Beyond bone mineral density: can existing clinical risk assessment instruments identify women at increased risk of osteoporosis?
OBJECTIVE
Although osteoporosis and fragility fracture are common amongst postmenopausal women, the extent of risk varies, and measurement of bone mineral density (BMD) is the standard tool used to diagnose and assess fracture risk. Rates of diagnosis remain relatively low, and several groups have developed instruments to help identify individuals who would most benefit from BMD testing. In this paper, we review and compare the performance of these instruments to identify those most useful in the primary care setting.


METHODS
Review of screening instruments comprised osteoporosis clinical risk factors and comparison of the sensitivity and specificity of these algorithms.


RESULTS
Validated instruments have varying complexity, but similar sensitivity and specificity for identifying individuals who are likely to have low BMD. The area under the receiver operating characteristic curve ranges from 0.75 (SOFSURF) to 0.81 (SCORE). The simplest of the instruments (OST) uses only age and weight and has an AUC of 0.79.


CONCLUSIONS
The Osteoporosis Self-assessment Tool, the simplest of the instruments, performs as well as more complex tools and, because of its simplicity, may be the most useful means for the busy clinician to identify postmenopausal women who would most benefit from BMD testing.
Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, MD, USA. lois_wehren@msn.com
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Wehren
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Siris
D015519:Bone Density; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000379:methods; D010024:Osteoporosis / Q000175:diagnosis* / Q000503:physiopathology; D018570:Risk Assessment / Q000592:standards*; D012307:Risk Factors