title: Comparisons of Different Screening Tools for Identifying Fracture/Osteoporosis Risk Among Community-Dwelling Older People.
abstract: A prospective study was conducted to compare criterion, predictive, and construct validities of 9 fracture/osteoporosis assessment tools, including calcaneal quantitative ultrasonography (QUS), Age Bulk One or Never Estrogens (ABONE), body weight criterion (BWC), Fracture Risk Assessment Tool (FRAX), Garvan fracture risk calculator (GARVAN), Osteoporosis Risk Assessment Instrument (ORAI), Osteoporosis Index of Risk (OSIRIS), Osteoporosis Self-Assessment Tool for Asians (OSTA), and Simple Calculated Osteoporosis Risk Estimation (SCORE), among older men and women in Taiwan.Using the femoral neck dual-energy x-ray absorptiometry (DXA) T-score as an external criterion, the sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios, and the area under the receiver operating characteristic curve (AUC) for each tool were calculated. The ability of these tools to predict injurious falls was examined. A principal component analysis was applied to understand whether these tools were measuring the same underlying construct.The FRAX, BWC, ORAI, OSIRIS, OSTA, and SCORE had AUCs of ≥0.8 in men, while the GARVAN, OSIRIS, OSTA, and SCORE had AUCs of ≥0.8 in women. The sensitivity, negative predictive value, and likelihood ratio of the ABONE, BWC, ORAI, OSIRIS, OSTA, and SCORE tools in both men and women were 100%, ≥90%, and 0.0, respectively; the specificity and positive predictive value and likelihood ratio were far from satisfactory. The GARVAN displayed the best predictive ability of a fall in both men (AUCs, 0.653-0.686) and women (AUCs, 0.560-0.567), despite being smaller in women. The 9 screening tools and 2 central DXA measurements assessed 5 different factors, while the ABONE, BWC, ORAI, OSIRIS, OSTA, and SCORE measured the same one.Simple self-assessment tools can serve as initial screening instruments to rule out persons who have osteoporosis; however, these tools may measure a different construct other than fracture/osteoporosis risk.
authors.affiliation: From the Department of Emergency Medicine (S-JC), Tri-Service General Hospital, National Defense Medical Center; Graduate Institute of Injury Prevention and Control (S-JC, C-YC, M-RL), College of Public Health and Nutrition, Taipei Medical University; Department of Nursing (Y-JC), Cathay General Hospital, Taipei; Department of Emergency Medicine (C-HC), Taichung Branch, Tzu-Chi General Hospital, Taichung, and Department of Nursing (Hei-FH), National Taipei University of Nursing and Health Science, Taipei, Taiwan.
authors.forename: Sy-Jou
authors.initials: SJ
authors.lastname: Chen
authors.forename: Yi-Ju
authors.initials: YJ
authors.lastname: Chen
authors.forename: Chui-Hsuan
authors.initials: CH
authors.lastname: Cheng
authors.forename: Hei-Fen
authors.initials: HF
authors.lastname: Hwang
authors.forename: Chih-Yi
authors.initials: CY
authors.lastname: Chen
authors.forename: Mau-Roung
authors.initials: MR
authors.lastname: Lin
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D019540:Area Under Curve; D002111:Calcaneus / Q000000981:diagnostic imaging*; D059026:Diagnostic Self Evaluation; D005260:Female; D005272:Femur Neck / Q000000981:diagnostic imaging; D006801:Humans; D057187:Independent Living; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D010024:Osteoporosis / Q000175:diagnosis* / Q000000981:diagnostic imaging; D058866:Osteoporotic Fractures / Q000517:prevention & control*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013624:Taiwan; D014463:Ultrasonography