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



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.

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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.


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).

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Authors and Affiliations



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.

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Correspondence to Kok-Yong Chin.

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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.

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

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Subramaniam, S., Chan, CY., Soelaiman, IN. et al. The performance of osteoporosis self-assessment tool for Asians (OSTA) in identifying the risk of osteoporosis among Malaysian population aged 40 years and above. Arch Osteoporos 14, 117 (2019).

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  • Bone
  • Osteopenia
  • Screening
  • Sensitivity
  • Specificity