Performance of Osteoporosis Risk Assessment Tools in Iranian Postmenopausal Women

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.