title: Development and validation of osteoporosis prescreening model for Iranian postmenopausal women.
abstract: BACKGROUND
  Studies have indicated that the commonly used osteoporosis prescreening tools are not appropriate for use in every nation. This study was designed to develop and validate a prescreening model for bone mineral densitometry among Iranian postmenopausal women.
  
  
  METHODS
  From 13613 individuals who were referred for bone mineral densitometry in Shariati hospital in Tehran, 8644 postmenopausal women were considered for the study after excluding men and premenopausal women. Questionnaires regarding the risk factors for osteoporosis were filled for each individual. Bone mineral density at the lumbar vertebrae (L2-L4), femoral neck and total femur was measured by dual X-ray absorptiometry. Using holdout validation, the study sample was divided into two parts; training set (5705) and test set (2939). Logistic regression analysis was performed on the training set. A scoring model was developed and tested in the test set.
  
  
  RESULTS
  Based on the training set, a seven-variable model named OPMIP (Osteoporosis Prescreening Model for Iranian Postmenopausal women) was developed with C statistics (area under curve) of 0.72. Using a cut-off of -2.5 for the model, the sensitivity, specificity, positive predictive value and negative predictive value were 72%, 59.5%, 64% and 69% respectively. The model performance was tested in the test set. OPMIP correctly classified 67.10% of cases with a sensitivity and specificity of 73.2% and 61%.
  
  
  CONCLUSIONS
  In order to appropriately refer patients for a bone mineral densitometry, OPMIP can be used as a prescreening tool in Iranian Postmenopausal women.
authors.affiliation: School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Nassim
authors.initials: N
authors.lastname: Matin
authors.affiliation: School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Omidreza
authors.initials: O
authors.lastname: Tabatabaie
authors.affiliation: Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Abbasali
authors.initials: A
authors.lastname: Keshtkar
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Kamran
authors.initials: K
authors.lastname: Yazdani
authors.affiliation: Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Mojgan
authors.initials: M
authors.lastname: Asadi
keywords: Holdout validation; Logistic regression; Osteoporosis; Prescreening; Scoring
references.citation: Am J Prev Med. 2009 Apr;36(4):366-75
references.pmid: 19285200
references.citation: Osteoporos Int. 2012 Apr;23(4):1371-9
references.pmid: 21769663
references.citation: Calcif Tissue Int. 2007 Mar;80(3):147-53
references.pmid: 17340222
references.citation: Indian J Orthop. 2011 Jan;45(1):15-22
references.pmid: 21221218
references.citation: JAMA. 2002 Oct 16;288(15):1898-900
references.pmid: 12377089
references.citation: Osteoporos Int. 2009 Apr;20(4):599-607
references.pmid: 18716823
references.citation: Osteoporos Int. 2011 Oct;22(10):2575-86
references.pmid: 21484361
references.citation: Osteoporos Int. 2012 Sep;23(9):2239-56
references.pmid: 22419370
references.citation: Semin Nucl Med. 1997 Jul;27(3):261-75
references.pmid: 9224666
references.citation: Yonsei Med J. 2013 Nov;54(6):1321-30
references.pmid: 24142634
references.citation: J Gen Intern Med. 2006 Jun;21(6):630-5
references.pmid: 16808748
references.citation: Aust Fam Physician. 1997 Oct;26(10):1181-5, 1188-91, 1194-6
references.pmid: 9339594
references.citation: J Bone Miner Res. 2006 May;21(5):765-71
references.pmid: 16734392
references.citation: Ann Intern Med. 2002 Sep 17;137(6):529-41
references.pmid: 12230356
references.citation: Osteoporos Int. 2011 May;22(5):1401-9
references.pmid: 20683710
references.citation: J Clin Epidemiol. 2001 Aug;54(8):774-81
references.pmid: 11470385
references.citation: Bone. 2001 Oct;29(4):374-80
references.pmid: 11595621
references.citation: Am J Manag Care. 1998 Jan;4(1):37-48
references.pmid: 10179905
references.citation: J Clin Endocrinol Metab. 2002 Jul;87(7):3057-67
references.pmid: 12107201
references.citation: J Bone Miner Res. 2013 Aug;28(8):1701-17
references.pmid: 23592255
references.citation: Osteoporos Int. 2007 Sep;18(9):1177-87
references.pmid: 17361324
references.citation: Osteoporos Int. 2005 Jul;16(7):764-72
references.pmid: 15986263
references.citation: CMAJ. 2000 May 2;162(9):1289-94
references.pmid: 10813010
references.citation: Osteoporos Int. 2001;12(8):699-705
references.pmid: 11580084
references.citation: Bone. 2008 Mar;42(3):467-75
references.pmid: 18180210
references.citation: Osteoporos Int. 2008 Aug;19(8):1175-83
references.pmid: 18219434
references.citation: Bone. 2013 Sep;56(1):16-22
references.pmid: 23669650
references.citation: J Adv Nurs. 2006 Jun;54(5):572-84
references.pmid: 16722955
references.citation: Ann Intern Med. 1990 Jan 15;112(2):96-101
references.pmid: 2294827
references.citation: BMJ. 2006 May 6;332(7549):1089-92
references.pmid: 16675820