Risk indices have been developed to identify postmenopausal women at risk of low bone mineral density who need to undergo BMD test-ing. The aim of study was to compare perform-ance of three decision rules for identifying women with primary osteoporosis in an Iranian post-menopausal population. Materials and Methods: Three osteoporosis risk indices- the osteoporosis self assessment tool (OST), the osteoporosis risk assessment instru-ment (ORAI), and body weight criterion were calculated for 5573 out patients without risk fac-tors for secondary osteoporosis or receiving ac-tive bone medication. BMD at spine and femoral neck were measured via dual x-ray absorpti-omety. The sensitivity, specificity, positive pre-dictive value, negative predicative value and area under receiver operating characteristic curve to identify those with osteoporosis were deter-mined for each decision rule; these were then compared. Results: The sensitivity of these risk indices ranged from 70% to 84/1% and specificity from 44.6 to 65.6%. The area under curve (ROC) in identifying patients with osteoporosis were sig-nificantly better for OST (0.75) and ORAI (0.74) compared with the body weight criteria (0.66). The negative predicative values ranged from 80 to 93%, while positive predication values ranged from 33 to 45%. Conclusion: Our data provide evidence for the application of OST, ORAI as useful clinical tools in making decision about which women need to be referred for BMD testing; more evidence however is needed to confirm validity of the body weight criterion. Of the three tools evalu-ated, the OST is the simplest and has the best potential for use in clinical practice.
Osteoporosis Postmenopausal women Osteoporosis risk indices Screening
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