Osteoporosis International

, Volume 19, Issue 8, pp 1175–1183 | Cite as

Clinical performance of osteoporosis risk assessment tools in women aged 67 years and older

  • M. L. Gourlay
  • J. M. Powers
  • L.-Y. Lui
  • K. E. Ensrud
  • for the Study of Osteoporotic Fractures Research Group
Original Article



Clinical performance of osteoporosis risk assessment tools was studied in women aged 67 years and older. Weight was as accurate as two of the tools to detect low bone density. Discriminatory ability was slightly better for the OST risk tool, which is based only on age and weight.


Screening performance of osteoporosis risk assessment tools has not been tested in a large, population-based US cohort.


We conducted a diagnostic accuracy analysis of the Osteoporosis Self-assessment Tool (OST), Osteoporosis Risk Assessment Instrument (ORAI), Simple Calculated Osteoporosis Risk Estimation (SCORE), and individual risk factors (age, weight or prior fracture) to identify low central (hip and lumbar spine) bone mineral density (BMD) in 7779 US women aged 67 years and older participating in the Study of Osteoporotic Fractures.


The OST had the greatest area under the receiver operating characteristic curve (AUC 0.76, 95% CI 0.74, 0.77). Weight had an AUC of 0.73 (95% CI 0.72, 0.75), which was ≥AUC values for the ORAI, SCORE, age or prior fracture. Using cut points from the development papers, the risk tools had sensitivities ≥85% and specificities ≤48%. When new cut points were set to achieve a likelihood ratio of negative 0.1–0.2, the tools ruled out fewer than 1/4 of women without low central BMD.


Weight identified low central BMD as accurately as the ORAI and SCORE. The risk tools would be unlikely to show an advantage over simple weight cut points in an osteoporosis screening protocol for elderly women.


Bone density Female Mass screening Osteoporosis Postmenopause Risk assessment 



We acknowledge Philip D. Sloane, MD, MPH for his comments on an earlier draft of the manuscript.

Financial disclosures

None reported.


The project described was funded by Grant Number K23RR024685 from the National Center for Research Resources and by the University of North Carolina Translational Science Program. The Study of Osteoporotic Fractures (SOF) is supported by the National Institutes of Health (Public Health Service research grants AG05407, AR35582, AG05394, AR35584, AR35583, R01 AG005407, R01 AG027576-22, 2 R01 AG005394-22A1, and 2 R01 AG027574-22A1). The content is solely the responsibility of the authors and does not necessarily reflect the official views of the funding agencies.

Role of the sponsor

The funding bodies had no role in data extraction and analyses, in the writing of the manuscript, or in the decision to submit the manuscript for publication.


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2008

Authors and Affiliations

  • M. L. Gourlay
    • 1
    • 5
  • J. M. Powers
    • 2
  • L.-Y. Lui
    • 3
  • K. E. Ensrud
    • 4
  • for the Study of Osteoporotic Fractures Research Group
  1. 1.Department of Family MedicineUniversity of North CarolinaChapel HillUSA
  2. 2.Department of BiostatisticsUniversity of North CarolinaChapel HillUSA
  3. 3.Research Institute, California Pacific Medical CenterSan FranciscoUSA
  4. 4.Department of Medicine and Division of EpidemiologyUniversity of Minnesota, VA Medical CenterMinneapolisUSA
  5. 5.Chapel HillUSA

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