Original Article

Osteoporosis International

, Volume 15, Issue 5, pp 361-366

The validity of decision rules for selecting women with primary osteoporosis for bone mineral density testing

  • Suzanne M. CadaretteAffiliated withDepartment of Health Policy, Management and Evaluation, University of TorontoOsteoporosis Research Program, Women’s College Ambulatory Care Centre, Sunnybrook and Women’s College Health Sciences Centre Email author 
  • , Warren J. McIsaacAffiliated withDepartment of Family and Community Medicine, University of TorontoMount Sinai Family Medicine Centre
  • , Gillian A. HawkerAffiliated withDepartment of Health Policy, Management and Evaluation, University of TorontoOsteoporosis Research Program, Women’s College Ambulatory Care Centre, Sunnybrook and Women’s College Health Sciences CentreDivision of Rheumatology, Women’s College Ambulatory Care Centre, Sunnybrook and Women’s College Health Sciences Centre
  • , Liisa JaakkimainenAffiliated withDepartment of Family and Community Medicine, University of TorontoInstitute for Clinical Evaluative Sciences in OntarioDepartment of Family and Community Medicine, Sunnybrook and Women’s College Health Sciences Centre
  • , Alison CulbertAffiliated withDepartment of Family and Community Medicine, University of TorontoDepartment of Family and Community Medicine, Sunnybrook and Women’s College Health Sciences Centre
  • , Gihane ZarifaAffiliated withDepartment of Family and Community Medicine, University of TorontoMount Sinai Family Medicine Centre
  • , Ebele OlaAffiliated withDepartment of Family and Community Medicine, University of TorontoMount Sinai Family Medicine Centre
  • , Susan B. JaglalAffiliated withDepartment of Health Policy, Management and Evaluation, University of TorontoOsteoporosis Research Program, Women’s College Ambulatory Care Centre, Sunnybrook and Women’s College Health Sciences CentreGraduate Department of Rehabilitation Science, University of Toronto

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Abstract

The purpose of this study was to determine the validity of the Osteoporosis Risk Assessment Instrument (ORAI), Osteoporosis Self-Assessment Tool (OST) chart and equation, and a criterion based on body weight for identifying women with asymptomatic primary osteoporosis. Prospective recruitment and chart abstractions from family practices of three University affiliated hospitals were completed for women aged 45 years or more with baseline bone mineral density (BMD) testing results by dual energy X-ray absorptiometry. Those taking bone active medication other than hormone therapy, with prior fragility fracture or with risk factors for secondary osteoporosis were excluded. Women were categorized as being normal, osteopenic or osteoporotic by lowest BMD T-score at either the femoral neck or lumbar spine (L1–L4). Sensitivity, specificity and area under the receiver operating characteristic (ROC) curve to identify those with osteoporosis were determined for each decision rule. The positive predictive value (PPV) for detecting osteoporosis after using a second cut point to convert each decision rule into a risk index (low, moderate or high risk) was also determined. The sensitivity of the decision rules to identify women with osteoporosis ranged from 92% to 95% and specificity from 35% to 46%. The area under the ROC curves were significantly better for the ORAI (0.80), OST chart (0.82) and OST equation (0.82) compared with the body weight criterion (0.73). PPV for detecting osteoporosis ranged from 30% to 58% among women deemed at high risk. These data confirm the validity of the ORAI, the OST chart and the OST equation as screening tools for BMD testing. Further evidence is required to confirm the validity of the body weight criterion.

Keywords

Decision aids Osteoporosis Screening Sensitivity Specificity Women