Beyond bone mineral density: can existing clinical risk assessment instruments identify women at increased risk of osteoporosis?

Authors


Lois E. Wehren MD, 4098 Fragile Sail Way, Ellicott City, MD 21042, USA.
(fax: +1 410 461 3418; e-mail: lois_wehren@msn.com).

Abstract.

Objective.  Although osteoporosis and fragility fracture are common amongst postmenopausal women, the extent of risk varies, and measurement of bone mineral density (BMD) is the standard tool used to diagnose and assess fracture risk. Rates of diagnosis remain relatively low, and several groups have developed instruments to help identify individuals who would most benefit from BMD testing. In this paper, we review and compare the performance of these instruments to identify those most useful in the primary care setting.

Design.  Review of screening instruments comprised osteoporosis clinical risk factors and comparison of the sensitivity and specificity of these algorithms.

Results.  Validated instruments have varying complexity, but similar sensitivity and specificity for identifying individuals who are likely to have low BMD. The area under the receiver operating characteristic curve ranges from 0.75 (SOFSURF) to 0.81 (SCORE). The simplest of the instruments (OST) uses only age and weight and has an AUC of 0.79.

Conclusions.  The Osteoporosis Self-assessment Tool, the simplest of the instruments, performs as well as more complex tools and, because of its simplicity, may be the most useful means for the busy clinician to identify postmenopausal women who would most benefit from BMD testing.

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