title: Evaluation of the validity of osteoporosis and fracture risk assessment tools (IOF One Minute Test, SCORE, and FRAX) in postmenopausal Palestinian women.
abstract: The need for simple self-assessment tools is necessary to predict women at high risk for developing osteoporosis. In this study, tools like the IOF One Minute Test, Fracture Risk Assessment Tool (FRAX), and Simple Calculated Osteoporosis Risk Estimation (SCORE) were found to be valid for Palestinian women. The threshold for predicting women at risk for each tool was estimated.
  
  
  OBJECTIVE
  The purpose of this study is to evaluate the validity of the updated IOF (International Osteoporosis Foundation) One Minute Osteoporosis Risk Assessment Test, FRAX, SCORE as well as age alone to detect the risk of developing osteoporosis in postmenopausal Palestinian women.
  
  
  METHODS
  Three hundred eighty-two women 45 years and older were recruited including 131 women with osteoporosis and 251 controls following bone mineral density (BMD) measurement, 287 completed questionnaires of the different risk assessment tools. Receiver operating characteristic (ROC) curves were evaluated for each tool using bone BMD as the gold standard for osteoporosis.
  
  
  RESULTS
  The area under the ROC curve (AUC) was the highest for FRAX calculated with BMD for predicting hip fractures (0.897) followed by FRAX for major fractures (0.826) with cut-off values ˃1.5 and ˃7.8%, respectively. The IOF One Minute Test AUC (0.629) was the lowest compared to other tested tools but with sufficient accuracy for predicting the risk of developing osteoporosis with a cut-off value ˃4 total yes questions out of 18. SCORE test and age alone were also as good predictors of risk for developing osteoporosis. According to the ROC curve for age, women ≥64 years had a higher risk of developing osteoporosis. Higher percentage of women with low BMD (T-score ≤-1.5) or osteoporosis (T-score ≤-2.5) was found among women who were not exposed to the sun, who had menopause before the age of 45 years, or had lower body mass index (BMI) compared to controls. Women who often fall had lower BMI and approximately 27% of the recruited postmenopausal Palestinian women had accidents that caused fractures.
  
  
  CONCLUSIONS
  Simple self-assessment tools like FRAX without BMD, SCORE, and the IOF One Minute Tests were valid for predicting Palestinian postmenopausal women at high risk of developing osteoporosis.
authors.affiliation: Faculty of Health Professions, Al-Quds University, Jerusalem, Palestine. akram.kharroubi@gmail.com.
authors.forename: Akram
authors.initials: A
authors.lastname: Kharroubi
authors.affiliation: Palestinian Osteoporosis Prevention Society [POPS], Bethlehem, Palestine.
authors.forename: Elias
authors.initials: E
authors.lastname: Saba
authors.affiliation: Faculty of Health Professions, Al-Quds University, Jerusalem, Palestine.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Ghannam
authors.affiliation: Palestinian Osteoporosis Prevention Society [POPS], Bethlehem, Palestine.|Medical Research Center, Al-Quds University, Jerusalem, Palestine.|Faculty of Allied Medical Sciences, Arab American University-Jenin AAUJ, Jenin, Palestine.
authors.forename: Hisham
authors.initials: H
authors.lastname: Darwish
mesh_terms: D000368:Aged; D018912:Arabs; D015519:Bone Density; D005260:Female; D006801:Humans; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000150:complications / Q000175:diagnosis; D058866:Osteoporotic Fractures / Q000453:epidemiology / Q000209:etiology; D017698:Postmenopause / Q000502:physiology; D011379:Prognosis; D012372:ROC Curve; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors
keywords: BMD; FRAX; IOF One Minute Test; Postmenopausal osteoporosis; ROC curve; SCORE