title: Osteoporosis screening in postmenopausal women aged 50-64 years: BMI alone compared with current screening tools.
abstract: OBJECTIVE
  Consensus on when to initiate DXA screening for early postmenopausal women (< 65 years of age) is lacking. Low body mass index (BMI) has been proposed as one of the major risk factors for osteoporosis. This study sought to compare the predictive performance of BMI alone with 5 screening modalities (the U.S. Preventive services task force [USPSTF] FRAX threshold of 9.3%, a risk factor based approach [≥ 1 risk factors], the osteoporosis self-assessment tool [OST < 2], the osteoporosis risk assessment instrument [ORAI ≥ 9], and the simple calculated osteoporosis risk estimation [SCORE ≥ 6]) in identifying early postmenopausal women with osteoporosis.
  
  
  METHODS
  Postmenopausal women aged 50-64 years presenting for a DXA test were recruited between January 1, 2007, and March 1, 2009. Demographic data and osteoporosis risk factors were obtained through a telephone survey. The performance of each screening tool in predicting osteoporosis was compared.
  
  
  RESULTS
  Of 445 study participants, 95% were White, 38 had osteoporosis (T-score ≤ -2.5). BMI (< 28) was associated with the highest Sensitivity (95%), the lowest Negative Likelihood Ratio (LR-) of 0.14, an AUC of 0.73, and the number needed to scan (NNS) of 8. The USPSTF approach had the lowest sensitivity (24%), highest LR- (0.91), lowest AUC (0.62), and highest NNS (9). Among 5 established modalities, SCORE (≥ 6) appears to be the best (sensitivity: 92%, LR-: 0.24, AUC: 0.75, NNS: 9).
  
  
  CONCLUSIONS
  BMI (< 28) had a comparable numerical screening performance overall to the current screening modalities. BMI (< 28) could be considered a potential indicator when screening early postmenopausal White women for osteoporosis. However, a better osteoporosis screening tool remains to be developed.
authors.affiliation: Reading Hospital, Department of Obstetrics and Gynecology, Reading, PA, United States; Sidney Kimmel Medical College of Thomas Jefferson University, Department of Obstetrics and Gynecology, Philadelphia, PA, United States. Electronic address: Daniel.Jiang@readinghealth.org.
authors.forename: Xuezhi
authors.initials: X
authors.lastname: Jiang
authors.affiliation: Reading Hospital, Department of Obstetrics and Gynecology, Reading, PA, United States.
authors.forename: Lauren E
authors.initials: LE
authors.lastname: Good
authors.affiliation: Reading Hospital, Department of Obstetrics and Gynecology, Reading, PA, United States.
authors.forename: Ryan
authors.initials: R
authors.lastname: Spinka
authors.affiliation: Reading Hospital, Department of Obstetrics and Gynecology, Reading, PA, United States; Reading Hospital, Department of Internal Medicine, Reading, PA, United States; Sidney Kimmel Medical College of Thomas Jefferson University, Department of Obstetrics and Gynecology, Philadelphia, PA, United States; Sidney Kimmel Medical College of Thomas Jefferson University, Department of Internal Medicine, Philadelphia, PA, United States.
authors.forename: Peter F
authors.initials: PF
authors.lastname: Schnatz
mesh_terms: D015502:Absorptiometry, Photon; D019540:Area Under Curve; D015992:Body Mass Index; D015519:Bone Density; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D010024:Osteoporosis / Q000175:diagnosis*; D017698:Postmenopause; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors
keywords: Bone mineral density; DXA scan; Early postmenopausal women; Osteoporosis screening