of life (Tellier & Maeseneer 2001).…”

Cost-Effectiveness of Using Clinical Risk Factors with and without DXA for Osteoporosis Screening in Postmenopausal Women

“…Although a case finding based on DXA alone (compared with fractures that will occur in the following 10 years) has a specificity (proportion of true‐negatives) of approximately 90%, its sensitivity (proportion of true‐positives) is only 34% [11]. Different strategies based on CRFs alone, in turn, have shown to exceed a sensitivity of 80% although their specificity is only about 50% (compared with the reference standard low BMD measured by DXA) [12]. Thus, predicting fracture risk based on CRFs in addition to BMD increases the GR for the prediction of hip and other fractures [4].…”