title: Performance of risk indices for identifying low bone mineral density and osteoporosis in Mexican Mestizo women with rheumatoid arthritis.
abstract: OBJECTIVE
  We evaluated the utility of 6 generic and 2 specific risk indices for identifying low bone mineral density (BMD) or osteoporosis in women with rheumatoid arthritis (RA); and their correlation with 10-year probability of fractures as assessed with the World Health Organization fracture risk assessment (FRAX) tool.
  
  
  METHODS
  Mexican Mestizo women with RA were evaluated in this cross-sectional study using 6 generic indices [Simple Calculated Osteoporosis Risk Estimation (SCORE); Osteoporosis Risk Assessment Instrument (ORAI); Osteoporosis Self-Assessment Tool; Age, Body Size, No Estrogen; Osteoporosis Index of Risk (OSIRIS); and Guidelines of the US National Osteoporosis Foundation], 2 specific indices (Amsterdam and modified Amsterdam), and FRAX. BMD results on dual-energy x-ray absorptiometry (DEXA) at the lumbar spine and femoral neck were considered the "gold standard." Sensitivity, specificity, and predictive values (PV) of the indices and their correlations with FRAX results were estimated.
  
  
  RESULTS
  Among 191 patients, 46 had osteoporosis (24.1%) and 119 had low BMD (62.3%). For predicting osteoporosis, SCORE showed the highest sensitivity (96%), whereas OSIRIS (87%) and ORAI (82%) showed the highest specificities. OSIRIS also had the greatest positive PV (92%). The specific indices had low sensitivity and low specificity (Amsterdam, 50% and 79%, respectively; modified Amsterdam, 56% and 70%). All the indices had a low but significant correlation with FRAX.
  
  
  CONCLUSIONS
  These findings support the use of some generic indices to identify patients with RA who should undergo DEXA testing. Currently available specific indices did not perform satisfactorily. New specific risk indices for osteoporosis in RA should be developed to increase sensitivity and specificity for predicting osteoporosis.
authors.affiliation: Department of Internal Medicine-Rheumatology, Hospital General Regional 110, Instituto Mexicano del Seguro Social and University Center of Health Sciences, University of Guadalajara, Guadalajara, Mexico.
authors.forename: Laura
authors.initials: L
authors.lastname: Gonzalez-Lopez
authors.forename: Jorge I
authors.initials: JI
authors.lastname: Gamez-Nava
authors.forename: Anahi
authors.initials: A
authors.lastname: Vega-Lopez
authors.forename: N Alejandra
authors.initials: NA
authors.lastname: Rodriguez-Jimenez
authors.forename: Norma
authors.initials: N
authors.lastname: Gonzalez-Montoya
authors.forename: Erika
authors.initials: E
authors.lastname: Aguilar-Chavez
authors.forename: M Fabiola
authors.initials: MF
authors.lastname: Alcaraz-Lopez
authors.forename: Alberto D
authors.initials: AD
authors.lastname: Rocha-Muñoz
authors.forename: Natasha
authors.initials: N
authors.lastname: Castro-Lizano
authors.forename: Jaime
authors.initials: J
authors.lastname: Morales-Romero
authors.forename: Mario
authors.initials: M
authors.lastname: Salazar-Paramo
authors.forename: Maria E
authors.initials: ME
authors.lastname: Suarez-Almazor
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging* / Q000453:epidemiology; D015519:Bone Density; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D003661:Decision Support Techniques; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging* / Q000453:epidemiology; D006801:Humans; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D010024:Osteoporosis / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000453:epidemiology; D015995:Prevalence; D012306:Risk; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D050071:Bone Density Conservation Agents