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 FractureHip FractureMajor Osteoporotic Fracture
MORESUniversalMORESUniversalMORESUniversal
Population (n)10,00010,00010,00010,00010,00010,000
    Sensitivity (MORES)0.9300.8000.800
    Specificity (MORES)0.5900.6950.695
Fracture risk0.1350.1350.0560.0560.1230.123
Osteoporosis prevalence0.0480.0480.0430.0430.0430.043
Relative risk of fracture with treatment0.6300.6300.6300.6300.5750.575
Adherence to treatment§0.7000.7000.7000.7000.7000.700
Predicted cases480480430430430430
    True positive446480344430344430
    False negative348686
    True negative5,6179,5206,6519,5706,6519,570
    False positive3,9032,9192,919
Referred for DXA (true positive + false positive)4,35010,0003,26310,0003,26310,000
Predicted hip fractures: MORES/DXA
    True positive44.6648.0214.2717.8429.7537.19
    False negative4.540.004.820.0010.590.00
    Total49.1948.0219.0917.8440.3337.19
    Unscreened (no DXA)64.8064.8024.0824.0852.9352.93
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.