Skip to main content

Advertisement

SpringerLink
Log in

An evaluation of osteoporosis screening tools for the osteoporotic fractures in men (MrOS) study

  • Short Communication
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

Summary

No large-scale evaluations of osteoporosis screening tools have been done in men. OST and MOST were examined among 4658 US Caucasian and 1914 Hong Kong Chinese men. Both tools have high negative predictive values, accurately screening out men with low risk, and saving a third of DXA tests.

Introduction

Prior investigations have studied the performance of osteoporosis screening tools in women, but no large-scale evaluations have been done in men.

Methods

This study examines the performance of the Osteoporosis Self-assessment Tool (OST), the Male Osteoporosis Screening Tool (MOST), quantitative ultrasound index (QUI), and body weight as screening tools. Osteoporosis was defined by a dual-energy X-ray absorptiometry (DXA) measured bone mineral density (BMD) T-score ≤−2.5. Four thousand six hundred and fifty-eight US Caucasian and 1914 Hong Kong Chinese men, aged ≥65 years and community-dwelling, were included in the analysis. Receiver operating characteristic (ROC) analysis was used to compare the area under the ROC curve (AUC) between different screening tools.

Results

MOST had a significantly larger AUC (≥0.8) than OST, QUI, and body weight in detecting osteoporosis. Using the second tertile as cutoff, OST and MOST yielded sensitivities of around 90% and negative predictive values (NPVs) of >97%, accurately screening out Caucasian and Chinese men with low risk of osteoporosis.

Conclusions

OST and MOST can effectively rule out osteoporosis for both Caucasian and Chinese men, and compared to referring men 65 years and older for BMD DXA testing, they save a third of DXA resources.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

References

  1. Cadarette SM, Jaglal SB, Murray TM et al Canadian Multicentre Osteoporosis Study (2001) Evaluation of decision rules for referring women for bone densitometry by dual-energy x-ray absorptiometry. JAMA 286(1):57–63

    Article  PubMed  CAS  Google Scholar 

  2. Koh LK, Sedrine WB, Torralba TP et al Osteoporosis Self-Assessment Tool for Asians (OSTA) Research Group (2001) A simple tool to identify Asian women at increased risk of osteoporosis. Osteoporos Int 12(8):699–705

    Article  PubMed  CAS  Google Scholar 

  3. Adler RA, Tran MT, Petkov VI (2003) Performance of the osteoporosis self-assessment screening tool for osteoporosis in American men. Mayo Clin Proc 78(6):723–727

    PubMed  Google Scholar 

  4. Lynn HS, Lau EM, Wong SY, Hong AW (2005) An osteoporosis screening tool for Chinese men. Osteoporos Int 16(7):829–834

    Article  PubMed  CAS  Google Scholar 

  5. Orwoll E, Blank J, Barrett-Connor E et al (2005) Design and baseline characteristics of the osteoporotic fractures in men (MrOS) study — a large observational study of the determinants of fracture in older man. Contemp Clin Trials 26(5):569–585

    Article  PubMed  Google Scholar 

  6. Blank J, Cawthon P, Carrion-Petersen M et al (2005) Overview of recruitment for the osteoporotic fractures in men study (MrOS). Contemp Clin Trials 26(5):557–568

    Article  PubMed  Google Scholar 

  7. Lau E, Leung P, Kwok T et al (2006) The determinants of bone mineral density in Chinese men — results from Mr. OS (Hong Kong), the first cohort study on osteoporosis in Asian men. Osteoporos Int 17:297–303

    Article  PubMed  CAS  Google Scholar 

  8. Looker AC, Wahner HW, Dunn WL et al (1998) Updated data on proximal femur bone mineral levels of US adults. Osteoporos Int 8:468–489

    Article  PubMed  CAS  Google Scholar 

  9. Lynn HS, Lau EM, Au B, Leung PC (2005) Bone mineral density reference norms for Hong Kong Chinese. Osteoporos Int 16:1663–1668

    Article  PubMed  CAS  Google Scholar 

  10. Delong ER, Delong DM, Clarke-Pearson DL (1988) Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 44:837–845

    Article  PubMed  CAS  Google Scholar 

  11. Rud B, Hilden J, Hyldstrup L, Hróbjartsson A (2007) Performance of the osteoporosis self-assessment tool in ruling out low bone mineral density in postmenopausal women: a systematic review. Osteoporos Int 18:1177–1187

    Article  PubMed  CAS  Google Scholar 

  12. Richy F, Deceulaer F, Ethgen O et al (2004) Development and validation of the ORACLE score to predict risk of osteoporosis. Mayo Clin Proc 79(11):1402–1408

    Article  PubMed  Google Scholar 

  13. Hochberg MC, Tracy JK, Van der Klift M, Pols H (2002) Validation of a risk index to identify men with increased likelihood of osteoporosis [Abstract]. J Bone Miner Res 17 (Suppl 1):S231

    Google Scholar 

  14. Kraemer DF, Nelson HD, Bauer DC, Helfand M (2006) Economic comparison of diagnostic approaches for evaluating osteoporosis in older women. Osteoporos Int 17:68–76

    Article  PubMed  Google Scholar 

  15. Schousboe JT, Taylor BC, Fink HA et al (2007) Cost-effectiveness of bone densitometry followed by treatment of osteoporosis in older men. JAMA 298(6):629–637

    Article  PubMed  CAS  Google Scholar 

  16. Hoffman JR, Mower WR, Wolfson AB et al (2000) Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. N Engl J Med 343:94–99

    Article  PubMed  CAS  Google Scholar 

  17. Reilly BM, Evans AT, Schaider JJ et al (2002) Impact of a clinical decision rule on hospital triage of patients with suspected acute cardiac ischemia in the emergency department. JAMA 288(3):342–350

    Article  PubMed  Google Scholar 

  18. Brown JP, Josse RJ for the Scientific Advisory Council, Osteoporosis Society of Canada (2002) Clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. CMAJ 167(10 Suppl):S1–S34

    PubMed  Google Scholar 

  19. Binkley N, Bilezikian J, Kendler D et al (2006) Official positions of the International Society for Clinical Densitometry and executive summary of the 2005 Position Development Conference. J Clin Densitom 9:4–14

    Article  PubMed  Google Scholar 

  20. Richy F, Gourlay M, Ross PD et al (2004) Validation and comparative evaluation of the osteoporosis assessment tool (OST) in a Caucasian population from Belgium. Q J Med 97:39–46

    CAS  Google Scholar 

Download references

Acknowledgment

The Osteoporotic Fractures in Men (MrOS) Study is supported by National Institutes of Health funding. The following institutes provided support: the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), the National Institute on Aging (NIA), the National Center for Research Resources (NCRR), and NIH Roadmap for Medical Research under the following grant numbers: U01 AR45580, U01 AR45614, U01 AR45632, U01 AR45647, U01 AR45654, U01 AR45583, U01 AG18197, U01-AG027810, and UL1 RR024140. Support for the study on Hong Kong subjects came from the Hong Kong Research Grants Council Earmarked grant CUHK4101/02M, and the NIAMS grant R01 AR49439. The authors wish to thank all the participants for their dedicated contribution to the study.

Conflicts of interest

Dr. Cauley has received research support from Merck & Company, Eli Lilly & Company, Pfizer Pharmaceuticals and Novartis Pharmaceuticals. She has also received consulting fees from Eli Lilly & Company, and Novartis Pharmaceuticals. She is on the speaker’s bureau for Merck & Co., Inc.

Author information

Authors and Affiliations

  1. Department of Biostatistics, School of Public Health, Fudan University, 138 Yi Xue Yuan Road, Shanghai, 200032, China

    H. S. Lynn

  2. Department of Medicine and Therapeutics, The Chinese University of Hong Kong HKSAR, Shatin (Hong Kong), China

    J. Woo

  3. Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong HKSAR, Shatin (Hong Kong), China

    P. C. Leung

  4. Department of Family and Preventive Medicine, University of California at San Diego, San Diego, CA, USA

    E. L. Barrett-Connor

  5. Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA, USA

    M. C. Nevitt

  6. Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA

    J. A. Cauley

  7. Section of Endocrinology, McGuire Veterans Affairs Medical Center, Richmond, VA, USA

    R. A. Adler

  8. General Clinical Research Center, Oregon Health and Sciences University, Portland, OR, USA

    E. S. Orwoll

Authors
  1. H. S. Lynn
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Woo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P. C. Leung
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. E. L. Barrett-Connor
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. C. Nevitt
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. A. Cauley
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. R. A. Adler
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. E. S. Orwoll
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

for the Osteoporotic Fractures in Men (MrOS) Study

Corresponding author

Correspondence to H. S. Lynn.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lynn, H.S., Woo, J., Leung, P.C. et al. An evaluation of osteoporosis screening tools for the osteoporotic fractures in men (MrOS) study. Osteoporos Int 19, 1087–1092 (2008). https://doi.org/10.1007/s00198-007-0553-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-007-0553-3

Keywords

Search

Navigation