title: Osteoporosis risk assessment and ethnicity: validation and comparison of 2 clinical risk stratification instruments.
abstract: BACKGROUND
  Dual energy x-ray absorptiometry (DXA), coupled with early treatment, may reduce morbidity and mortality associated with osteoporosis. Clinical tools to enhance selection of women for DXA screening have not been developed or validated in an ethnically diverse population.
  
  
  OBJECTIVE
  To compare the performance of the osteoporosis risk assessment instrument (ORAI) and the simple calculated osteoporosis risk estimation (SCORE) instrument across 3 racial/ethnic groups to identify women who would benefit from DXA scans.
  
  
  METHODS
  Blinded comparison of the instruments in a cross-sectional sample.
  
  
  METHODS
  Two-hundred twenty-six postmenopausal women were recruited from a university-based family medicine clinic. Women with a prior diagnosis of osteoporosis or those taking bone active medications were excluded.
  
  
  METHODS
  Participants completed a questionnaire that contained the ORAI and the SCORE questions; 203 completed a DXA scan.
  
  
  RESULTS
  The sensitivity and specificity for the ORAI (0.68, [0.49 to 0.88, 95% CI]; 0.66, [0.59 to 0.73, 95% CI]) and the SCORE instrument (0.54, [0.34 to 0.75, 95% CI]; 0.72, [0.65 to 0.78, 95% CI]) differed significantly from previous reports. Overall, the accuracy of the ORAI (66.5%) and SCORE instrument (70.0%) were similar (McNemar's test P value = .37). The accuracy between instruments differed significantly in African-American women (McNemar's test, P value <.001). In African Americans, the SCORE instrument correctly identified more women without osteoporosis, but missed 70% of those with osteoporosis.
  
  
  CONCLUSIONS
  The performance of the ORAI and SCORE instrument differed significantly from previous reports. Although both can reduce the use of DXA scans for screening for osteoporosis, lower sensitivities resulted in underrecognition of osteoporosis and may limit their clinical usefulness in an ethnically diverse population.
authors.affiliation: The University of Texas Medical Branch, Galveston, TX 77555-1123, USA. acass@utmb.edu
authors.forename: Alvah R
authors.initials: AR
authors.lastname: Cass
authors.forename: Angela J
authors.initials: AJ
authors.lastname: Shepherd
authors.forename: Carol A
authors.initials: CA
authors.lastname: Carlson
mesh_terms: D000368:Aged; D044383:Black People; D002986:Clinical Trials as Topic; D003430:Cross-Sectional Studies; D006630:Hispanic or Latino; D006801:Humans; D008875:Middle Aged; D010024:Osteoporosis / Q000145:classification* / Q000453:epidemiology*; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D014481:United States; D001741:Black or African American