OST Is Best For Selecting Men For Osteoporosis Screening

According to a recent study, the Osteoporosis Self-Assessment Tool (OST) had better specificity and sensitivity for identifying community-dwelling men for bone mineral testing (BMD) to determine if they had osteoporosis compared with the Fracture Risk Assessment Tool (FRAX).

In their prospective cohort study, the researchers assessed 4043 community-dwelling men aged 70 years or older for osteoporosis using dual-energy x-ray to measure BMD at total hip, femoral neck, and lumbar spine. Additionally, they assessed the ability of the OST and FRAX without BMD to determine which participants needed to undergo BMD screening for osteoporosis, as well as the ability of both tools to discriminate between those recommended for pharmacological therapy from those not recommended therapy.
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A total of 216 participants (5.3%) had a BMD T-score of -2.5 or below at the femoral neck, total hip, or lumbar spine. Overall, 1184 (29.2%) participants met the criteria to be considered for pharmacological therapy based on the National Osteoporosis Foundation guidelines.

OST had better discrimination and was able to identify participants with T-score-defined osteoporosis more effectively than FRAX. The sensitivity and specificity of OST with a threshold below 2 was 0.83 and 0.36, respectively, compared with FRAX with a cutoff of 9.3% for a 10-year risk of major osteoporotic fractures (0.59 and 0.59, respectively).

Overall, the use of OST with a cutoff below 2 to select men for BMD testing would result in 654 men out of 1000 who would be referred for further testing, of whom 44 would be identified with osteoporosis and 9 with osteoporosis would be missed.

“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,” the researchers concluded.

—Melissa Weiss

Reference:

Diem SJ, Peters KW, Gourlay ML, et al. Screening for osteoporosis in older men: operating characteristics of proposed strategies for selecting men for BMD testing [published August 16, 2017]. J Gen Intern Med. https://doi.org/10.1007/s11606-017-4153-4.