title: Predicting the risk of osteopenia for women aged 40-55 years.
abstract: OBJECTIVE
  Osteoporosis has been linked to an increased fracture risk and subsequent mortality in the later life. Previous prediction models have focused on osteoporosis in postmenopausal women; however, a prediction tool for osteopenia is needed. Our objective was to establish a prediction model for osteopenia risk in women aged 40-55 years.
  
  
  METHODS
  This was a cross-sectional study. A total of 1350 Taiwanese women aged 40-55 years were recruited from a health checkup center from 2009 to 2010. The main outcome measure was osteopenia (-1≥bone mineral density T-score > -2.5).
  
  
  RESULTS
  The Osteoporosis Preclinical Assessment Tool (OPAT) developed in this study was based on variables with biological importance to osteopenia and variables that remained significant (p<0.05) in the multivariable analysis, which include age, menopausal status, weight, and alkaline phosphatase level. The OPAT has a total score that ranges from 0 to 7, and categorizes women into high-, moderate-, and low-risk groups. The predictive ability of the OPAT (area under the receiver operating characteristic curve=0.77) was significantly better than that of the Osteoporosis Self-assessment Tool for Asians (area under the receiver operating characteristic curve=0.69). The inclusion of serum total alkaline phosphatase level in the model, which is easy to obtain from routine health checkups, significantly enhanced the sensitivity (McNemar test, p=0.004) for detecting osteopenia in women aged 40-55 years.
  
  
  CONCLUSIONS
  Our findings provide an important tool for identifying women at risk of osteoporosis at the preclinical phase.
authors.affiliation: Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
authors.forename: Jen-Hau
authors.initials: JH
authors.lastname: Chen
authors.affiliation: Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
authors.forename: Yen-Ching
authors.initials: YC
authors.lastname: Chen
authors.affiliation: Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
authors.forename: Min-Kuang
authors.initials: MK
authors.lastname: Tsai
authors.affiliation: Institute of Statistical Science, Academia Sinica, Taipei, Taiwan.
authors.forename: Jeng-Min
authors.initials: JM
authors.lastname: Chiou
authors.affiliation: Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
authors.forename: Wen-Chung
authors.initials: WC
authors.lastname: Lee
authors.affiliation: MJ Health Management Institution, Taipei, Taiwan.
authors.forename: Chwen-Keng
authors.initials: CK
authors.lastname: Tsao
authors.affiliation: Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: kstsaimd@ntu.edu.tw.
authors.forename: Keh-Sung
authors.initials: KS
authors.lastname: Tsai
authors.affiliation: Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan. Electronic address: weichu@ntu.edu.tw.
authors.forename: Wei-Chu
authors.initials: WC
authors.lastname: Chie
mesh_terms: D000328:Adult; D015519:Bone Density; D001851:Bone Diseases, Metabolic / Q000175:diagnosis* / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D012372:ROC Curve; D012307:Risk Factors; D012647:Self-Assessment; D013624:Taiwan
keywords: osteopenia; osteoporosis; prediction model; women