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Wingood M, Criss MG, Irwin KE, Freshman C, Phillips EL, Dhaliwal P, Chui KK. Screening for Osteoporosis Risk Among Community-Dwelling Older Adults: A Scoping Review. J Geriatr Phys Ther 2023; 46:E137-E147. [PMID: 36827688 DOI: 10.1519/jpt.0000000000000381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
BACKGROUND AND PURPOSE Due to potential health-related consequences of osteoporosis (OP), health care providers who do not order imaging, such as physical therapists, should be aware of OP screening tools that identify individuals who need medical and rehabilitation care. However, current knowledge and guidance on screening tools is limited. Therefore, we explored OP screening tools that are appropriate and feasible for physical therapy practice, and evaluated tools' effectiveness by examining their clinimetric properties. METHODS A systematic search of the following databases was performed: PubMed, PEDro, PsycINFO, CINAHL, and Web of Science. Articles were included if the study population was 50 years and older, had a diagnosis of OP, if the screening tool was within the scope of physical therapy practice, and was compared to either a known diagnosis of OP or bone densitometry scan results. Included articles underwent multiple reviews for inclusion and exclusion, with each review round having a different randomly selected pair of reviewers. Data were extracted from included articles for participant demographics, outcome measures, cut-off values, and clinimetric properties. Results were categorized with positive and negative likelihood ratios (+LR/-LR) based on the magnitude of change in the probability of having or not having OP. RESULTS +LRs ranged from 0.15 to 20.21, with the Fracture Risk Assessment Tool (FRAX) and Study of Osteoporotic Fractures (SOF) having a large shift in posttest probability. -LRs ranged from 0.03 to 1.00, with the FRAX, Male Osteoporosis Risk Estimation Scores, Osteoporosis Self-Assessment Tool (OST), and Simple Calculated Osteoporosis Risk Estimation having a large shift in posttest probability. CONCLUSION Tools with moderate-large shift for both +LR and -LR recommended for use are: (1) OST; (2) FRAX; and (3) SOF. The variability in cut-off scores and clinimetric properties based on gender, age, and race/ethnicities made it impossible to provide one specific recommendation for an OP screening tool. Future research should focus on OP risk prediction among males and racial and ethnic groups.
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Affiliation(s)
- Mariana Wingood
- Department of Rehabilitation and Movement Sciences, University of Vermont, Burlington
| | - Michelle G Criss
- School of Health Sciences, Chatham University, Pittsburgh, Pennsylvania
| | - Kent E Irwin
- Department of Physical Therapy, Midwestern University, Downers Grove, Illinois
| | - Christina Freshman
- Department of Physical Therapy, Lebanon Valley College, Annville, Pennsylvania
| | | | - Puneet Dhaliwal
- Department of Physical Therapy, SUNY Downstate Health Sciences University, Brooklyn, New York
| | - Kevin K Chui
- Department of Physical Therapy, Radford University, Roanoke, Virginia
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Rahim F, Zaki Zadeh A, Javanmardi P, Emmanuel Komolafe T, Khalafi M, Arjomandi A, Ghofrani HA, Shirbandi K. Machine learning algorithms for diagnosis of hip bone osteoporosis: a systematic review and meta-analysis study. Biomed Eng Online 2023; 22:68. [PMID: 37430259 DOI: 10.1186/s12938-023-01132-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 06/26/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Osteoporosis is a significant health problem in the skeletal system, associated with bone tissue changes and its strength. Machine Learning (ML), on the other hand, has been accompanied by improvements in recent years and has been in the spotlight. This study is designed to investigate the Diagnostic Test Accuracy (DTA) of ML to detect osteoporosis through the hip dual-energy X-ray absorptiometry (DXA) images. METHODS The ISI Web of Science, PubMed, Scopus, Cochrane Library, IEEE Xplore Digital Library, CINAHL, Science Direct, PROSPERO, and EMBASE were systematically searched until June 2023 for studies that tested the diagnostic precision of ML model-assisted for predicting an osteoporosis diagnosis. RESULTS The pooled sensitivity of univariate analysis of seven studies was 0.844 (95% CI 0.791 to 0.885, I2 = 94% for 7 studies). The pooled specificity of univariate analysis was 0.781 (95% CI 0.732 to 0.824, I2 = 98% for 7 studies). The pooled diagnostic odds ratio (DOR) was 18.91 (95% CI 14.22 to 25.14, I2 = 93% for 7 studies). The pooled mean positive likelihood ratio (LR+) and the negative likelihood ratio (LR-) were 3.7 and 0.22, respectively. Also, the summary receiver operating characteristics (sROC) of the bivariate model has an AUC of 0.878. CONCLUSION Osteoporosis can be diagnosed by ML with acceptable accuracy, and hip fracture prediction was improved via training in an Architecture Learning Network (ALN).
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Affiliation(s)
- Fakher Rahim
- Department of Anesthesia, Cihan University - Sulaimaniya, Sulaymaniyah, Kurdistan Region, Iraq
| | - Amin Zaki Zadeh
- Medical Doctor (MD), School of Medicine, Ahvaz Jondishapour University of Medical Sciences, Ahvaz, Iran
| | - Pouya Javanmardi
- Department of Radiologic Technology, Faculty of Paramedicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Mohammad Khalafi
- School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Ali Arjomandi
- Department of Radiologic Technology, Faculty of Paramedicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Haniye Alsadat Ghofrani
- Department of Radiologic Technology, Faculty of Paramedicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Kiarash Shirbandi
- Research Center for Molecular and Cellular Imaging, Tehran University of Medical Sciences, Tehran, Iran.
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Bui HM, Ha MH, Pham HG, Dao TP, Nguyen TTT, Nguyen ML, Vuong NT, Hoang XHT, Do LT, Dao TX, Le CQ. Predicting the risk of osteoporosis in older Vietnamese women using machine learning approaches. Sci Rep 2022; 12:20160. [PMID: 36418408 PMCID: PMC9684431 DOI: 10.1038/s41598-022-24181-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/11/2022] [Indexed: 11/25/2022] Open
Abstract
Osteoporosis contributes significantly to health and economic burdens worldwide. However, the development of osteoporosis-related prediction tools has been limited for lower-middle-income countries, especially Vietnam. This study aims to develop prediction models for the Vietnamese population as well as evaluate the existing tools to forecast the risk of osteoporosis and evaluate the contribution of covariates that previous studies have determined to be risk factors for osteoporosis. The prediction models were developed to predict the risk of osteoporosis using machine learning algorithms. The performance of the included prediction models was evaluated based on two scenarios; in the first one, the original test parameters were directly modeled, and in the second the original test parameters were transformed into binary covariates. The area under the receiver operating characteristic curve, the Brier score, precision, recall and F1-score were calculated to evaluate the models' performance in both scenarios. The contribution of the covariates was estimated using the Permutation Feature Importance estimation. Four models, namely, Logistic Regression, Support Vector Machine, Random Forest and Neural Network, were developed through two scenarios. During the validation phase, these four models performed competitively against the reference models, with the areas under the curve above 0.81. Age, height and weight contributed the most to the risk of osteoporosis, while the correlation of the other covariates with the outcome was minor. Machine learning algorithms have a proven advantage in predicting the risk of osteoporosis among Vietnamese women over 50 years old. Additional research is required to more deeply evaluate the performance of the models on other high-risk populations.
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Affiliation(s)
- Hanh My Bui
- grid.56046.310000 0004 0642 8489Department of Tuberculosis and Lung Disease, Hanoi Medical University, Hanoi, Vietnam ,grid.488446.2Department of Functional Exploration, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Minh Hoang Ha
- grid.511102.60000 0004 8341 6684ORLab, Faculty of Computer Science, Phenikaa University, Hanoi, Vietnam
| | - Hoang Giang Pham
- grid.511102.60000 0004 8341 6684ORLab, Faculty of Computer Science, Phenikaa University, Hanoi, Vietnam
| | - Thang Phuoc Dao
- grid.56046.310000 0004 0642 8489Department of Scientific Research and International Cooperation, Hanoi Medical University, Hanoi, Vietnam
| | - Thuy-Trang Thi Nguyen
- grid.488446.2Department of Functional Exploration, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Minh Loi Nguyen
- grid.67122.30Administration of Science Technology and Training, Ministry of Health Vietnam, Hanoi, Vietnam
| | - Ngan Thi Vuong
- grid.488446.2Department of Functional Exploration, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Xuyen Hong Thi Hoang
- grid.56046.310000 0004 0642 8489Department of Scientific Research and International Cooperation, Hanoi Medical University, Hanoi, Vietnam ,grid.56046.310000 0004 0642 8489Center for Development of Curriculum and Human Resources in Health Hanoi Medical University, Hanoi, Vietnam
| | - Loc Tien Do
- grid.488446.2Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Thanh Xuan Dao
- grid.56046.310000 0004 0642 8489Department of Orthopaedic, Hanoi Medical University, Hanoi, Vietnam
| | - Cuong Quang Le
- grid.56046.310000 0004 0642 8489Department of Neurology, Hanoi Medical University, Hanoi, Vietnam
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Miller KL, Mccoy K, Richards C, Seaman A, Solimeo SL. Engagement in Primary Prevention Program among Rural Veterans With Osteoporosis Risk. JBMR Plus 2022; 6:e10682. [PMID: 36248271 PMCID: PMC9549732 DOI: 10.1002/jbm4.10682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/24/2022] [Accepted: 09/05/2022] [Indexed: 02/05/2023] Open
Abstract
A primary osteoporosis prevention program using a virtual bone health team (BHT) was implemented to comanage the care of rural veterans in the Mountain West region of the United States. The BHT identified, screened, and treated rural veterans at risk for osteoporosis using telephone and United States Postal Service communications. Eligibility was determined by regular use of Veterans Health Administration primary care, age 50 or older, and evidence of fracture risk. This study was conducted to identify demographic and clinical factors associated with the acceptance of osteoporosis screening and the initiation of medication where indicated. A cross-sectional cohort design (N = 6985) was utilized with a generalized estimating equation and logit link function to account for facility-level clustering. Fully saturated and reduced models were fitted using backward selection. Less than a quarter of eligible veterans enrolled in BHT's program and completed screening. Factors associated with a lower likelihood of clinic enrollment included being of older age, unmarried, greater distance from VHA services, having a copayment, prior fracture, or history of rheumatoid arthritis. A majority of veterans with treatment indication started medication therapy (N = 453). In this subpopulation, Fisher's exact test showed a significant association between osteoporosis treatment uptake and a history of two or more falls in the prior year, self-reported parental history of fracture, current smoking, and weight-bearing exercise. The BHT was designed to reduce barriers to screening; however, for this population cost and travel continue to limit engagement. The remarkable rate of medication initiation notwithstanding, low enrollment reduces the impact of this primary prevention program, and findings pertaining to fracture, smoking, and exercise imply that health beliefs are an important contributing factor. Efforts to identify and address barriers to osteoporosis screening and treatment, such as clinical factors, social determinants of health, and health beliefs, may pave the way for effective implementation of population bone health care delivery systems. Published 2022. This article is a U.S. Government work and is in the public domain in the USA. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Karla L. Miller
- VHA Office of Rural Health, Veterans Rural Health Resource Center‐Salt Lake City, Department of Internal Medicine, Rheumatology SectionVeterans Affairs Salt Lake City Health Care SystemSalt Lake CityUtahUSA,Associate Professor (Clinical) of Medicine, Division of RheumatologyUniversity of Utah School of MedicineSalt Lake CityUtahUSA
| | - Kimberly Mccoy
- VHA Office of Rural Health, Veterans Rural Health Resource Center‐Iowa City (VRHRC‐IC), Center for Access & Delivery Research and Evaluation (CADRE)Veterans Affairs Iowa City VHA Health Care SystemIowa CityIowaUSA
| | - Chris Richards
- VHA Office of Rural Health, Veterans Rural Health Resource Center‐Iowa City (VRHRC‐IC), Center for Access & Delivery Research and Evaluation (CADRE)Department of Veterans Affairs Iowa City VHA Health Care SystemIowa CityIowaUSA
| | - Aaron Seaman
- VHA Office of Rural Health, Veterans Rural Health Resource Center‐Iowa City (VRHRC‐IC)Veterans Affairs Iowa City VHA Health Care SystemIowa CityIowaUSA,Division of General Internal Medicine, Department of Internal Medicine, Carver College of MedicineUniversity of IowaIowa CityIowaUSA
| | - Samantha L. Solimeo
- VHA Office of Rural Health, Veterans Rural Health Resource Center‐Iowa City (VRHRC‐IC), Center for Access & Delivery Research and Evaluation (CADRE), Primary Care Analytics Team Iowa City (PCAT‐IC)Veterans Affairs Iowa City VHA Health Care SystemIowa CityIowaUSA,Division of General Internal Medicine, Department of Internal Medicine, Carver College of MedicineUniversity of IowaIowa CityIowaUSA
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E E, Wang T, Yang L, Dempsey M, Brennan A, Yu M, Chan WP, Whelan B, Silke C, O'Sullivan M, Rooney B, McPartland A, O'Malley G, Carey JJ. Machine Learning Can Improve Clinical Detection of Low BMD: The DXA-HIP Study. J Clin Densitom 2021; 24:527-537. [PMID: 33187864 DOI: 10.1016/j.jocd.2020.10.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/08/2020] [Accepted: 10/12/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Identification of those at high risk before a fracture occurs is an essential part of osteoporosis management. This topic remains a significant challenge for researchers in the field, and clinicians worldwide. Although many algorithms have been developed to either identify those with a diagnosis of osteoporosis or predict their risk of fracture, concern remains regarding their accuracy and application. Scientific advances including machine learning methods are rapidly gaining appreciation as alternative techniques to develop or enhance risk assessment and current practice. Recent evidence suggests that these methods could play an important role in the assessment of osteoporosis and fracture risk. METHODS Data used for this study included Dual-energy X-ray Absorptiometry (DXA) bone mineral density and T-scores, and multiple clinical variables drawn from a convenience cohort of adult patients scanned on one of 4 DXA machines across three hospitals in the West of Ireland between January 2000 and November 2018 (the DXA-Heath Informatics Prediction Cohort). The dataset was cleaned, validated and anonymized, and then split into an exploratory group (80%) and a development group (20%) using the stratified sampling method. We first established the validity of a simple tool, the Osteoporosis Self-assessment Tool Index (OSTi) to identify those classified as osteoporotic by the modified International Society for Clinical Densitometry DXA criteria. We then compared these results to seven machine learning techniques (MLTs): CatBoost, eXtreme Gradient Boosting, Neural network, Bagged flexible discriminant analysis, Random forest, Logistic regression and Support vector machine to enhance the discrimination of those classified as osteoporotic or not. The performance of each prediction model was measured by calculating the area under the curve (AUC) with 95% confidence interval (CI), and was compared against the OSTi. RESULTS A cohort of 13,577 adults aged ≥40 yr at the age of their first scan was identified including 11,594 women and 1983 men. 2102 (18.13%) females and 356 (17.95%) males were identified with osteoporosis based on their lowest T-score. The OSTi performed well in our cohort in both men (AUC 0.723, 95% CI 0.659-0.788) and women (AUC 0.810, 95% CI 0.787-0.833). Four MLTs improved discrimination in both men and women, though the incremental benefit was small. eXtreme Gradient Boosting showed the most promising results: +4.5% (AUC 0.768, 95% CI 0.706-0.829) for men and +2.3% (AUC 0.833, 95% CI 0.812-0.853) for women. Similarly MLTs outperformed OSTi in sensitivity analyses-which excluded those subjects taking osteoporosis medications-though the absolute improvements differed. CONCLUSION The OSTi retains an important role in identifying older men and women most likely to have osteoporosis by bone mineral density classification. MLTs could improve DXA detection of osteoporosis classification in older men and women. Further exploration of MLTs is warranted in other populations, and with additional data.
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Affiliation(s)
- Erjiang E
- Department of Industrial Engineering, Tsinghua University, Beijing, China
| | - Tingyan Wang
- Department of Industrial Engineering, Tsinghua University, Beijing, China
| | - Lan Yang
- Department of Industrial Engineering, Tsinghua University, Beijing, China; School of Engineering, National University of Ireland, Galway, Ireland
| | - Mary Dempsey
- School of Engineering, National University of Ireland, Galway, Ireland
| | - Attracta Brennan
- School of Computer Science, National University of Ireland, Galway, Ireland
| | - Ming Yu
- Department of Industrial Engineering, Tsinghua University, Beijing, China
| | - Wing P Chan
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taiwan
| | - Bryan Whelan
- School of Medicine, National University of Ireland, Galway, Ireland; Department of Rheumatology, Our Lady's University Hospital, Manorhamilton, Co. Leitrim, Ireland
| | - Carmel Silke
- School of Medicine, National University of Ireland, Galway, Ireland; Department of Rheumatology, Our Lady's University Hospital, Manorhamilton, Co. Leitrim, Ireland
| | - Miriam O'Sullivan
- School of Medicine, National University of Ireland, Galway, Ireland; Department of Rheumatology, Our Lady's University Hospital, Manorhamilton, Co. Leitrim, Ireland
| | - Bridie Rooney
- Department of Geriatric Medicine, Sligo University Hospital, Sligo, Ireland
| | - Aoife McPartland
- Department of Rheumatology, Our Lady's University Hospital, Manorhamilton, Co. Leitrim, Ireland
| | - Gráinne O'Malley
- School of Medicine, National University of Ireland, Galway, Ireland; Department of Geriatric Medicine, Sligo University Hospital, Sligo, Ireland
| | - John J Carey
- School of Medicine, National University of Ireland, Galway, Ireland; Department of Rheumatology, Galway University Hospitals, Galway, Ireland.
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E E, Wang T, Yang L, Dempsey M, Brennan A, Yu M, Chan WP, Whelan B, Silke C, O'Sullivan M, Rooney B, McPartland A, O'Malley G, Carey JJ. Utility of Osteoporosis Self-Assessment Tool as a Screening Tool for Osteoporosis in Irish Men and Women: Results of the DXA-HIP Project. J Clin Densitom 2021; 24:516-526. [PMID: 33789806 DOI: 10.1016/j.jocd.2021.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/24/2021] [Accepted: 03/01/2021] [Indexed: 12/11/2022]
Abstract
Many algorithms have been developed and publicised over the past 2 decades for identifying those most likely to have osteoporosis or low BMD, or at increased risk of fragility fracture. The Osteoporosis Self-assessment Tool index (OSTi) is one of the oldest, simplest, and widely used for identifying men and women with low BMD or osteoporosis. OSTi has been validated in many cohorts worldwide but large studies with robust analyses evaluating this or other algorithms in adult populations residing in the Republic of Ireland are lacking, where waiting times for public DXA facilities are long. In this study we evaluated the validity of OSTi in men and women drawn from a sampling frame of more than 36,000 patients scanned at one of 3 centres in the West of Ireland. 18,670 men and women aged 40 years and older had a baseline scan of the lumbar spine femoral neck and total hip available for analysis. 15,964 (86%) were female, 5,343 (29%) had no major clinical risk factors other than age, while 5,093 (27%) had a prior fracture. Approximately 2/3 had a T-score ≤-1.0 at one or more skeletal sites and 1/3 had a T-score ≤-1.0 at all 3 skeletal sites, while 1 in 5 had a DXA T-score ≤-2.5 at one or more skeletal sites and 5% had a T-score ≤-2.5 at all 3 sites. OSTi generally performed well in our population with area under the curve (AUC) values ranging from 0.581 to 0.881 in men and 0.701 to 0.911 in women. The performance of OSTi appeared robust across multiple sub-group analyses. AUC values were greater for women, proximal femur sites, those without prior fractures and those not taking osteoporosis medication. Optimal OSTi cut-points were '2' for men and '0' for women in our study population. OSTi is a simple and effective tool to aid identification of Irish men and women with low BMD or osteoporosis. Use of OSTi could improve the effectiveness of DXA screening programmes for older adults in Ireland.
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Affiliation(s)
- Erjiang E
- Department of Industrial Engineering, Tsinghua University, Beijing, China
| | - Tingyan Wang
- Department of Industrial Engineering, Tsinghua University, Beijing, China; Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Lan Yang
- Department of Industrial Engineering, Tsinghua University, Beijing, China; School of Engineering, National University of Ireland, Galway, Ireland
| | - Mary Dempsey
- School of Engineering, National University of Ireland, Galway, Ireland
| | - Attracta Brennan
- School of Computer Science, National University of Ireland, Galway, Ireland
| | - Ming Yu
- Department of Industrial Engineering, Tsinghua University, Beijing, China
| | - Wing P Chan
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taiwan
| | - Bryan Whelan
- School of Medicine, National University of Ireland, Galway, Ireland; Department of Rheumatology, Our Lady's Hospital, Manorhamilton, Co. Leitrim, Ireland
| | - Carmel Silke
- School of Medicine, National University of Ireland, Galway, Ireland; Department of Rheumatology, Our Lady's Hospital, Manorhamilton, Co. Leitrim, Ireland
| | - Miriam O'Sullivan
- School of Medicine, National University of Ireland, Galway, Ireland; Department of Rheumatology, Our Lady's Hospital, Manorhamilton, Co. Leitrim, Ireland
| | - Bridie Rooney
- Department of Geriatric Medicine, Sligo University Hospital, Sligo, Ireland
| | - Aoife McPartland
- Department of Rheumatology, Our Lady's Hospital, Manorhamilton, Co. Leitrim, Ireland
| | - Gráinne O'Malley
- School of Medicine, National University of Ireland, Galway, Ireland; Department of Geriatric Medicine, Sligo University Hospital, Sligo, Ireland
| | - John J Carey
- School of Medicine, National University of Ireland, Galway, Ireland; Department of Rheumatology, Galway University Hospitals, Galway, Ireland.
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Miller KL, Steffen MJ, McCoy KD, Cannon G, Seaman AT, Anderson ZL, Patel S, Green J, Wardyn S, Solimeo SL. Delivering fracture prevention services to rural US veterans through telemedicine: a process evaluation. Arch Osteoporos 2021; 16:27. [PMID: 33566174 PMCID: PMC7875846 DOI: 10.1007/s11657-021-00882-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 01/04/2021] [Indexed: 02/03/2023]
Abstract
An informatics-driven population bone health clinic was implemented to identify, screen, and treat rural US Veterans at risk for osteoporosis. We report the results of our implementation process evaluation which demonstrated BHT to be a feasible telehealth model for delivering preventative osteoporosis services in this setting. PURPOSE An established and growing quality gap in osteoporosis evaluation and treatment of at-risk patients has yet to be met with corresponding clinical care models addressing osteoporosis primary prevention. The rural bone health tea m (BHT) was implemented to identify, screen, and treat rural Veterans lacking evidence of bone health care and we conducted a process evaluation to understand BHT implementation feasibility. METHODS For this evaluation, we defined the primary outcome as the number of Veterans evaluated with DXA and a secondary outcome as the number of Veterans who initiated prescription therapy to reduce fracture risk. Outcomes were measured over a 15-month period and analyzed descriptively. Qualitative data to understand successful implementation were collected concurrently by conducting interviews with clinical personnel interacting with BHT and BHT staff and observations of BHT implementation processes at three site visits using the Promoting Action on Research Implementation in Health Services (PARIHS) framework. RESULTS Of 4500 at-risk, rural Veterans offered osteoporosis screening, 1081 (24%) completed screening, and of these, 37% had normal bone density, 48% osteopenia, and 15% osteoporosis. Among Veterans with pharmacotherapy indications, 90% initiated therapy. Qualitative analyses identified barriers of rural geography, rural population characteristics, and the infrastructural resource requirement. Data infrastructure, evidence base for care delivery, stakeholder buy-in, formal and informal facilitator engagement, and focus on teamwork were identified as facilitators of implementation success. CONCLUSION The BHT is a feasible population telehealth model for delivering preventative osteoporosis care to rural Veterans.
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Affiliation(s)
- Karla L. Miller
- VA Office of Rural Health, Veterans Rural Health Resource Center-Salt Lake City (VRHRC-SLC), Salt Lake City, UT USA
- Department of Internal Medicine, Rheumatology Section, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT USA
- Division of Rheumatology, University of Utah School of Medicine, Salt Lake City, UT USA
| | - Melissa J. Steffen
- VA Office of Rural Health, Veterans Rural Health Resource Center-Salt Lake City (VRHRC-SLC), Salt Lake City, UT USA
- VA Office of Rural Health, Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Salt Lake City, UT USA
- Comprehensive Access & Delivery Research and Evaluation (CADRE), Primary Care Analytics Team Iowa City (PCAT-IC), Department of Veterans Affairs, CADRE, Iowa City VA HCS, Research 152, 601 Highway 6 West, Iowa City, IA 52246 USA
| | - Kimberly D. McCoy
- VA Office of Rural Health, Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Salt Lake City, UT USA
- Comprehensive Access & Delivery Research and Evaluation (CADRE), Primary Care Analytics Team Iowa City (PCAT-IC), Department of Veterans Affairs, CADRE, Iowa City VA HCS, Research 152, 601 Highway 6 West, Iowa City, IA 52246 USA
| | - Grant Cannon
- Department of Internal Medicine, Rheumatology Section, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT USA
| | - Aaron T. Seaman
- VA Office of Rural Health, Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Salt Lake City, UT USA
- Division of Genera l Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, 200 Hawkins Drive, 52242 Iowa City, IA USA
| | - Zachary L. Anderson
- VA Office of Rural Health, Veterans Rural Health Resource Center-Salt Lake City (VRHRC-SLC), Salt Lake City, UT USA
- Department of Anesthesiology, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT USA
| | - Shardool Patel
- VA Office of Rural Health, Veterans Rural Health Resource Center-Salt Lake City (VRHRC-SLC), Salt Lake City, UT USA
- Department of Anesthesiology, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT USA
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT USA
| | - Janiel Green
- VA Office of Rural Health, Veterans Rural Health Resource Center-Salt Lake City (VRHRC-SLC), Salt Lake City, UT USA
- Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT USA
| | - Shylo Wardyn
- VA Office of Rural Health, Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Salt Lake City, UT USA
| | - Samantha L. Solimeo
- VA Office of Rural Health, Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Salt Lake City, UT USA
- Comprehensive Access & Delivery Research and Evaluation (CADRE), Primary Care Analytics Team Iowa City (PCAT-IC), Department of Veterans Affairs, CADRE, Iowa City VA HCS, Research 152, 601 Highway 6 West, Iowa City, IA 52246 USA
- Division of Genera l Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, 200 Hawkins Drive, 52242 Iowa City, IA USA
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Assessing underlying bone quality in spine surgery patients: a narrative review of dual-energy X-ray absorptiometry (DXA) and alternatives. Spine J 2021; 21:321-331. [PMID: 32890786 DOI: 10.1016/j.spinee.2020.08.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/15/2020] [Accepted: 08/29/2020] [Indexed: 02/06/2023]
Abstract
Poor bone quality and low bone mineral density (BMD) have been previously tied to higher rates of postoperative mechanical complications in patients undergoing spinal fusion. These include higher rates of proximal junctional kyphosis, screw pullout, pseudoarthrosis, and interbody subsidence. For these reasons, accurate preoperative assessment of a patient's underlying bone quality is paramount for all elective procedures. Dual-energy X-ray absorptiometry (DXA) is currently considered to be the gold standard for assessing BMD. However, a growing body of research has suggested that in vivo assessments of BMD using DXA are inaccurate and have, at best, moderate correlations to postoperative mechanical complications. Consequently, there have been investigations into using alternative methods for assessing in vivo bone quality, including using computed tomography (CT) and magnetic resonance imaging (MRI) volumes that are commonly obtained as part of surgical evaluation. Here we review the data regarding the accuracy of DXA for the evaluation of spine bone quality and describe the alternative imaging modalities currently under investigation.
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Xuan Y, Wang W, Zhang H, Tan I, Butlin M, Avolio A, Zuo J. Osteoporosis is inversely associated with arterial stiffness in the elderly: An investigation using the Osteoporosis Self-assessment Tool for Asians index in an elderly Chinese cohort. J Clin Hypertens (Greenwich) 2019; 21:405-411. [PMID: 30734463 DOI: 10.1111/jch.13493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 12/27/2018] [Accepted: 12/28/2018] [Indexed: 12/21/2022]
Abstract
Although the association of arterial stiffness and osteoporosis has been reported, the relation of arterial stiffness with risk of osteoporosis and bone fracture is not established. The authors investigated the correlation between arterial stiffness (brachial-ankle pulse wave velocity [baPWV]), including a cutoff value, and risk of osteoporosis as assessed by the Osteoporosis Self-assessment Tool for Asia (OSTA) index in 129 elderly Chinese community-dwelling individuals (age 83.2 ± 12.8 years, 63 females). OSTA was negatively correlated with baPWV (r = -0.326, P = 0.023) after adjusting for confounding factors such as gender, body mass index, low-density lipoprotein, triglycerides, estimated glomerular filtration rate, absence or presence of diabetes, absence or presence of hypertension, and uric acid. baPWV was an independent factor for changes in OSTA (β = -0.001, P = 0.002). ROC curve analysis confirmed association between baPWV and OSTA index (AUC = 0.742 [CI: 0.660, 0.824]; P < 0.001) with a baPWV cutoff value of 1676 cm/s (sensitivity, 80.7%; specificity, 60%) for prediction of high OSTA index. The study showed a significant correlation between OSTA index and baPWV, suggesting a potential predictive value of baPWV in elderly patient at high risk of osteoporosis.
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Affiliation(s)
- Yan Xuan
- Department of Geriatric Medicine, Shanghai Jiatong School of Medicine, Ruijin Hospital North, Shanghai, China
| | - Weiliang Wang
- Department of Neurology Medicine, Xuhui District Central Hospital, Shanghai, China
| | - Hong Zhang
- Department of Geriatric Medicine, Shanghai Jiatong School of Medicine, Ruijin Hospital North, Shanghai, China
| | - Isabella Tan
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Mark Butlin
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Alberto Avolio
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Junli Zuo
- Department of Geriatric Medicine, Shanghai Jiatong School of Medicine, Ruijin Hospital North, Shanghai, China
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Subramaniam S, Ima-Nirwana S, Chin KY. Performance of Osteoporosis Self-Assessment Tool (OST) in Predicting Osteoporosis-A Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1445. [PMID: 29987247 PMCID: PMC6068473 DOI: 10.3390/ijerph15071445] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 06/28/2018] [Accepted: 07/04/2018] [Indexed: 12/15/2022]
Abstract
Bone health screening plays a vital role in the early diagnosis and treatment of osteoporosis to prevent fragility fractures among the elderly and high-risk individuals. Dual-energy X-ray absorptiometry (DXA), which detects bone mineral density, is the gold standard in diagnosing osteoporosis but is not suitable for screening. Therefore, many screening tools have been developed to identify individuals at risk for osteoporosis and prioritize them for DXA scanning. The Osteoporosis Self-assessment Tool (OST) is among the first tools established to predict osteoporosis in postmenopausal women. It can identify the population at risk for osteoporosis, but its performance varies according to ethnicity, gender, and age. Thus, these factors should be considered to ensure the optimal use of OST worldwide. Overall, OST is a simple and economical screening tool to predict osteoporosis and it can help to optimize the use of DXA.
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Affiliation(s)
- Shaanthana Subramaniam
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia.
| | - Soelaiman Ima-Nirwana
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia.
| | - Kok-Yong Chin
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia.
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Varsavsky M, Romero Muñoz M, Ávila Rubio V, Becerra A, García Martín A, Martínez Díaz-Guerra G, Rozas Moreno P, Jódar Gimeno E, Muñoz Torres M. Consensus document on osteoporosis in males. ACTA ACUST UNITED AC 2018. [PMID: 29530627 DOI: 10.1016/j.endinu.2017.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To provide practical recommendations to assess and treat osteoporosis in males. PARTICIPANTS Members of the Bone Metabolism Working Group of the Spanish Society of Endocrinology. METHODS Recommendations were formulated using the GRADE system (Grading of Recommendations, Assessment, Development, and Evaluation) to describe both the strength of recommendations and the quality of evidence. A systematic search was made in Medline (PubMed) using the following associated terms: «osteoporosis», «men», «fractures», «bone mineral density», «treatment», «hypogonadism», and «prostate cancer». Papers in English and Spanish with publication date before 30 August 2017 were included. Current evidence for each disease was reviewed by 2group members. Finally, recommendations were discussed in a meeting of the working group. CONCLUSIONS The document provides evidence-based practical recommendations for diagnosis, assessment, and management of osteoporosis in men and special situations such as hypogonadism and prostate cancer.
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Affiliation(s)
- Mariela Varsavsky
- Servicio de Endocrinología, Metabolismo y Medicina Nuclear, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - Manuel Romero Muñoz
- Unidad de Endocrinología y Nutrición, Hospital General Universitario Rafael Méndez. Lorca, Murcia, España
| | - Verónica Ávila Rubio
- Unidad de Metabolismo Óseo, UGC Endocrinología y Nutrición, Complejo Hospitalario Universitario de Granada, Granada, España
| | - Antonio Becerra
- Unidad de Identidad de Género, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Antonia García Martín
- Servicio de Endocrinología y Nutrición, Hospital Campus de la Salud, Granada, España
| | | | - Pedro Rozas Moreno
- Sección de Endocrinología y Nutrición, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - Esteban Jódar Gimeno
- Departamento de Endocrinología y Nutrición Clínica, Hospital Universitario Quirón Salud Madrid, Universidad Europea de Madrid, Madrid, España
| | - Manuel Muñoz Torres
- UGC de Endocrinología y Nutrición, Hospital Universitario Campus de la Salud, CIBERFES, Granada, España
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Zhang X, Lin J, Yang Y, Wu H, Li Y, Yang X, Fei Q. Comparison of three tools for predicting primary osteoporosis in an elderly male population in Beijing: a cross-sectional study. Clin Interv Aging 2018; 13:201-209. [PMID: 29440880 PMCID: PMC5798543 DOI: 10.2147/cia.s145741] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Purpose In this cross-sectional study, three clinical tools, the Osteoporosis Self-Assessment Tool for Asians (OSTA), Fracture Risk Assessment Tool (FRAX) without bone mineral density (BMD), and body mass index (BMI), for predicting primary osteoporosis (OP) were compared and ideal thresholds for omission of screening BMD were proposed in a community-dwelling elderly Han Beijing male population. Patients and methods A total of 1,349 community-dwelling elderly Han Beijing males aged ≥50 years were enrolled in this study. All subjects completed a questionnaire and measured BMD by dual-energy X-ray absorptiometry (DXA). Osteoporosis was defined as a T-score of -2.5 SD or lower than that of the average young adult in different diagnostic criteria (lumbar spine [L1-L4], femoral neck, total hip, worst hip, and World Health Organization [WHO]). FRAX without BMD, OSTA, and BMI were assessed for predicting OP by receiver operating characteristic (ROC) curves. Sensitivity, specificity, and areas under the ROC curves (AUCs) were determined. Ideal thresholds for omission of screening BMD were proposed. Results The prevalence of OP ranged from 1.8% to 12.8% according to different diagnostic criteria. This study showed that the BMI has highest discriminating ability. The AUC of FRAX without BMD ranged from 0.536 to 0.630, which suggested limiting predictive value for identifying OP in elderly Beijing male. The AUCs of BMI (0.801-0.880) were slightly better than OSTA (0.722-0.874) in predicting OP at all sites. The AUC of BMI to identify OP in worst hip was 0.824, yielding a sensitivity of 84.8% and a specificity of 64.4%. 40% of participants on BMD measurements saved only 0.1%-2.7% missed OP. Compared to OSTA and FRAX without BMD, the BMI got the best predictive value for OP. Conclusion BMI may be a simple and effective tool for identifying OP in the elderly male population in Beijing to omit BMD screening reasonably.
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Affiliation(s)
- XiaoDong Zhang
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University
| | - JiSheng Lin
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University
| | - Yong Yang
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University
| | - Hao Wu
- Fangzhuang Community Health Service Center
| | - Yongjin Li
- Tuanjiehu Community Health Service Center
| | - Xiuquan Yang
- Wangzuo Community Health Service Center, Beijing, People's Republic of China
| | - Qi Fei
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University
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Diem SJ, Peters KW, Gourlay ML, Schousboe JT, Taylor BC, Orwoll ES, Cauley JA, Langsetmo L, Crandall CJ, Ensrud KE. Screening for Osteoporosis in Older Men: Operating Characteristics of Proposed Strategies for Selecting Men for BMD Testing. J Gen Intern Med 2017; 32:1235-1241. [PMID: 28815485 PMCID: PMC5653561 DOI: 10.1007/s11606-017-4153-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 02/27/2017] [Accepted: 07/27/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND The optimal approach for selecting men for bone mineral density (BMD) testing to screen for osteoporosis is uncertain. OBJECTIVE To compare strategies for selecting older men for screening BMD testing. DESIGN Prospective cohort study. PARTICIPANTS A total of 4043 community-dwelling men aged ≥70 years at four US sites. MAIN MEASURES BMD at the total hip, femoral neck, and lumbar spine using dual-energy x-ray absorptiometry (DXA). Sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, and area under the receiver operating curve (AUC) of the Osteoporosis Self-Assessment Tool (OST) and Fracture Risk Assessment Tool (FRAX) without BMD to discriminate between those with and without osteoporosis as defined by World Health Organization (WHO) diagnostic criteria, and between those recommended and not recommended for pharmacologic therapy based on the National Osteoporosis Foundation (NOF) guidelines. KEY RESULTS Among the cohort, 216 (5.3%) had a BMD T-score ≤ -2.5 at the femoral neck, total hip, or lumbar spine, and 1184 (29.2%) met criteria for consideration of pharmacologic therapy according to NOF guidelines. The OST had better discrimination (AUC 0.68) than the FRAX (AUC 0.62; p = 0.004) for identifying T-score-defined osteoporosis. Use of an OST threshold of <2 resulted in sensitivity of 0.83 and specificity of 0.36 for the identification of osteoporosis, compared to sensitivity of 0.59 and specificity of 0.59 for the use of FRAX with a cutoff of 9.3% 10-year risk of major osteoporotic fracture. CONCLUSIONS The OST performs modestly better than the more complex FRAX in selecting older men for BMD testing to screen for osteoporosis; the use of either tool substantially reduces the proportion of men referred for BMD testing compared to universal screening. Of 1000 men aged 70 and older in this community-based cohort, the use of an OST cutoff of <2 to select men for BMD testing would result in 654 men referred for BMD testing, of whom 44 would be identified as having osteoporosis, and nine with osteoporosis would be missed.
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Affiliation(s)
- Susan J Diem
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN, USA.
| | - Katherine W Peters
- California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - Margaret L Gourlay
- Department of Family Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - John T Schousboe
- Park Nicollet Clinic & HealthPartners Institute, Minneapolis, MN, USA
- Division of Health Policy & Management, University of Minnesota, Minneapolis, MN, USA
| | - Brent C Taylor
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN, USA
- Center for Chronic Disease Outcomes Research, VA Health Care System, Minneapolis, MN, USA
| | - Eric S Orwoll
- Bone and Mineral Unit, Oregon Health & Science University, Portland, OR, USA
| | - Jane A Cauley
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lisa Langsetmo
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN, USA
| | | | - Kristine E Ensrud
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN, USA
- Center for Chronic Disease Outcomes Research, VA Health Care System, Minneapolis, MN, USA
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Bhat KA, Kakaji M, Awasthi A, Kumar K, Mishra K, Shukla M, Gupta SK. Utility of Osteoporosis Self-Assessment Tool as a Screening Tool for Predicting Osteoporosis in Indian Men. J Clin Densitom 2017; 20:160-163. [PMID: 27210803 DOI: 10.1016/j.jocd.2016.04.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 04/07/2016] [Indexed: 11/21/2022]
Abstract
The osteoporosis self-assessment tool (OSTA) predicts the risk of osteoporosis in an individual. It is a simple calculation-based tool [wt (kg) - age (yr)/5] and can be used for measuring bone mineral density (BMD). However, OSTA is influenced by ethnicity. We studied the performance of OSTA index as a screening tool for osteoporosis in 257 community-dwelling North Indian men above 50 yr age. Each subject underwent a detailed clinical, dietary, anthropometric, and biochemical assessment and bone density measurement using dual-energy X-ray absorptiometry. As per World Health Organization criteria, osteoporosis, osteopenia, and normal BMD were observed in 17.9%, 58.8%, and 23.3%, respectively. OSTA index ranged between -6.4 and 8.8. OST index ≤2 predicted osteoporosis with a sensitivity of 95.7% and a specificity of 33.6% and an area under the curve for a receiver operating characteristic curve of 0.702. The OSTA index is an effective screening tool for measuring BMD in elderly Indian men and can be used by primary care physicians.
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Affiliation(s)
- Khurshid A Bhat
- Department of Endocrinology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Manisha Kakaji
- Department of Endocrinology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Ashish Awasthi
- Department of Biostatistics and Health Informatics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Karambir Kumar
- Department of Endocrinology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Kshtij Mishra
- Department of Endocrinology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Manoj Shukla
- Department of Endocrinology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Sushil K Gupta
- Department of Endocrinology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
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15
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Moon JH, Kim LO, Kim HJ, Kong MH. Evaluation of the Predictive Index for Osteoporosis as a Clinical Tool to Identify the Risk of Osteoporosis in Korean Men by Using the Korea National Health and Nutrition Examination Survey Data. Korean J Fam Med 2016; 37:346-350. [PMID: 27900073 PMCID: PMC5122667 DOI: 10.4082/kjfm.2016.37.6.346] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 04/19/2016] [Accepted: 04/27/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND We previously proposed the Predictive Index for Osteoporosis as a new index to identify men who require bone mineral density measurement. However, the previous study had limitations such as a single-center design and small sample size. Here, we evaluated the usefulness of the Predictive Index for Osteoporosis using the nationally representative data of the Korea National Health and Nutrition Examination Survey. METHODS Participants underwent bone mineral density measurements via dual energy X-ray absorptiometry, and the Predictive Index for Osteoporosis and Osteoporosis Self-Assessment Tool for Asians were assessed. Receiver operating characteristic analysis was used to obtain optimal cut-off points for the Predictive Index for Osteoporosis and Osteoporosis Self-Assessment Tool for Asians, and the predictability of osteoporosis for the 2 indices was compared. RESULTS Both indices were useful clinical tools for identifying osteoporosis risk in Korean men. The optimal cut-off value for the Predictive Index for Osteoporosis was 1.07 (sensitivity, 67.6%; specificity, 72.7%; area under the curve, 0.743). When using a cut-off point of 0.5 for the Osteoporosis Self-Assessment Tool for Asians, the sensitivity and specificity were 71.9% and 64.0%, respectively, and the area under the curve was 0.737. CONCLUSION The Predictive Index for Osteoporosis was as useful as the Osteoporosis Self-Assessment Tool for Asians as a screening index to identify candidates for dual energy X-ray absorptiometry among men aged 50-69 years.
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Affiliation(s)
- Ji Hyun Moon
- Department of Family Medicine, Jeju National University Hospital, Jeju, Korea.; Graduate School of Jeju National University, Jeju, Korea
| | - Lee Oh Kim
- Department of Family Medicine, Jeju National University Hospital, Jeju, Korea
| | - Hyeon Ju Kim
- Department of Family Medicine, Jeju National University Hospital, Jeju, Korea.; Department of Family Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Mi Hee Kong
- Department of Family Medicine, Jeju National University Hospital, Jeju, Korea.; Department of Family Medicine, Jeju National University School of Medicine, Jeju, Korea
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Chang SF, Yang RS. Optimal Analysis to Discriminate Males’ Osteoporosis With Simple Physiological Indicators. Am J Mens Health 2016; 10:487-494. [PMID: 25766506 DOI: 10.1177/1557988315574857] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Males account for one third of global hip fracture patients, and their hip fracture-related mortality rate is higher than that of females. Scholars have primarily investigated self-evaluation indicators for elderly Caucasians and other ethnicities, and have rarely conducted large-scale cutoff point studies on Asian males. In this study, a large-scale database on bone mineral density (BMD) examinations was used to conduct a cutoff point study on males with osteoporosis. This study involved a retrospective research design. Males who accepted BMD examinations from 2009 to 2012 at a large teaching hospital in Taiwan were sampled in this study. This study used the database for analyzing effects with using osteoporosis self-assessment indicator, age, body weight, and body mass index (BMI) to discriminate osteoporosis in males, specifically focusing on accuracy, cutoff point, sensitivity, specificity, and positive and negative predictive values. Overall, receiver operating characteristic curve for the samples reached 70%. These cutoff points included: a body weight is less than 58.8 kg, BMI is 23 kg/m2, and the osteoporosis self-assessment score is −1.86, to identify osteoporosis. Involving body weight and BMI as optimal assessing indicators for assessing osteoporosis among males younger than 65 years, and the osteoporosis self-assessment tool was ideal for measuring males older than 65 years. Professional health staff should apply convenient, low-cost, and accurate evaluation tools that can assist Asian males in planning preventive osteoporosis strategies to avoid osteoporotic fractures and death.
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Affiliation(s)
- Shu-Fang Chang
- National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, Republic of China
| | - Rong-Sen Yang
- National Taiwan University Hospital, Taipei, Taiwan, Republic of China
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Zhang HM, Liu HL, Wang X, Chen W, Chen D, Zhang ZZ, Wang HM. Clinical value of self-assessment risk of osteoporosis in Chinese. Open Med (Wars) 2016; 11:190-195. [PMID: 28352792 PMCID: PMC5329823 DOI: 10.1515/med-2016-0036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Accepted: 04/18/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Early detection of high-risk population for osteoporosis is the key to preventing this disease. METHODOLOGY In this cross-sectional study a continuous sample of 270 women and 89 men (age: 20-90 years) was divided into four groups by age (≤ 55 or > 55 years) and sex. Participants completed the IOF test. Low-, medium-, and high-risk grades were defined by an OSTA index of greater than -1, -1 to -4, and less than -4, respectively. RESULTS Most participants were categorized in the low-risk group (240 people, 66.9%), followed by the medium-risk (102 people, 28.4%) and high-risk groups (17 people, 4.7%). Compared to women, men in both age groups had significantly higher OSTA index and greater numbers of positive answers on the IOF test. 64.3% individuals were susceptible to osteoporosis risk (≥1 positive answers on the IOF test). Multiple regression analysis demonstrated that family history of fragility fracture (OR: 0.503, 95% CI: 0.26-0.97), height loss exceeding 3 cm (OR: 2.51, 95% CI: 1.55-4.05), and earlier menopause (OR: 0.434, 95% CI: 0.19-0.97) were associated with higher risk grades. CONCLUSIONS Combined use of the OSTA and IOF test is a simple and effective method for assessing the risk of osteoporosis.
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Affiliation(s)
- Hong-Mei Zhang
- Department of Endocrinology, The Central Hospital of Wuhan, No.26, Shengli Street, Jiang'an District, 430014, Wuhan, China
| | - Hui-Ling Liu
- Hubei Integrated Traditional Chinese and Western Medicine Hospital, Hubei University of Chinese Medicine Affiliated Hospital, No 5, New Tian-Men Dun Road,430015, Wuhan, China
| | - Xuan Wang
- Wuhan Polytechnic University, No 68, Southern Xue-Fu Road, 430023, Wuhan China
| | - Wei Chen
- Hubei Integrated Traditional Chinese and Western Medicine Hospital, Hubei University of Chinese Medicine Affiliated Hospital, No 5, New Tian-Men Dun Road,430015, Wuhan, China
| | - Dan Chen
- Hubei Integrated Traditional Chinese and Western Medicine Hospital, Hubei University of Chinese Medicine Affiliated Hospital, No 5, New Tian-Men Dun Road,430015, Wuhan, China
| | - Zhong-Zhi Zhang
- Hubei Integrated Traditional Chinese and Western Medicine Hospital, Hubei University of Chinese Medicine Affiliated Hospital, No 5, New Tian-Men Dun Road,430015, Wuhan, China
| | - Han-Ming Wang
- Hubei Integrated Traditional Chinese and Western Medicine Hospital, Hubei University of Chinese Medicine Affiliated Hospital, No 5, New Tianmen Dun Road, 430015, Wuhan, China . Facsimile numbers: 862765600947, Telephone number: 8618971697988
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Reddish W. A Description of How Advanced Practice Nurses Screen for Osteoporosis in Maryland. J Dr Nurs Pract 2016; 9:60-68. [DOI: 10.1891/2380-9418.9.1.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Osteoporosis is a major health problem in the United States, yet the evidence suggests that practitioners often fail to screen for osteoporosis risk and, as a result, underdiagnose and fail to treat the disease. Because little is known about how well advanced practice nurses (APNs) evaluate osteoporotic risk, determining the extent to which they screen may enhance our understanding of the scope of APN diagnostic practice. The purpose of this study was 3-fold: (a) to determine if APNs routinely screen for osteoporotic risks, (b) to ascertain how they screen, and (c) to identify barriers that influence osteoporosis screening. Survey methods were used to poll members of the Nurse Practitioner Association of Maryland (n = 357) who identified themselves as adult, family, geriatric, and women’s health nurse practitioners. The results suggest that master’s-prepared APNs screen for osteoporosis more so than APNs with doctor of nursing practice (DNP) degrees. In addition, adult APN screened more often than family APNs and APNs in urban areas screened more frequently than rural-based APNs. Logistic regression failed to predict which APNs were likely to screen for osteoporosis.
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Oh SM, Song BM, Nam BH, Rhee Y, Moon SH, Kim DY, Kang DR, Kim HC. Development and Validation of Osteoporosis Risk-Assessment Model for Korean Men. Yonsei Med J 2016; 57:187-96. [PMID: 26632400 PMCID: PMC4696952 DOI: 10.3349/ymj.2016.57.1.187] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 05/18/2015] [Accepted: 06/05/2015] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The aim of the present study was to develop an osteoporosis risk-assessment model to identify high-risk individuals among Korean men. MATERIALS AND METHODS The study used data from 1340 and 1110 men ≥50 years who participated in the 2009 and 2010 Korean National Health and Nutrition Examination Survey, respectively, for development and validation of an osteoporosis risk-assessment model. Osteoporosis was defined as T score ≤-2.5 at either the femoral neck or lumbar spine. Performance of the candidate models and the Osteoporosis Self-assessment Tool for Asian (OSTA) was compared with sensitivity, specificity, and area under the receiver operating characteristics curve (AUC). A net reclassification improvement was further calculated to compare the developed Korean Osteoporosis Risk-Assessment Model for Men (KORAM-M) with OSTA. RESULTS In the development dataset, the prevalence of osteoporosis was 8.1%. KORAM-M, consisting of age and body weight, had a sensitivity of 90.8%, a specificity of 42.4%, and an AUC of 0.666 with a cut-off score of -9. In the validation dataset, similar results were shown: sensitivity 87.9%, specificity 39.7%, and AUC 0.638. Additionally, risk categorization with KORAM-M showed improved reclassification over that of OSTA up to 22.8%. CONCLUSION KORAM-M can be simply used as a pre-screening tool to identify candidates for dual energy X-ray absorptiometry tests.
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Affiliation(s)
- Sun Min Oh
- Cardiovascular and Metabolic Disease Etiology Research Center, Yonsei University College of Medicine, Seoul, Korea
| | - Bo Mi Song
- Cardiovascular and Metabolic Disease Etiology Research Center, Yonsei University College of Medicine, Seoul, Korea
- Department of Public Health, Yonsei University Graduate School, Seoul, Korea
| | - Byung Ho Nam
- Biometric Research Branch, National Cancer Center, Goyang, Korea
| | - Yumie Rhee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Seong Hwan Moon
- Department of Orthopedics Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Deog Young Kim
- Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Dae Ryong Kang
- Department of Medical Humanities and Social Medicines, Ajou University School of Medicine, Suwon, Korea
| | - Hyeon Chang Kim
- Cardiovascular and Metabolic Disease Etiology Research Center, Yonsei University College of Medicine, Seoul, Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.
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Keshtkar A, Tabatabaie O, Matin N, Mohammadi Z, Ebrahimi M, Khashayar P, Asadi M. Clinical performance of seven prescreening tools for osteoporosis in Iranian postmenopausal women. Rheumatol Int 2015; 35:1995-2004. [PMID: 25980683 DOI: 10.1007/s00296-015-3286-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 05/08/2015] [Indexed: 11/27/2022]
Abstract
This study was designed to evaluate seven prescreening osteoporosis models in postmenopausal Iranian women. This study was performed on 8644 postmenopausal women who have been referred for bone mineral densitometry (BMD) in BMD center of Shariati hospital in Tehran between 2001 and 2011. Diagnostic properties of seven prescreening instruments were evaluated. With regard to area under curve (AUC), these models have low accuracy (AUC ≤ 0.65). Considering only femoral neck or total femur area, these models had low accuracy but were more sensitive. Except for three models with sensitivities of ≤65 % in both osteoporosis and fracture threshold, other models were around 70 % sensitive. However, these models were not considered clinically useful regarding their positive predictive values (PPV) especially in BMDs ≤02.5. With regard to different measures of diagnostic property, none of these models were good screening tools for osteoporosis or fracture threshold. Although some of them are sensitive, considering other measures such as PPV indicates that they are not completely useful for clinical use. Attempts should be made for developing newer prescreening methods and calibration of the existing models with regard to the studied population.
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Affiliation(s)
- Abbas Keshtkar
- Osteoporosis Research Center (ORC), Endocrinology and Metabolism Clinical Sciences Research Institute (ECSI), Tehran University of Medical Sciences, Tehran, Iran.
| | - Omidreza Tabatabaie
- Osteoporosis Research Center (ORC), Endocrinology and Metabolism Clinical Sciences Research Institute (ECSI), Tehran University of Medical Sciences, Tehran, Iran.
- MD-MPH, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Nassim Matin
- Osteoporosis Research Center (ORC), Endocrinology and Metabolism Clinical Sciences Research Institute (ECSI), Tehran University of Medical Sciences, Tehran, Iran.
- MD-MPH, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Zahra Mohammadi
- Osteoporosis Research Center (ORC), Endocrinology and Metabolism Clinical Sciences Research Institute (ECSI), Tehran University of Medical Sciences, Tehran, Iran.
| | - Mehdi Ebrahimi
- Osteoporosis Research Center (ORC), Endocrinology and Metabolism Clinical Sciences Research Institute (ECSI), Tehran University of Medical Sciences, Tehran, Iran.
| | - Patricia Khashayar
- Osteoporosis Research Center (ORC), Endocrinology and Metabolism Clinical Sciences Research Institute (ECSI), Tehran University of Medical Sciences, Tehran, Iran.
| | - Mojgan Asadi
- Osteoporosis Research Center (ORC), Endocrinology and Metabolism Clinical Sciences Research Institute (ECSI), Tehran University of Medical Sciences, Tehran, Iran.
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Nayak S, Edwards DL, Saleh AA, Greenspan SL. Systematic review and meta-analysis of the performance of clinical risk assessment instruments for screening for osteoporosis or low bone density. Osteoporos Int 2015; 26:1543-54. [PMID: 25644147 PMCID: PMC4401628 DOI: 10.1007/s00198-015-3025-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 01/02/2015] [Indexed: 10/24/2022]
Abstract
UNLABELLED We performed a systematic review and meta-analysis of the performance of clinical risk assessment instruments for screening for DXA-determined osteoporosis or low bone density. Commonly evaluated risk instruments showed high sensitivity approaching or exceeding 90% at particular thresholds within various populations but low specificity at thresholds required for high sensitivity. Simpler instruments, such as OST, generally performed as well as or better than more complex instruments. INTRODUCTION The purpose of the study is to systematically review the performance of clinical risk assessment instruments for screening for dual-energy X-ray absorptiometry (DXA)-determined osteoporosis or low bone density. METHODS Systematic review and meta-analysis were performed. Multiple literature sources were searched, and data extracted and analyzed from included references. RESULTS One hundred eight references met inclusion criteria. Studies assessed many instruments in 34 countries, most commonly the Osteoporosis Self-Assessment Tool (OST), the Simple Calculated Osteoporosis Risk Estimation (SCORE) instrument, the Osteoporosis Self-Assessment Tool for Asians (OSTA), the Osteoporosis Risk Assessment Instrument (ORAI), and body weight criteria. Meta-analyses of studies evaluating OST using a cutoff threshold of <1 to identify US postmenopausal women with osteoporosis at the femoral neck provided summary sensitivity and specificity estimates of 89% (95%CI 82-96%) and 41% (95%CI 23-59%), respectively. Meta-analyses of studies evaluating OST using a cutoff threshold of 3 to identify US men with osteoporosis at the femoral neck, total hip, or lumbar spine provided summary sensitivity and specificity estimates of 88% (95%CI 79-97%) and 55% (95%CI 42-68%), respectively. Frequently evaluated instruments each had thresholds and populations for which sensitivity for osteoporosis or low bone mass detection approached or exceeded 90% but always with a trade-off of relatively low specificity. CONCLUSIONS Commonly evaluated clinical risk assessment instruments each showed high sensitivity approaching or exceeding 90% for identifying individuals with DXA-determined osteoporosis or low BMD at certain thresholds in different populations but low specificity at thresholds required for high sensitivity. Simpler instruments, such as OST, generally performed as well as or better than more complex instruments.
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Affiliation(s)
- S Nayak
- Swedish Center for Research and Innovation, Swedish Health Services, Swedish Medical Center, 747 Broadway, Seattle, WA, 98122-4307, USA,
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Pavon JM, Sanders LL, Sloane R, Colón-Emeric C. Sensitivity of osteoporosis screening guidelines for eventual hip fracture in older male veterans. BONEKEY REPORTS 2014; 3:530. [PMID: 24876931 DOI: 10.1038/bonekey.2014.25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 01/30/2014] [Indexed: 11/09/2022]
Abstract
This study sought to determine whether guideline-recommended clinical criteria to select men for osteoporosis screening provide significantly better sensitivity than the osteoporotic screening tool (OST) among men who later went on to have a hip fracture, and whether the sensitivity differs by race. This retrospective observational study uses data from the Department of Veterans Affairs Austin Automation Center. We identified 825 male veterans with hip fractures from 2007 to 2009. Clinical risk factors used as screening selection criteria were abstracted from five accepted guidelines. Outpatient encounters were examined for each subject to determine whether they would have met screening selection criteria for each guideline in the 5 years before their hip fracture event. Sensitivities for each guideline were compared with the OST, using McNemar's exact test. Sensitivities of Veterans Affairs Health Service Research and Development Services (VA HSR&D) and National Osteoporosis Foundation (NOF) guidelines were 77% and 82%, respectively, and were significantly better than the OST sensitivity of 72% (P<0.05). Sensitivities of American College of Physicians (ACP; 68%), VA Secretary's Letters (45%) and Center for Medicare and Medicaid Services (13%) were significantly worse than the OST sensitivity (P<0.001). The sensitivities of the VA HSR&D, ACP and NOF were significantly higher in Whites compared with non-Whites (76% vs 65%, P<0.01; 70% vs 58%, P<0.01; and 84% vs 70%, P<0.001, respectively). Only VA HSR&D and NOF clinical screening criteria are more sensitive than OST in identifying veterans who subsequently experience hip fractures, and these sensitivities vary by race.
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Affiliation(s)
- Juliessa M Pavon
- Division of Geriatrics, Duke University Medical Center, Duke University , Durham, NC, USA ; Durham VAMC GRECC, Durham VA Medical Center , Durham, NC, USA
| | - Linda L Sanders
- Division of General Internal Medicine, Duke University Medical Center, Duke University , Durham, NC, USA
| | - Richard Sloane
- Division of Geriatrics, Duke University Medical Center, Duke University , Durham, NC, USA
| | - Cathleen Colón-Emeric
- Division of Geriatrics, Duke University Medical Center, Duke University , Durham, NC, USA ; Durham VAMC GRECC, Durham VA Medical Center , Durham, NC, USA
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Kim LO, Kim HJ, Kong MH. A New Predictive Index for Osteoporosis in Men under 70 Years of Age: An Index to Identify Male Candidates for Osteoporosis Screening by Bone Mineral Density. J Osteoporos 2014; 2014:781897. [PMID: 24724035 PMCID: PMC3960559 DOI: 10.1155/2014/781897] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 01/27/2014] [Accepted: 01/27/2014] [Indexed: 11/17/2022] Open
Abstract
Background. Bone mineral density (BMD) screening guidelines for osteoporosis in men seem to have remained unclear. We aimed to set up a predictive index for the osteoporosis(PIO) in men under 70 years of age and present the optimal cutoff value of it, so that clinicians might use it to identify male candidates who benefit from taking the BMD screening. Methods. Adult men under 70 years old who met certain criteria were included. With the determined significant predictors for osteoporosis, we created a new index that presumably best predicts the osteoporosis and compared the predictability of it to other variables. Lastly, the optimal cutoff value of the PIO was calculated. Results. A total of 359 men were included. Age, weight, and current smoking status turned out to be significant predictors for osteoporosis. The PIO was as follows: [age(years) + 10 (for current smoker)]/weight(kg). Compared to other variables, the PIO showed the greatest predictive performance with the optimal cutoff point being 0.87 at which sensitivity and specificity were 71.9% and 70.0%, respectively. Conclusion. A new predictive index appeared to predict the presence of osteoporosis fairly well and thus can be used with its cutoff point to identify men under 70 years of age who need BMD screening.
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Affiliation(s)
- Lee Oh Kim
- Department of Family Medicine, Jeju National University Hospital, Aran 13gil 15, Jeju-si, Jeju 690-767, Republic of Korea
| | - Hyeon-Ju Kim
- Department of Family Medicine, Jeju National University Hospital, Aran 13gil 15, Jeju-si, Jeju 690-767, Republic of Korea
- Department of Family Medicine, School of Medicine, Jeju National University, Jeju, Republic of Korea
| | - Mi Hee Kong
- Department of Family Medicine, Jeju National University Hospital, Aran 13gil 15, Jeju-si, Jeju 690-767, Republic of Korea
- Department of Family Medicine, School of Medicine, Jeju National University, Jeju, Republic of Korea
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Steuart Richards J, Lazzari AA, Teves Qualler DA, Desale S, Howard R, Kerr GS. Validation of the osteoporosis self-assessment tool in US male veterans. J Clin Densitom 2014; 17:32-7. [PMID: 23489972 DOI: 10.1016/j.jocd.2013.02.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 02/05/2013] [Indexed: 10/27/2022]
Abstract
The osteoporosis self-assessment tool (OST) is a screening instrument that uses age and weight as parameters to predict the risk of osteoporosis. This study was designed to evaluate OST in predicting osteoporosis in males. Male veterans aged 50yr and older with no prior diagnosis of osteoporosis and no prior bone densitometry (dual-energy X-ray absorptiometry [DXA]) testing were eligible for the study. Sociodemographic information, medical history, and risk factors for osteoporosis were recorded. Anthropometric measurements were taken and DXA testing performed. The OST index for each subject was calculated and predictive values and receiver operating characteristic (ROC) curves were evaluated for OST and osteoporosis. Five hundred eighteen subjects underwent DXA, 92 (17.8%) had osteoporosis, 281 (54.2%) had low bone mass, and 145 (28.0%) had normal bone mineral density. The OST index ranged from -8 to 23 with a mean of 4 (standard deviation ± 4.3). An OST index of 6 or lower predicted osteoporosis with a sensitivity of 82.6%, specificity of 33.6%, and an area under the curve for the ROC curve of 0.67. OST index performed better in non-Hispanic whites and males >65 yr. OST predicts osteoporosis with moderate sensitivity and poor specificity in men.
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Affiliation(s)
- J Steuart Richards
- Veterans Affairs Medical Center, Washington, DC, USA; Department of Medicine, Georgetown University, Washington, DC, USA.
| | - Antonio A Lazzari
- Boston Division VA Health Care System, Boston University Medical School, Boston, MA, USA
| | - Denise A Teves Qualler
- Zablocki VA Medical Center in Milwaukee, Milwaukee, WI, USA; Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sameer Desale
- Medstar Health Research Institute, Hyattsville, MD, USA
| | | | - Gail S Kerr
- Veterans Affairs Medical Center, Washington, DC, USA; Department of Medicine, Georgetown University, Washington, DC, USA; Department of Medicine, Howard University, Washington, DC, USA
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Malabanan AO, Rosen HN, Vokes TJ, Deal CL, Alele JD, Olenginski TP, Schousboe JT. Indications of DXA in women younger than 65 yr and men younger than 70 yr: the 2013 Official Positions. J Clin Densitom 2013; 16:467-71. [PMID: 24055260 DOI: 10.1016/j.jocd.2013.08.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 08/14/2013] [Indexed: 11/20/2022]
Abstract
Dual-energy X-ray absorptiometry (DXA) is the method of choice to assess fracture risk for women 65 yr and older and men 70 yr and older. The 2007 International Society for Clinical Densitometry Official Positions had developed guidelines for assessing bone density in younger women during and after the menopausal transition and in men 50-69 yr and the 2008 National Osteoporosis Foundation (NOF) guidelines recommended testing in postmenopausal women younger than 65 yr and men 50-69 yr only in the presence of clinical risk factors. The purpose of the 2013 DXA Task Force was to reassess the NOF guidelines for ordering DXA in postmenopausal women younger than 65 yr and men 50-69 yr. The Task Force reviewed the literature published since the 2007 Position Development Conference and 2008 NOF, reviewing clinical decision rules such as the Osteoporosis Screening Tool and FRAX and sought to keep recommendations simple to remember and implement. Based on this assessment, the NOF guidelines were endorsed; DXA was recommended in those postmenopausal women younger than 65 yr and men 50-69 yr only in the presence of clinical risk factors for low bone mass, such as low body weight, prior fracture, high-risk medication use, or a disease or condition associated with bone loss.
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Affiliation(s)
- Alan O Malabanan
- Division of Endocrinology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Wong CP, Lok MK, Wun YT, Pang SM. Chinese men's knowledge and risk factors of osteoporosis: compared with women's. Am J Mens Health 2013; 8:159-66. [PMID: 24027205 DOI: 10.1177/1557988313503981] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Male osteoporosis is underappreciated. Little is known about men's knowledge of osteoporosis and how much men are at risk. This study surveyed men's knowledge of osteoporosis and their risk factors with reference to women in the primary care setting in Macau, China. A convenience sample of 302 men and 635 women aged 18 to 90 years completed questionnaires comprising the Osteoporosis Knowledge Assessment Tool and the One-Minute Osteoporosis Risk Test. Their risks of osteoporosis were assessed with the Osteoporosis Self-Assessment Screening Test. Men and women, who were aged 55 years or below, had similarly limited knowledge of osteoporosis. People aged above 55 years had significantly less knowledge; men had less knowledge than women only in this age-group. If questions specific to women or menopause were excluded, men had similar knowledge as women. A higher proportion of men than women had risk factors as more men consumed alcohol or smoked tobacco. Similar proportions of men and women reported a loss of 1 inch in body height after age 40. After age 55, 29.2% men were at medium to high risk of osteoporosis. This study concludes that health education and primary prevention of osteoporosis should be promoted to men starting in middle-age.
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Affiliation(s)
- Chi Peng Wong
- 1Health Bureau, Macau Special Administrative Region, Macau, China
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Rubin KH, Abrahamsen B, Friis-Holmberg T, Hjelmborg JVB, Bech M, Hermann AP, Barkmann R, Glüer CC, Brixen K. Comparison of different screening tools (FRAX®, OST, ORAI, OSIRIS, SCORE and age alone) to identify women with increased risk of fracture. A population-based prospective study. Bone 2013; 56:16-22. [PMID: 23669650 DOI: 10.1016/j.bone.2013.05.002] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 04/16/2013] [Accepted: 05/03/2013] [Indexed: 01/03/2023]
Abstract
PURPOSE To compare the power of FRAX® without bone mineral density (BMD) and simpler screening tools (OST, ORAI, OSIRIS, SCORE and age alone) in predicting fractures. METHODS This study was a prospective, population-based study performed in Denmark comprising 3614 women aged 40-90 years, who returned a questionnaire concerning items on risk factors for osteoporosis. Fracture risk was calculated using the different screening tools (FRAX®, OST, ORAI, OSIRIS and SCORE) for each woman. The women were followed using the Danish National Register registering new major osteoporotic fractures during 3 years, counting only the first fracture per person. Area under the receiver operating characteristic curve (ROC) and statistics and Harrell's index were calculated. Agreement between the tools was calculated by kappa statistics. RESULTS A total of 4% of the women experienced a new major osteoporotic fracture during the follow-up period. There were no differences in the area under the curve (AUC) values between FRAX® and the simpler tools; AUC values between 0.703 and 0.722 (p = 0.86). Also, Harrell's C values were very similar between the tools. Agreement between the tools was modest. CONCLUSION During 3 years follow-up FRAX® did not perform better in the fracture risk prediction compared with simpler tools such as OST, ORAI, OSIRIS, SCORE or age alone in a screening scenario where BMD was not measured. These findings suggest that simpler models based on fewer risk factors, which would be easier to use in clinical practice by the GP or the patient herself, could just as well as FRAX® be used to identify women with increased risk of fracture. SUMMARY Comparison of FRAX® and simpler screening tools (OST, ORAI, OSIRIS, SCORE) in predicting fractures indicate that FRAX® did not perform better in fracture risk prediction compared with the simpler tools or even age alone in a screening scenario without bone mineral density assessment.
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Affiliation(s)
- Katrine Hass Rubin
- Institute of Clinical Research, University of Southern Denmark, Denmark.
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Fransiska Y, Tiksnadi B, Chaidir R, Ismiarto YD. The male osteoporosis risk estimation score and the osteoporosis self-assessment screening tool for Indonesian men. J Orthop Surg (Hong Kong) 2012; 20:205-8. [PMID: 22933680 DOI: 10.1177/230949901202000214] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To evaluate the male osteoporosis risk estimation score (MORES) and the osteoporosis self-assessment screening tool (OST) score as a means of screening for osteoporosis in men. METHODS Records of 113 Indonesian men aged 50 to 91 (mean, 71) years who underwent evaluation of bone mineral density (T-score) using Dual-energy X-ray absorptiometry were retrospectively reviewed. The MORES was determined by 3 osteoporosis risk factors: age (in years), body weight (in kg), and chronic obstructive pulmonary disorder. A MORES of ≥6 indicated osteoporosis and corresponded to a T-score of ≤-2.5. The OST score was calculated as body weight (in kg) minus age (in years) multiplied by 0.2. An OST score of ≤2 indicated osteoporosis and corresponded to a T-score of ≤-2.5. Sensitivity, specificity, and positive and negative predictive values of the MORES and the OST score were determined. RESULTS Respectively for the MORES and the OST score, sensitivity values were 100% and 74%, specificity values were 7% and 41%, positive predictive values were 25% and 28%, and negative predictive values were 100% and 83%. Using receiver operating characteristic curves, the area under curve was 0.535 for the MORES and 0.574 for the OST score. CONCLUSION The MORES and the OST score should be used together to screen for osteoporosis in men.
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Affiliation(s)
- Yuliana Fransiska
- Department of Orthopaedic Surgery, Hasan Sadikin General Hospital, Bandung, Indonesia.
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Watts NB, Adler RA, Bilezikian JP, Drake MT, Eastell R, Orwoll ES, Finkelstein JS. Osteoporosis in men: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2012; 97:1802-22. [PMID: 22675062 DOI: 10.1210/jc.2011-3045] [Citation(s) in RCA: 379] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim was to formulate practice guidelines for management of osteoporosis in men. EVIDENCE We used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe the strength of recommendations and evidence quality. CONSENSUS PROCESS Consensus was guided by systematic evidence reviews, one in-person meeting, and multiple conference calls and e-mails. Task Force drafts were reviewed successively by The Endocrine Society's Clinical Guidelines Subcommittee and Clinical Affairs Core Committee; representatives of ASBMR, ECTS, ESE, ISCD; and members at large. At each stage, the Task Force received written comments and incorporated needed changes. The reviewed document was approved by The Endocrine Society Council before submission for peer review. CONCLUSIONS Osteoporosis in men causes significant morbidity and mortality. We recommend testing higher risk men [aged ≥70 and men aged 50-69 who have risk factors (e.g. low body weight, prior fracture as an adult, smoking, etc.)] using central dual-energy x-ray absorptiometry. Laboratory testing should be done to detect contributing causes. Adequate calcium and vitamin D and weight-bearing exercise should be encouraged; smoking and excessive alcohol should be avoided. Pharmacological treatment is recommended for men aged 50 or older who have had spine or hip fractures, those with T-scores of -2.5 or below, and men at high risk of fracture based on low bone mineral density and/or clinical risk factors. Treatment should be monitored with serial dual-energy x-ray absorptiometry testing.
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Affiliation(s)
- Nelson B Watts
- Mercy Health Osteoporosis & Bone Health Services, Cincinnati Ohio 45236, USA
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Ryan CS, Petkov VI, Adler RA. Osteoporosis in men: the value of laboratory testing. Osteoporos Int 2011; 22:1845-53. [PMID: 20936403 DOI: 10.1007/s00198-010-1421-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Accepted: 09/13/2010] [Indexed: 10/19/2022]
Abstract
UNLABELLED Evaluation of 234 men referred for osteoporosis found many with undiagnosed secondary causes and multiple unrecognized risk factors. INTRODUCTION Studies in women with postmenopausal osteoporosis suggest that many have unrecognized disorders affecting bone. Men are considered more likely to have underlying, possibly correctable causes. We studied the prevalence of risk factors, secondary causes, and laboratory abnormalities in men with and without previously known causes for osteoporosis. METHODS We reviewed the charts of 234 men with osteoporosis diagnosed by bone mineral density testing. In addition to screening chemistries, 25-hydroxyvitamin D, testosterone, luteinizing hormone, follicle-stimulating hormone, thyroid-stimulating hormone, and spot urinary calcium-to-creatinine ratio were measured. RESULTS The mean age was 70.6 years and mean weight was 76.4 kg. The mean T-score for spine, femoral neck, and forearm was -2.2, -2.4, and -2.3, respectively. Evaluation revealed secondary osteoporosis in 75% overall including hypogonadism, vitamin D deficiency, hypercalciuria, subclinical hyperthyroidism, and hyperparathyroidism. In those men with known secondary osteoporosis at the time of dual energy X-ray absorptiometry testing, additional diagnoses were found in just over half. Vitamin D deficiency and insufficiency were very common, and other common risk factors for osteoporosis included age >65, current smoking, and prior fracture. Half of the subjects had ≥ 4 risk factors. CONCLUSION Evaluation revealed a specific cause in about half of men thought to have primary osteoporosis. Among men with known secondary osteoporosis, additional risk factors and secondary causes were frequently identified. In conclusion, a relatively modest evaluation of men with osteoporosis will often provide useful information.
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Affiliation(s)
- C S Ryan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
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D'Alesio V, Salvig BE, Fourakre TN. Evaluation of Osteoporosis Risk Assessment in Veterans Receiving Androgen-Deprivation Therapy. ACTA ACUST UNITED AC 2011; 26:43-7. [DOI: 10.4140/tcp.n.2011.43] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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El Maghraoui A, Ghazi M, Gassim S, Ghozlani I, Mounach A, Rezqi A, Dehhaoui M. Risk factors of osteoporosis in healthy Moroccan men. BMC Musculoskelet Disord 2010; 11:148. [PMID: 20602777 PMCID: PMC2909164 DOI: 10.1186/1471-2474-11-148] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Accepted: 07/05/2010] [Indexed: 12/02/2022] Open
Abstract
Background Although not as common as in women, osteoporosis remains a significant health care problem in men. Data concerning risk factors of osteoporosis are lacking for the male Moroccan population. The objective of the study was to identify some determinants associated to low bone mineral density in Moroccan men. Methods a sample of 592 healthy men aged 20-79 years was recruited from the area of Rabat, the capital of Morocco. Measurements were taken at the lumbar spine and proximal femurs using DXA (Lunar Prodigy Vision, GE). Biometrical, clinical, and lifestyle determinants were collected. Univariate, multivariate, and logistic regression analyses were performed. Results the mean (SD) age of the patients was 49 (17.2) years old. The prevalence of osteoporosis and osteopenia were 8.7% and 52.8%, respectively. Lumbar spine and hip BMD correlated significantly with age, weight and BMI. When comparing the subjects according to the WHO classification, significant differences were revealed between the three groups of subjects for age, weight and BMI, prevalence of low calcium intake and low physical activity. The multiple regression analysis found that only age, BMI, and high coffee consumption were independently associated to the osteoporotic status. Conclusion ageing and low BMI are the main risk factors associated with osteoporosis in Moroccan men.
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Machado P, Coutinho M, da Silva JAP. Selecting men for bone densitometry: performance of osteoporosis risk assessment tools in Portuguese men. Osteoporos Int 2010; 21:977-83. [PMID: 19727909 DOI: 10.1007/s00198-009-1036-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2009] [Accepted: 07/29/2009] [Indexed: 11/28/2022]
Abstract
SUMMARY Clinicians need tools to identify patients most likely to benefit from bone mineral density (BMD) testing, for which cost-effectiveness does not allow generalized screening. This study supports the utility of osteoporosis risk assessment tools in selecting men for BMD testing. Different cutoff values may be appropriate for different countries and/or ethnic origins. INTRODUCTION Our aim was to evaluate the utility of three osteoporosis (OP) risk assessment tools in a large group of Portuguese men aged 50 or more and to determine the best cutoff value to be used for selecting men for bone densitometry. METHODS We assessed the performance of three simple tools in 202 randomly selected men: body weight criterion (BWC), osteoporosis self-assessment tool for Asians (OSTA), and a modified version of the OSTA equation (OST). Previously published cutoff values (validated in postmenopausal women) and three additional cutoff values were tested. Sensitivity (SE), specificity (SP), predictive values, and area under the receiver operating characteristic (AUROC) curve for correctly selecting men with OP (defined by BMD testing) were determined. RESULTS Mean age of the cohort was 63.8 years. According to the World Health Organization diagnostic categories, 16.8% had osteoporosis. The best performing cutoffs for correctly selecting men with OP for BMD testing were OST < 3 (SE = 75.5%, SP = 50.0%, AUROC = 0.632), OSTA < 3 (SE = 73.5%, SP = 58.3%, AUROC = 0.659), and BWC < 75 kg (SE = 73.5%, SP = 61.3%, AUROC = 0.674). CONCLUSIONS OP risk assessment tools seem to be useful in men aged 50 or more. Best cutoff values are different from those recommended for postmenopausal women. Different cutoff values may be appropriate for different countries and/or ethnic origins.
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Affiliation(s)
- P Machado
- Rheumatology Department, Coimbra University Hospital, Coimbra, Portugal.
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Poh LS, Taylor S, McAteer S. Refinement of an osteoporosis risk-assessment questionnaire for use in community pharmacy. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2010. [DOI: 10.1211/ijpp.16.5.0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Abstract
Objective
To explore the influence of bone mineral density (BMD) tests in osteoporosis risk categorisation in community pharmacies, and to develop a simple tool for pharmacists to use as a pre-BMD test screen.
Method
A secondary data analysis was conducted on the responses of 193 participants to a risk-assessment questionnaire, used in previous osteoporosis research that included a BMD test. To explore the impact of the BMD test on pharmacists' categorisation of risk, the researchers made an independent assessment based on responses of the questionnaire. The influence of risk factors on BMD scores/bone status was explored using multiple and logistic regression respectively.
Key findings
A total of responses of 193 participants were available for study, with 113 in the BMD group and 80 from the non-BMD group. In the BMD group, both researchers and pharmacists identified a similar proportion of patients in the moderate/high-risk category when BMD results were incorporated in the risk assessments (X2 = 0.78, degrees of freedom (df) = 1, 0.3 < P < 0.5). A statistically significant difference in risk categorisation was found between the pharmacists and researchers in the non-BMD group (X2 = 23.9, df = 1, P < 0.001). Risk factors identified to be significantly affecting BMD and of use for identifying patients at high risk for osteopenia/osteoporosis were age, weight, postmenopause and absence of hormone replacement therapy (HRT). These four factors were used to construct a simple risk index to guide pharmacists' initial risk categorisation.
Conclusion
The findings of this study suggested that BMD testing may increase the effectiveness of risk assessments and enhance the screening procedures in the community pharmacy. The simple risk index could serve as a pre-BMD test screen, with a BMD test recommended when necessary. A refined risk-assessment questionnaire could serve to guide pharmacists in directing individualised counselling and advice for at-risk patients, through identification of modifiable risk factors and conditions.
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Affiliation(s)
- Lee Ser Poh
- Faculty of Pharmacy, University of Sydney, Australia
| | - Susan Taylor
- Faculty of Pharmacy, University of Sydney, Australia
| | - Sean McAteer
- Faculty of Pharmacy, University of Sydney, Australia
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Richards JS, Peng J, Amdur RL, Mikuls TR, Hooker RS, Michaud K, Reimold AM, Cannon GW, Caplan L, Johnson D, Hines AE, Kerr GS. Dual-energy X-ray absorptiometry and evaluation of the osteoporosis self-assessment tool in men with rheumatoid arthritis. J Clin Densitom 2009; 12:434-40. [PMID: 19775920 DOI: 10.1016/j.jocd.2009.06.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2009] [Revised: 06/16/2009] [Accepted: 06/17/2009] [Indexed: 12/16/2022]
Abstract
Males with rheumatoid arthritis (RA) are at risk for osteoporosis but infrequently undergo dual-energy X-ray absorptiometry (DXA). We examined the frequency of DXA in males enrolled in the Veterans Affairs Rheumatoid Arthritis Registry. The Osteoporosis Self-Assessment Tool (OST) index, a formula using age and weight, was calculated for all subjects. DXA was performed on 282 (35.5%) of the males who were younger (p < 0.01), had lower mean OST index score (p < 0.05), and were more likely to have been prescribed prednisone (p < 0.01) than subjects without DXA. Low bone mass (T-score < -1) was present in 73% of subjects with DXA; 37% of subjects with low-risk OST index scores had normal bone mineral density (BMD) compared with 5.6% of those with high-risk OST index scores (p < 0.01). There was a significant but modest correlation between BMD and the OST index (r = 0.17, p < 0.01). No OST score had a sensitivity and specificity of more than 80%. Association between OST index and BMD was strongest in non-Hispanic whites, subjects older than 60 yr, and smokers. DXA was underutilized in males with RA. The OST index correlated with low bone mass but could not reliably predict osteoporosis in this population.
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Affiliation(s)
- J Steuart Richards
- Rheumatology Section, Washington DC Veterans Affairs Medical Center, Washington, DC 20422, USA.
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Scholtissen S, Guillemin F, Bruyère O, Collette J, Dousset B, Kemmer C, Culot S, Crémer D, Dejardin H, Hubermont G, Lefebvre D, Pascal-Vigneron V, Weryha G, Reginster JY. Assessment of determinants for osteoporosis in elderly men. Osteoporos Int 2009; 20:1157-66. [PMID: 19011728 DOI: 10.1007/s00198-008-0789-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2008] [Accepted: 10/08/2008] [Indexed: 10/21/2022]
Abstract
SUMMARY The aim of this cross-sectional study was to determine and quantify some determinants associated to low bone mineral density (BMD) in elderly men. This study showed that ageing, a lower body mass index (BMI), a higher blood level of C-terminal cross-linking telopeptides of type I collagen (CTX-1), family history of osteoporosis, and/or fracture and prior fracture were associated with bone mineral density. INTRODUCTION Our aims were to identify some determinants associated to low bone mineral density in men and to develop a simple algorithm to predict osteoporosis. METHODS A sample of 1,004 men aged 60 years and older was recruited. Biometrical, serological, clinical, and lifestyle determinants were collected. Univariate, multivariate, and logistic regression analyses were performed. Receiver operating characteristic analysis was used to assess the discriminant performance of the algorithm. RESULTS In the multiple regression analysis, only age, BMI, CTX-1, and family history of osteoporosis and/or fracture were able to predict the femoral neck T-score. When running the procedure with the total hip T-score, prior fracture also appeared to be significant. With the lumbar spine T-score, only age, BMI, and CTX-1 were retained. The best algorithm was based on age, BMI, family history, and CTX-1. A cut-off point of 0.25 yielded a sensibility of 78%, a specificity of 59% with an area under the curve of 0.73 in the development and validation cohorts. CONCLUSION Ageing, a lower BMI, higher CTX-1, family history, and prior fracture were associated with T-score. Our algorithm is a simple approach to identify men at risk for osteoporosis.
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Affiliation(s)
- S Scholtissen
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Sart-Tilman, Belgium.
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McLeod KM, Johnson CS. Identifying Women with Low Bone Mass: A Systematic Review of Screening Tools. Geriatr Nurs 2009; 30:164-73. [DOI: 10.1016/j.gerinurse.2008.07.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2008] [Revised: 07/20/2008] [Accepted: 07/26/2008] [Indexed: 10/21/2022]
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Validation of the Dutch guidelines for dual X-ray absorptiometry measurement. Br J Gen Pract 2009; 59:256-60. [PMID: 19341554 DOI: 10.3399/bjgp09x420338] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND In Europe, a case-finding strategy for osteoporosis is recommended above widespread population-based screening. However, no universally accepted policy currently exists. In 2005, the Dutch College of General Practitioners published guidelines for GPs to select patients for dual energy X-ray absorptiometry (DXA). AIM To evaluate the sensitivity, specificity, and predictive value of the Dutch guidelines to select participants with osteoporosis for DXA. DESIGN OF STUDY Cross-sectional. SETTING A total of 345 females aged over 50 years (mean age = 62 years, standard deviation [SD] = 8.3) and 99 males over 65 years of age (mean age = 72 years, SD = 5.2) of a Dutch general practice. METHOD Calculation of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the Dutch case-finding instrument for selecting patients with osteoporosis for DXA measurement. RESULTS Sensitivity was 19.5%, specificity 85.6%, PPV 18.6%, and NPV 86.6%. CONCLUSION The Dutch guidelines are unreliable in detecting people at risk for osteoporosis.
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Lim LS, Hoeksema LJ, Sherin K. Screening for osteoporosis in the adult U.S. population: ACPM position statement on preventive practice. Am J Prev Med 2009; 36:366-75. [PMID: 19285200 DOI: 10.1016/j.amepre.2009.01.013] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2008] [Revised: 12/08/2008] [Accepted: 01/08/2009] [Indexed: 11/27/2022]
Abstract
CONTEXT Osteoporosis is a common and costly disease that is associated with high morbidity and mortality. There is a lack of direct evidence supporting the benefits of bone mineral density (BMD) screening on osteoporosis outcomes. However, there is indirect evidence to support screening for osteoporosis given the availability of medications with good antifracture efficacy. This paper addresses the position of the American College of Preventive Medicine (ACPM) on osteoporosis screening. EVIDENCE ACQUISITION The medical literature was reviewed for studies examining the benefits and harms of osteoporosis screening. An overview is also provided of available modalities for osteoporosis screening, risk-assessment tools, cost effectiveness, benefits and harms of screening, rationale for the study, and recommendations from leading health organizations and ACPM. A review was done of English language articles published prior to September 2008 that were retrieved via search on PubMed, from references from pertinent review or landmark articles, and from websites of leading health organizations. EVIDENCE SYNTHESIS There were no randomized controlled trials (RCTs) of osteoporosis screening on fracture outcomes. However, there was one observational study that demonstrated reduced fracture incidence among recipients of BMD testing. Dual energy x-ray absorptiometry is currently one of the most widely accepted and utilized methods for assessing BMD. Other potential tests for detecting osteoporosis include quantitative ultrasound, quantitative computer tomography, and biochemical markers of bone turnover. Testing via BMD is a cost-effective method for detecting osteoporosis in both men and women. Osteoporosis risk-assessment tools such as the WHO fracture-risk algorithm are useful supplements to BMD assessments as they provide estimates of absolute fracture risks. They can also be used with or without BMD testing to assist healthcare providers and patients in making decisions regarding osteoporosis treatments. CONCLUSIONS All adult patients aged >or=50 years should be evaluated for risk factors for osteoporosis. Screening with BMD testing for osteoporosis is recommended in women aged >or=65 years and in men aged >or=70 years. Younger postmenopausal women and men aged 50-69 years should undergo screening if they have at least one major or two minor risk factors for osteoporosis. It is also recommended that clinicians consider using an osteoporosis risk-assessment tool to evaluate absolute fracture risk to determine appropriate osteoporosis therapies.
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Affiliation(s)
- Lionel S Lim
- Department of Internal Medicine, Griffin Hospital, Derby, Connecticut, USA.
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Ito K, Hollenberg JP, Charlson ME. Using the Osteoporosis Self-Assessment Tool for Referring Older Men for Bone Densitometry: A Decision Analysis. J Am Geriatr Soc 2009; 57:218-24. [DOI: 10.1111/j.1532-5415.2008.02110.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Lee CH, Oh SW, Seung JH, Do HJ, Lym YL, Choi JK, Joh HK, Kweon HJ, Cho DY. Evaluation of Osteoporosis Self-Assessment Tool Usefulness as a Screening Test for Osteoporosis in Korean Men. Korean J Fam Med 2009. [DOI: 10.4082/kjfm.2009.30.12.944] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Chang-Hun Lee
- Department of Family Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Seung-Won Oh
- Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Jeung-Hwan Seung
- Department of Family Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Hyun-Jin Do
- Department of Family Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Youl-Lee Lym
- Department of Family Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Jae-Kyung Choi
- Department of Family Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Hee-Kyung Joh
- Department of Family Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Hyuk-Jung Kweon
- Department of Family Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Dong-Yung Cho
- Department of Family Medicine, Konkuk University School of Medicine, Seoul, Korea
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Abstract
Dual-energy X-ray absorptiometry (DXA) is recognized as the reference method to measure bone mineral density (BMD) with acceptable accuracy errors and good precision and reproducibility. The World Health Organization (WHO) has established DXA as the best densitometric technique for assessing BMD in postmenopausal women and based the definitions of osteopenia and osteoporosis on its results. DXA allows accurate diagnosis of osteoporosis, estimation of fracture risk and monitoring of patients undergoing treatment. However, when DXA studies are performed incorrectly, it can lead to major mistakes in diagnosis and therapy. This article reviews the fundamentals of positioning, scan analysis and interpretation of DXA in clinical practice.
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Affiliation(s)
- A El Maghraoui
- Rheumatology and Physical Rehabilitation Centre, Military Hospital Mohammed V, Rabat, PO Box: 1018, Morocco.
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Lynn HS, Woo J, Leung PC, Barrett-Connor EL, Nevitt MC, Cauley JA, Adler RA, Orwoll ES. An evaluation of osteoporosis screening tools for the osteoporotic fractures in men (MrOS) study. Osteoporos Int 2008; 19:1087-92. [PMID: 18239959 DOI: 10.1007/s00198-007-0553-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2007] [Accepted: 11/13/2007] [Indexed: 11/24/2022]
Abstract
UNLABELLED No large-scale evaluations of osteoporosis screening tools have been done in men. OST and MOST were examined among 4658 US Caucasian and 1914 Hong Kong Chinese men. Both tools have high negative predictive values, accurately screening out men with low risk, and saving a third of DXA tests. INTRODUCTION Prior investigations have studied the performance of osteoporosis screening tools in women, but no large-scale evaluations have been done in men. METHODS This study examines the performance of the Osteoporosis Self-assessment Tool (OST), the Male Osteoporosis Screening Tool (MOST), quantitative ultrasound index (QUI), and body weight as screening tools. Osteoporosis was defined by a dual-energy X-ray absorptiometry (DXA) measured bone mineral density (BMD) T-score < or =-2.5. Four thousand six hundred and fifty-eight US Caucasian and 1914 Hong Kong Chinese men, aged > or =65 years and community-dwelling, were included in the analysis. Receiver operating characteristic (ROC) analysis was used to compare the area under the ROC curve (AUC) between different screening tools. RESULTS MOST had a significantly larger AUC (> or =0.8) than OST, QUI, and body weight in detecting osteoporosis. Using the second tertile as cutoff, OST and MOST yielded sensitivities of around 90% and negative predictive values (NPVs) of >97%, accurately screening out Caucasian and Chinese men with low risk of osteoporosis. CONCLUSIONS OST and MOST can effectively rule out osteoporosis for both Caucasian and Chinese men, and compared to referring men 65 years and older for BMD DXA testing, they save a third of DXA resources.
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Affiliation(s)
- H S Lynn
- Department of Biostatistics, School of Public Health, Fudan University, 138 Yi Xue Yuan Road, Shanghai 200032, China.
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Schousboe JT. Cost effectiveness of screen-and-treat strategies for low bone mineral density: how do we screen, who do we screen and who do we treat? APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2008; 6:1-18. [PMID: 18774866 DOI: 10.2165/00148365-200806010-00001] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Bone densitometry is currently widely recommended for, and considered central to, identifying post-menopausal women and older men at high risk of fracture and establishing an indication for pharmacological fracture-prevention therapy. The purpose of this article is to comprehensively review cost-effectiveness modelling studies published to date of bone mass measurement technologies (primarily dual energy x-ray absorptiometry [DXA]) designed to identify those individuals at sufficiently high risk of fracture to warrant pharmacological fracture-prevention therapy.Based on older paradigms of the pharmacological treatment of those with a bone density value below a specific threshold, bone densitometry appears to be cost effective for post-menopausal women aged > or =65 years, regardless of the presence or absence of other clinical risk factors. For younger post-menopausal women, bone densitometry is likely to be cost effective only for those with specific clinical risk factors, such as prior fracture or low bodyweight. For older men, bone densitometry may be cost effective for those who have had a prior fracture and/or are aged > or =80 years, but the subset of men for whom bone densitometry is likely to be cost effective may vary from country to country depending on societal willingness to pay for health benefits, fracture rates in the population and the costs of bone densitometry and drug treatment. The cost effectiveness of other technologies such as heel ultrasound, peripheral DXA and quantitative CT remains uncertain.However, in the context of the new WHO paradigm of directing treatment based on absolute fracture risk rather than bone density, a new generation of cost-effectiveness modelling studies will be required to define the most cost-effective way bone densitometry can be used to identify those who are likely to benefit sufficiently from pharmacological fracture-prevention therapies.
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Affiliation(s)
- John T Schousboe
- Park Nicollet Health Services, Park Nicollet Clinic, Minneapolis, Minnesota 55416, USA.
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Shepherd AJ, Cass AR, Carlson CA, Ray L. Development and internal validation of the male osteoporosis risk estimation score. Ann Fam Med 2007; 5:540-6. [PMID: 18025492 PMCID: PMC2094029 DOI: 10.1370/afm.753] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE We wanted to develop and validate a clinical prediction rule to identify men at risk for osteoporosis and subsequent hip fracture who might benefit from dual-energy x-ray absorptiometry (DXA). METHODS We used risk factor data from the National Health and Nutrition Examination Survey III to develop a best fitting multivariable logistic regression model in men aged 50 years and older randomized to either the development (n = 1,497) or validation (n = 1,498) cohorts. The best fitting model was transformed into a simplified scoring algorithm, the Male Osteoporosis Risk Estimation Score (MORES). We validated the MORES, comparing sensitivity, specificity, and area under the receiver operating characteristics (ROC) curve in the 2 cohorts and assessed clinical utility with an analysis of the number needed-to-screen (NNS) to prevent 1 additional hip fracture. RESULTS The MORES included 3 variables-age, weight, and history of chronic obstructive pulmonary disease-and showed excellent predictive validity in the validation cohort. A score of 6 or greater yielded an overall sensitivity of 0.93 (95% CI, 0.85-0.97), a specificity of 0.59 (95% CI, 0.56-0.62), and an area under the ROC curve of 0.832 (95% CI, 0.807-0.858). The overall NNS to prevent 1 additional hip fracture was 279 in a cohort of men representative of the US population. CONCLUSIONS Osteoporosis is a major predictor of hip fractures. Experts believe bisphosphonate treatment in men should yield results similar to that in women and reduce hip fracture rates associated with osteoporosis. In men aged 60 years and older, the MORES is a simple approach to identify men at risk for osteoporosis and refer them for confirmatory DXA scans.
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Pérez-Castrillón JL, Sagredo MG, Conde R, del Pino-Montes J, de Luis D. OST risk index and calcaneus bone densitometry in osteoporosis diagnosis. J Clin Densitom 2007; 10:404-7. [PMID: 17662631 DOI: 10.1016/j.jocd.2007.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2007] [Revised: 06/12/2007] [Accepted: 06/12/2007] [Indexed: 11/29/2022]
Abstract
The gold-standard method for osteoporosis diagnosis is by dual-energy X-ray absorptiometry (DXA) of the lumbar spine and/or hip. DXA is expensive and alternative approaches are being analyzed. The objective of this study was to evaluate whether the Osteoporosis Self-Assessment Tool (OST) combined with calcaneal DXA improves the sensitivity and specificity of the DXA. One hundred and sixty-one (67 males and 94 females) outpatients referred due to suspected osteoporosis or lumbar pain were included. Hip, spinal, or calcaneal DXA was performed in all patients and the OST index was administered. The cutoff point for patients of high- or low-risk osteoporosis was 2 for women and 3 for men. The mean OST index value was 3.62+/-4.3. Twenty-seven percent of the patients were osteoporotic. Sixty-two percent presented a low risk and 38% a high risk. In men, the OST had a sensitivity of 39% and a specificity of 86%, whereas in women the sensitivity was 94% with a specificity of 59%. The combination of the calcaneal DXA with the OST index did not modify the validity of DXA in men. In women, the sensitivity of the different cutoff points was improved at the expense of a decrease in the specificity without modifying the area under the curve. The combination of the calcaneal DXA with the OST index did not improve the value of each of the separate techniques. The OST index is useful in women to facilitate the densitometry indication for hip and/or spine.
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Zimering MB, Shin JJ, Shah J, Wininger E, Engelhart C. Validation of a novel risk estimation tool for predicting low bone density in Caucasian and African American men veterans. J Clin Densitom 2007; 10:289-97. [PMID: 17459748 DOI: 10.1016/j.jocd.2007.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2006] [Revised: 03/05/2007] [Accepted: 03/07/2007] [Indexed: 11/27/2022]
Abstract
Osteoporosis in men is a frequently missed diagnosis. We developed an additive risk index, Mscore (male, "simple calculated osteoporosis risk estimation"), based on bone mineral density (BMD) at the femoral neck (FN) in 639 ambulatory older male veterans. Mscore was derived from the nearest whole number ratio among regression coefficients for 5 variables independently associated with osteoporosis. Mscore=[2 x (patient age in decades)-(weight in lb/10)+4 if gastrectomy, +4 if emphysema, +3 if two or more prior fractures+14]. Age and weight variable scores are truncated to integers (i.e., 7 if 75 yr, 18 if 185 lb). Increased risk is reflected in higher Mscore values. We validated Mscore in 197 Caucasian male patients (mean age, 69 yr): values of 9 or higher had 88% sensitivity, 57% specificity, and an area under the curve (AUC) of 0.84 for predicting osteoporosis at the FN (population prevalence, 11%). Mscore values ranged from -9 to 20 allowing us to define low (<9), moderate (9-13), or high (>13) risk categories. Two percent of low-risk men had osteoporosis, 36% or 55% of high-risk men had osteoporosis or osteopenia, respectively. In younger African American (n=134) male veterans (mean age, 61 yr), age and weight were the only variables independently predictive of FN BMD. A reduced Mscore(age-weight) (age and weight variable scores+14) at a cutoff threshold of 9 predicted osteoporosis in African American men (population prevalence, 3%) with a sensitivity of 100%, a specificity of 73%, and an AUC of 0.99. Finally, we compared Mscore with another validated osteoporosis self-assessment tool (OST). OST at a cutoff threshold of 4 or Mscore(age-weight) at a cutoff threshold of 9 performed similarly in both of our populations of Caucasian and African American men. In conclusion, a validated Mscore index with 5 variables was only slightly more robust for predicting osteoporosis in older Caucasian men than 2 (independently derived) risk indices based on age and weight. Mscore(age-weight) or OST is easy to use and can be applied in populations of younger African American men.
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Affiliation(s)
- Mark B Zimering
- Medicine, Veterans Affairs New Jersey Health Care System, Lyons, NJ, USA.
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Anders M, Turner L, Wallace LS. Use of decision rules for osteoporosis prevention and treatment: Implications for nurse practitioners. ACTA ACUST UNITED AC 2007; 19:299-305. [PMID: 17535339 DOI: 10.1111/j.1745-7599.2007.00229.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To describe the current literature regarding the benefits of bone mineral density (BMD) screening and to discuss clinical decision rules for BMD screening. DATA SOURCES Extensive review of the scientific literature regarding osteoporosis, BMD screening, and current clinical decision rules. CONCLUSIONS Osteoporosis is a disease characterized by deterioration of bone and increased susceptibility to fractures, crippling, and disfigurement. BMD testing is the best predictor for osteoporosis and associated fractures; however, routine global BMD testing is cost-prohibitive. A need exists for a selective and practical clinical decision rule for referral for testing. IMPLICATIONS FOR PRACTICE Several effective clinical decision rules are presented, and their uses and applications are described. The osteoporosis self-assessment tool is recommended by the authors because of its predictive power and ease of use.
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Affiliation(s)
- Michael Anders
- College of Health Related Professions, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Hochberg MC. Recommendations for measurement of bone mineral density and identifying persons to be treated for osteoporosis. Rheum Dis Clin North Am 2007; 32:681-9. [PMID: 17288971 DOI: 10.1016/j.rdc.2006.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Clinical practice guidelines exist for the diagnosis and treatment of osteoporosis in men and postmenopausal women. These guidelines present a uniform set of recommendations. Unfortunately, studies have shown a low rate of screening and treatment, particularly in high-risk groups, such as patients who have experienced a fracture. It is hoped that quality improvement projects, such as that being conducted by the American Medical Association in conjunction with numerous specialty societies, will lead to an improvement in physician practices in this area that will result in a reduction in morbidity and mortality from osteoporotic fractures.
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Affiliation(s)
- Marc C Hochberg
- Division of Rheumatology, Department of Medicine, University of Maryland School of Medicine, 10 South Pine Street, MSTF 8-34 Baltimore, MD 21201, USA.
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