title: Postmenopausal bone density referral decision rules: correlation with clinical fractures.
abstract: OBJECTIVE
  To test decision rules for bone mineral density (BMD) against fractures.
  
  
  METHODS
  We surveyed postmenopausal women in a military primary care clinic and tested three national clinical decision rules (Osteoporosis Risk Assessment Instrument; age, body size, no estrogen; weight) for correlation with fracture history. Outcome measures included relative risk (RR), area under the receiver operating characteristics curve (aROC), sensitivity, and specificity.
  
  
  RESULTS
  Patients were 69 years old on average, 53% were Caucasian, 38% were African American, and 15% had a history of fractures. Caucasian women (RR, 1.8; 95% confidence interval [CI], 1.1-3.1) and those older than 65 years (RR, 2.0; 95% CI, 1.2-3.5) had higher prevalence of fractures. The Osteoporosis Risk Assessment Instrument decision rule had the highest aROC (0.65; 95% CI, 0.57-0.731 and sensitivity (sensitivity, 0.83; specificity, 0.31). Age, Body Size, No Estrogen had the next highest aROC (0.63; 95% CI, 0.54-0.71) and sensitivity (sensitivity, 0.74; specificity, 0.46). Weight criterion was the most specific (aROC, 0.60; 95% CI, 0.52-0.68; sensitivity, 0.64; specificity, 0.56).
  
  
  CONCLUSIONS
  Current postmenopausal bone density referral decision rules only modestly correlate with clinical fractures.
authors.affiliation: Medicine-Educational Programs, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
authors.forename: Gina S
authors.initials: GS
authors.lastname: Wei
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Jackson
mesh_terms: D015502:Absorptiometry, Photon / Q000706:statistics & numerical data*; D000368:Aged; D003657:Decision Making; D005260:Female; D050723:Fractures, Bone / Q000517:prevention & control*; D006772:Hospitals, Military; D006801:Humans; D008396:Maryland; D008875:Middle Aged; D010024:Osteoporosis / Q000000981:diagnostic imaging*; D017698:Postmenopause / Q000502:physiology*; D011237:Predictive Value of Tests; D012017:Referral and Consultation / Q000592:standards*; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology