Prescreening tools to determine who needs DXA.
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.
Schwartz
Elliott N
EN
The Northern California Institute for Bone Health, Inc., 3100 Telegraph Avenue, Suite 3000, Oakland, CA 94609, USA. Administrator@betterbones.org
Steinberg
Dee M
DM
D015502:Absorptiometry, Photon / Q000706:statistics & numerical data*; D015519:Bone Density / Q000502:physiology; D020000:Decision Support Systems, Clinical; D003661:Decision Support Techniques; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D010024:Osteoporosis / Q000175:diagnosis* / Q000503:physiopathology; D018579:Patient Selection; D018570:Risk Assessment / Q000379:methods; D012680:Sensitivity and Specificity