Archives of Osteoporosis

, 14:117 | Cite as

The performance of osteoporosis self-assessment tool for Asians (OSTA) in identifying the risk of osteoporosis among Malaysian population aged 40 years and above

  • Shaanthana Subramaniam
  • Chin-Yi Chan
  • Ima-Nirwana Soelaiman
  • Norazlina Mohamed
  • Norliza Muhammad
  • Fairus Ahmad
  • Pei-Yuen Ng
  • Nor Aini Jamil
  • Noorazah Abd Aziz
  • Kok-Yong ChinEmail author
Original Article



The concordance between osteoporosis self-assessment tool for Asians (OSTA) and dual-energy X-ray absorptiometry (DXA) was fair in the study. Modification of OSTA cutoff values improved its sensitivity to identify subjects at risk for suboptimal bone health (osteopenia/osteoporosis) and osteoporosis.


Osteoporosis self-assessment tool for Asians (OSTA) is a convenient screening algorithm used widely to identify patients at risk of osteoporosis. Currently, the number of studies validating OSTA in Malaysian population is limited. This study aimed to validate the performance of OSTA in identifying subjects with osteoporosis determined with DXA.


This cross-sectional study recruited 786 Malaysians in Klang Valley, Malaysia. Their bone health status was assessed by DXA and OSTA. The association and agreement between OSTA and bone mineral density assessment by DXA were determined by Pearson’s correlation and Cohen’s kappa, respectively. Receiver operating characteristics (ROC) curves were used to determine the sensitivity, specificity, and area under the curve (AUC) for OSTA.


OSTA and DXA showed a fair association in the study (r = 0.382, κ = 0.159, p < 0.001). OSTA (cutoff < − 1) revealed a sensitivity of 32.3%, specificity of 92.3%, and AUC of 0.618 in identifying subjects with suboptimal bone health. The sensitivity of OSTA (cutoff < − 4) in determining subjects at risk of osteoporosis was better among women (sensitivity = 20%) than men (sensitivity = 0%). Modified OSTA cutoff values improved the sensitivity of OSTA in identifying subjects with suboptimal bone health (men = 81.0% at cutoff 3.4, women = 82.8% at cutoff 2.0) and osteoporosis (men = 81.8% at cutoff 1.8, women = 81.3% at cutoff 0.8).


OSTA with its original cutoff values is ineffective in identifying individuals at risk for osteoporosis. Adjusting the cutoff values significantly increases the sensitivity of OSTA, thus highlighting the need to validate this instrument among the local population before using it for osteoporosis screening clinically.


Bone Osteopenia Screening Sensitivity Specificity 



We would like to extend our gratitude to Mr. Azlan Mohd Arslamsyah, Mr. Mustazil Mohd Noor, and Mrs. Farhana Mohd Fozi from the Department of Pharmacology for their kind assistance.

Authors’ contributions

Subramaniam Shaanthana and Chin-Yi Chan recruited subjects, collected data, and drafted the manuscript. Ima-Nirwana Soelaiman and Kok-Yong Chin planned the study, obtained funding and approval for this study, critically reviewed the manuscript, and provided final approval for the publication. Norazlina Mohamed, Norliza Muhammad, Fairus Ahmad, Pei-Yuen Ng Nor Aini Jamil, and Noorazah Abd Aziz provided expertise and supervised the study.

Funding information

We would like to thank Universiti Kebangsaan Malaysia for providing financial support through postgraduate research grant GUP-2017-060 and Arus Perdana Grant (AP-2017-009/1).

Compliance with ethical standards

Ethical approval

All procedures performed in studies involving human participants were in accordance with the Research Ethics Committee of Universiti Kebangsaan Malaysia (Code: UKM PPI/111/8/JEP-2017-761) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Conflicts of interest



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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2019

Authors and Affiliations

  • Shaanthana Subramaniam
    • 1
  • Chin-Yi Chan
    • 1
  • Ima-Nirwana Soelaiman
    • 1
  • Norazlina Mohamed
    • 1
  • Norliza Muhammad
    • 1
  • Fairus Ahmad
    • 2
  • Pei-Yuen Ng
    • 3
  • Nor Aini Jamil
    • 4
  • Noorazah Abd Aziz
    • 5
  • Kok-Yong Chin
    • 1
    Email author
  1. 1.Department of Pharmacology, Faculty of MedicineUniversiti Kebangsaan MalaysiaCherasMalaysia
  2. 2.Department of Anatomy, Faculty of MedicineUniversiti Kebangsaan MalaysiaCherasMalaysia
  3. 3.Faculty of PharmacyUniversiti Kebangsaan MalaysiaKuala LumpurMalaysia
  4. 4.School of Healthcare Sciences, Faculty of Health ScienceUniversiti Kebangsaan MalaysiaKuala LumpurMalaysia
  5. 5.Department of Family Medicine, Faculty of MedicineUniversiti Kebangsaan MalaysiaCherasMalaysia

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