Article Figures & Data
Tables
- Table 2. Validation of the Male Osteoporosis Risk Estimation Score (MORES): Demographic and Clinical Characteristics of the Primary Care Study Sample (n = 346)
Variables Age, years (mean ± SD) 70.2 ± 6.9 Height, cm (mean ± SD) 177.4 ± 7.2 Weight, kg (mean ± SD) 90.2 ± 16.7 Osteoporosis* 15 (4.3) Severe osteopenia† 19 (5.5) Race/ethnicity Non-Hispanic white 263 (76.0) African American 41 (11.8) Hispanic 37 (10.7) Other 5 (1.4) Education Less than high school 42 (12.1) High school graduate 70 (20.2) College/college graduate 172 (49.7) Postgraduate 62 (17.9) Marital status Married/living with someone 245 (70.9) Single/never married 28 (8.1) Divorced/separated 42 (12.1) Widowed 31 (9.0) Family history of parental hip fracture 42 (12.1) Previous fragility fracture 6 (1.7) History of rheumatoid arthritis 7 (2.0) History of secondary cause of osteoporosis 31 (9.0) Chronic obstructive pulmonary disease 29 (8.4) Alcohol use Current use 217 (62.7) Heavy (≥3 drinks per day) 23 (6.6) Tobacco use Current smoker 39 (11.3) Former smoker 201 (58.1) Never smoked 106 (30.6) Glucocorticoid use 7 (2.0) - Table 3. Comparison of Operating Characteristics of the Male Osteoporosis Risk Estimation Score in the National Health and Nutrition Examination Survey (NHANES) III Development Study43 and the Current Validation Study
NHANES III (n = 2995) Current Study (n = 346) Prevalence of osteoporosis (%) 4.8 4.3 Sensitivity 0.93 (0.88–0.97) 0.80 (0.52–0.96) Specificity 0.59 (0.57–0.61) 0.70 (0.64–0.74) Positive predictive value 0.10 (0.09–0.12) 0.11 (0.06–0.18) Negative predictive value 0.99 (0.99–1.00) 0.99 (0.96–1.00) Area under the curve 0.83 (0.81–0.86) 0.82 (0.71–0.92) 95% Confidence intervals are set in parentheses.
- Table 4. Distribution of the Male Osteoporosis Risk Estimation Score Risk Factors in Men With and Without Osteoporosis of the Hip
Risk Factor Osteoporosis (n = 15) No Osteoporosis (n = 331) Adjusted Odds Ratio (95% CI) Age ≤55 — — — 56–74 5 253 Reference ≥75 10 78 6.4 (2.0–20.0) Weight (kg) ≤70 4 29 8.6 (1.9–38.2) 71–80 7 55 6.7 (1.8–24.7) >80 4 247 Reference Chronic obstructive pulmonary disease Yes 3 26 3.0 (0.7–13.0) No 12 305 Reference - Table 5. Impact Analysis of the Male Osteoporosis Risk Estimation Score (MORES)*: Simulated Screening for Osteoporosis in 10,000 Men, 60 Years of Age and Older, and 10-year Fracture Outcomes
NHANES III Development Cohort43 (n = 2995) Clinical Validation Cohort (n = 346) Hip Fracture Hip Fracture Major Osteoporotic Fracture MORES Universal MORES Universal MORES Universal Population (n) 10,000 10,000 10,000 10,000 10,000 10,000 Sensitivity (MORES) 0.930 — 0.800 — 0.800 — Specificity (MORES) 0.590 — 0.695 — 0.695 — Fracture risk† 0.135 0.135 0.056 0.056 0.123 0.123 Osteoporosis prevalence 0.048 0.048 0.043 0.043 0.043 0.043 Relative risk of fracture with treatment‡ 0.630 0.630 0.630 0.630 0.575 0.575 Adherence to treatment§ 0.700 0.700 0.700 0.700 0.700 0.700 Predicted cases 480 480 430 430 430 430 True positive 446 480 344 430 344 430 False negative 34 — 86 — 86 — True negative 5,617 9,520 6,651 9,570 6,651 9,570 False positive 3,903 — 2,919 — 2,919 — Referred for DXA (true positive + false positive) 4,350 10,000 3,263 10,000 3,263 10,000 Predicted hip fractures: MORES/DXA True positive 44.66 48.02 14.27 17.84 29.75 37.19 False negative 4.54 0.00 4.82 0.00 10.59 0.00 Total 49.19 48.02 19.09 17.84 40.33 37.19 Unscreened (no DXA) 64.80 64.80 24.08 24.08 52.93 52.93 Number needed-to-screen (95% CI) 279 (257–306) 596 (—) 654 (485–1132) 1,604 (—) 259 (192–449) 636 (—) ↵* Formulas used in the calculation were adapted from Nelson et al.52 and are available upon request.
↵† Fracture risks for the NHANES III cohort were obtained from Kanis et al.58 Fracture risks for the current study were obtained from FRAX for both hip and major osteoporotic fractures and reflect the characteristics of the study population.54
↵‡ Risk reduction estimates are supported by clinical trials, and the estimates for hip fractures are those used by Nelson et al.52 The point estimate for the relative risk reduction for major osteoporotic fractures is a weighted average from published reports.19,20
↵§ Compliance with treatment estimates are from Nelson et al.52
DXA, dual-energy X-ray absorptiometry; NHANES, National Health and Nutrition Examination Survey.
