title: Osteoporosis screening in postmenopausal women 50 to 64 years old: comparison of US Preventive Services Task Force strategy and two traditional strategies in the Women's Health Initiative.
abstract: The US Preventive Services Task Force (USPSTF) recommends osteoporosis screening for women younger than 65 years whose 10-year predicted risk of major osteoporotic fracture is ≥ 9.3%. For identifying screening candidates among women aged 50 to 64 years, it is uncertain how the USPSTF strategy compares with the Osteoporosis Self-Assessment Tool (OST) and the Simple Calculated Osteoporosis Risk Estimate (SCORE). We examined data (1994 to 2012) from 5165 Women's Health Initiative participants aged 50 to 64 years. For the USPSTF (Fracture Risk Assessment Tool [FRAX] major fracture risk ≥ 9.3% calculated without bone mineral density [BMD]), OST (score <2), and SCORE (score >7) strategies, we assessed sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) to discriminate between those with and without femoral neck (FN) T-score ≤-2.5. Sensitivity, specificity, and AUC for identifying FN T-score ≤-2.5 were 34.1%, 85.8%, and 0.60 for USPSTF (FRAX); 74.0%, 70.8%, and 0.72 for SCORE; and 79.8%, 66.3%, and 0.73 for OST. The USPSTF strategy identified about one-third of women aged 50 to 64 years with FN T-scores ≤-2.5. Among women aged 50 to 64 years, the USPSTF strategy was modestly better than chance alone and inferior to conventional SCORE and OST strategies in discriminating between women with and without FN T-score ≤-2.5.
authors.affiliation: Department of Internal Medicine, University of California at Los Angeles, Los Angeles, CA, USA.
authors.forename: Carolyn J
authors.initials: CJ
authors.lastname: Crandall
authors.forename: Joseph
authors.initials: J
authors.lastname: Larson
authors.forename: Margaret L
authors.initials: ML
authors.lastname: Gourlay
authors.forename: Meghan G
authors.initials: MG
authors.lastname: Donaldson
authors.forename: Andrea
authors.initials: A
authors.lastname: LaCroix
authors.forename: Jane A
authors.initials: JA
authors.lastname: Cauley
authors.forename: Jean
authors.initials: J
authors.lastname: Wactawski-Wende
authors.forename: Margery L
authors.initials: ML
authors.lastname: Gass
authors.forename: John A
authors.initials: JA
authors.lastname: Robbins
authors.forename: Nelson B
authors.initials: NB
authors.lastname: Watts
authors.forename: Kristine E
authors.initials: KE
authors.lastname: Ensrud
mesh_terms: D026683:Advisory Committees; D000368:Aged; D019540:Area Under Curve; D015519:Bone Density; D005260:Female; D005272:Femur Neck / Q000503:physiopathology; D006801:Humans; D008875:Middle Aged; D010024:Osteoporosis / Q000175:diagnosis* / Q000503:physiopathology / Q000517:prevention & control*; D017698:Postmenopause / Q000502:physiology*; D011237:Predictive Value of Tests; D012372:ROC Curve; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014481:United States; D016387:Women's Health
keywords: BONE MINERAL DENSITY; FRACTURE; FRACTURE RISK ASSESSMENT TOOL; OSTEOPOROSIS; USPSTF, OST, SCORE, FRAX