Comparison of Clinical Risk Tools for Predicting Osteoporosis in Women Ages 50–64

Jennifer L. Pecina; Lindy Romanovsky; Stephen P. Merry; Kurt A. Kennel; Tom D. Thacher

doi:10.3122/jabfm.2016.02.150237

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Figure 1.
Distribution of the estimated 10-year major osteoporotic fracture risk (MOF) among 290 women, based on the World Health Organization Fracture Risk Assessment Tool (FRAX; calculated without femoral neck bone density).

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Table 1. Clinical Risk Factors Used to Calculate the Fracture Risk Assessment Tool,¹³ Simple Calculated Osteoporosis Risk Estimation,¹² Osteoporosis Self-Assessment Tool,¹¹ and the Osteoporosis Risk Assessment Instrument¹⁰

	Clinical Risk Factors by Tool
	FRAX	SCORE	OST	ORAI
	Age	Age	Weight	Age
	Sex	Weight	Age	Weight
	Body mass index	Race		Current estrogen use
	History of fracture	Fracture history
	History of parental hip fracture	Rheumatoid arthritis
	Current smoking	Estrogen use
	Glucocorticoid use
	Rheumatoid arthritis
	Alcohol use
	Disease history associated with secondary osteoporosis
Suggested threshold for bone density screening	≥9.3%^*	≥6	<2	≥9

↵* 10-Year major osteoporotic fracture risk.
FRAX, Fracture Risk Assessment Tool; SCORE, Simple Calculated Osteoporosis Risk Estimation; OST, Osteoporosis Self-Assessment Tool; ORAI, Osteoporosis Risk Assessment Instrument.

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Table 2. Characteristics of 290 Women Who Underwent Dual-Energy Radiographic Angiography

Characteristics	No. (%)
Age (years)
50–54	96 (33.1)
55–59	119 (41.0)
60–64	75 (25.9)
Ethnicity
White	284 (97.9)
Asian	4 (1.4)
Hispanic	1 (0.3)
Black	1 (0.3)
Other
Body mass index (kg/m²)
<18.5	2 (0.7)
18.5–24.9	108 (37.2)
25.0–29.9	99 (34.1)
≥30.0	81 (27.9)
Estrogen use
Ever use	92 (31.7)
Current use	21 (7.2)
Previous fractures (n)
0	262 (90.3)
1	25 (8.6)
≥2	3 (1.0)
History of rheumatoid arthritis	17 (5.9)
Osteoporosis
Femoral neck	19 (6.6)
Lumbar spine	41 (14.1)
Lumbar spine and/or femoral neck	50 (17.2)

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Table 3. Performance for each tool at recommended thresholds to detect densitometric osteoporosis and number of women who would be sent for screening

	Sensitivity (95% CI)	Specificity (95% CI)	PPV (95% CI)	NPV (95% CI)	AUC	Patients Who Would Be Sent for Screening, n (%)
ORAI ≥9	52 (37–66)	67 (61–73)	25 (17–34)	87 (81–91)	0.60	104 (36)
OST <2	56 (41–69)	69 (63–75)	27 (19–37)	88 (82–92)	0.63	101 (35)
SCORE ≥6	74 (59–84)	42 (36–49)	21 (15–28)	88 (81–93)	0.58	174 (60)
FRAX ≥9.3%	36 (23–50)	73 (67–79)	22 (14–33)	84 (78–89)	0.55	81 (28)

AUC, area under the receiver operating characteristic curve; CI, confidence interval; FRAX, Fracture Risk Assessment Tool; NPV, negative predictive value; ORAI, Osteoporosis Risk Assessment Instrument; OST, Osteoporosis Self-Assessment Tool; PPV, positive predictive value; SCORE, Simple Calculated Osteoporosis Risk Estimation.

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Table 4. Performance, Threshold Values, and Number of Women Who Would Be Sent for Screening with Thresholds That Give Sensitivities Near 90% for Each Tool

	Sensitivity (95% CI)	Specificity (95% CI)	PPV (95% CI)	NPV 95% CI)	AUC	Women Who Would Be Sent for Screening, n (%)
ORAI ≥5	94 (82–98)	19 (15–25)	19 (15–25)	94 (82–98)	0.57	240 (83)
OST <6	90 (77–96)	25 (20–32)	20 (15–26)	92 (82–97)	0.58	224 (77)
SCORE ≥4	88 (75–95)	28 (22–34)	20 (15–26)	92 (82–97)	0.58	217 (75)
FRAX ≥4.7%	90 (77–96)	17 (13–23)	18 (13–24)	89 (76–96)	0.54	243 (84)
FRAX ≥6.8%	66 (51–78)	51 (45–58)	22 (16–30)	88 (81–93)	0.59	149 (51)

AUC, area under the receiver operating characteristic curve; CI, confidence interval; FRAX, Fracture Risk Assessment Tool; NPV, negative predictive value; ORAI, Osteoporosis Risk Assessment Instrument; OST, Osteoporosis Self-Assessment Tool; PPV, positive predictive value; SCORE, Simple Calculated Osteoporosis Risk Estimation.