The diagnostic value of combined risk factor analysis and radiological imaging in determining osteoporosis in post-menopausal women.
OBJECTIVE
To determine the diagnostic value of risk factor analysis (age, duration of menopause, body mass index and physical activities) and radiological imaging (Singh index and cortical index of the femoral neck) in diagnosing osteoporosis in post-menopausal women.


METHODS
The study was cross sectional on 64 post-menopausal women without secondary risk factor for osteoporosis. They were classified proportionally using the Singh index. Bone density was measured using DEXA (dual x-ray absorptiometry) on the femoral neck and lumbal 2-4 spine areas. The Singh index and cortical index of the femoral neck were evaluated using femoral neck antero-posterior x-ray. Physical activities were measured using a Historical leisure activity questionnaire. Bivariat statistical analysis was conducted using the t-test and chi-square, whereas multivariate analysis was conducted using multinomial logistic regression.


RESULTS
There was a significant association (p<0.05) between bone density and age, body weight, height, body mass index, duration of menopause and Singh index. With multinomial logistic regression analysis, it was demonstrated that only Singh index, the duration of menopause and body mass index had the highest sensitivity and specificity. The score system algorithm could be utilized in two steps, the first was to diagnose osteoporosis and the second was to distinguish between osteopenia and normal bone. This score system had a sensitivity of 91.4% and a specificity of 89.6%, a positive prediction value of 91.4% in determining osteoporosis, and a sensitivity of 66.7%, a specificity of 89.1% and a positive prediction value of 70.6% in determining osteopenia, whereas the negative prediction value was 75%.


CONCLUSIONS
The score system algorithm is the best method for determining osteoporosis in post-menopausal women. If there is osteopenia, evaluation using DEXA is then required. The score system algorithm cannot be used to follow up the therapy.
Trijoto
Indah
I
Department of Internal Medicine, Faculty of Medicine, University of Indonesia-Dr.Cipto Mangunkusumo National General Hospital, Jakarta.
Isbagio
Harry
H
Setiyohadi
Bambang
B
Soegondo
Sidartawan
S
Kusumawidjaja
Kahar
K
Ariawan
Iwan
I
D000367:Age Factors; D000368:Aged; D001835:Body Weight; D015519:Bone Density; D003430:Cross-Sectional Studies; D015444:Exercise; D005260:Female; D005272:Femur Neck / Q000000981:diagnostic imaging*; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000000981:diagnostic imaging* / Q000209:etiology; D011237:Predictive Value of Tests; D011859:Radiography; D018570:Risk Assessment; D012307:Risk Factors