The Osteoporosis Self-Assessment Tool versus alternative tests for selecting postmenopausal women for bone mineral density assessment: a comparative systematic review of accuracy
- 331 Downloads
We performed a systematic review of studies comparing the Osteoporosis Self-Assessment Tool (OST) and other tests used to select women for bone mineral density (BMD) assessment. In comparative meta-analyses, we found that the accuracy of OST was similar to other tests that are based on information from the medical history. By contrast, assessment by quantitative ultrasonography at the heel was more accurate than OST in discriminating between women with high and low BMD. The methodological quality of the included studies was generally low.
Numerous tests are suggested for triaging postmenopausal women for bone mineral density (BMD) assessment by dual-energy X-ray absorptiometry. Previous studies suggest that OST, based on age and weight only, may be as accurate as more complex triage tests. We systematically compare the accuracy of OST and alternative triage tests in postmenopausal women.
We searched PubMed, Embase, Web of Science, citation lists, and conference proceedings. Our main measure of accuracy was the diagnostic odds ratio (DOR). We compared summary estimates of DOR (sDOR) for OST and alternative tests in pairwise meta-analyses by using the Moses–Littenberg approach.
Summary estimates of DOR for OST and the clinical decision rules Simple Calculated Osteoporosis Risk Estimation (SCORE) and Osteoporosis Risk Assessment Instrument (ORAI) did not differ significantly in white women (relative sDOR: 0.57–1.17, all p ≥ 0.11). By contrast, sDOR was higher for Stiffness Index assessed by calcaneal quantitative ultrasonography than for OST (relative sDOR: 1.9, p = 0.005). Studies were few in Asian and black women. Methodological quality, assessed with the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) checklist, was generally low.
In white women, the accuracy of OST and alternative clinical decision rules was similar, whereas Stiffness Index was more accurate than OST. Low study quality renders transferability to clinical settings uncertain.
KeywordsAccuracy Bone mineral density Meta-analysis Osteoporosis Self-Assessment Tool Systematic review Triage test
We wish to thank the authors of studies included in the review who replied to our request for additional information.
Conflicts of interest
- 5.Harris ST, Watts NB, Genant HK et al (1999) Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. Vertebral Efficacy With Risedronate Therapy (VERT) Study Group. JAMA 282:1344–1352PubMedCrossRefGoogle Scholar
- 13.Gudmundsdottir SL, Indridason OS, Franzson L et al (2005) Age-related decline in bone mass measured by dual-energy X-ray absorptiometry and quantitative ultrasound in a population-based sample of both sexes:identification of useful ultrasound thresholds for osteoporosis screening. J Clin Densitom 8:80–86PubMedCrossRefGoogle Scholar
- 27.Armitage P, Berry G (1987) Statistical inference. In Statistical methods in medical research, 2nd edn. Blackwell, Oxford, pp 93–140Google Scholar
- 35.Cho J-J (2005) Evaluation of two screening decision rules for osteoporosis of menopause or perimenopause women in Korea. Osteoporos Int 13(suppl 3):S68Google Scholar
- 38.Gambacciani M, Genazzani AR (2004) Osteoporosis screening: comparison of the heel ultrasound measurement to calculated risk assessment tools. Osteoporos Int 15(suppl 1):S36Google Scholar
- 39.Mossman EA, Grinnell NC, Cole L et al (2002) Quantitative ultrasound of the heel does not predict bone density at the femoral neck more accurately than simple clinical indices in postmenopausal Caucasian women. J Bone Miner Res 17:S422Google Scholar
- 40.Poriau S, Geusens P, Van den Bosch F et al (2004) Osteoporosis screening: comparison of heel ultrasound measurement to calculated risk assessment tools (OST). J Bone Miner Res 20(suppl 2):S378Google Scholar
- 41.Rud B, Abrahamsen B, Rejnmark L et al (2005) How does estrogen use in early postmenopausal women affect the diagnostic performance of the Osteoporosis Self-assessment Tool and quantitative ultrasonography? Bone 36:S345Google Scholar
- 44.Mossman EA, DeFrancisco T, Strot S et al (2004) OST versus weight alone in groups defined by clinical guidelines. J Clin Densitom 7:234Google Scholar
- 46.Choi H, Park YJ, Lee CM et al (2004) The validation and comparisional study of several risk indices for prediction of osteoporosis in peri- and postmenopausal Korean women. Osteoporos Int 15(suppl 1):S27Google Scholar
- 49.Taguchi A, Suei Y, Sanada M et al (2004) Validation of dental panoramic radiography measures for identifying postmenopausal women with spinal osteoporosis. Am J Roentgenol 183:1755–1760Google Scholar
- 53.Pepe MS (2003) Combining binary tests and regression analysis. In The statistical evaluation of medical tests for classification and prediction, 1st edn. Oxford University Press, Oxford, pp 35–65Google Scholar
- 56.Gunaydin R, Kaya T, Goksel Karatepe A et al (2006) Performance of several risk indices for prediction of osteoporosis in peri- and postmenopausal women. Osteoporos Int 17([suppl 2]):S168Google Scholar
- 62.Marin F, Lopez-Bastida J, Diez-Perez A et al (2004) Bone mineral density referral for dual-energy X-ray absorptiometry using quantitative ultrasound as a prescreening tool in postmenopausal women from the general population: a cost-effectiveness analysis. Calcif Tissue Int 74:277–283PubMedCrossRefGoogle Scholar