Performance and interventional cutoffs of osteoporosis self-assessment tools in the community: implications for screening and early referral.

UNLABELLED: Patients with lower bone mineral density (BMD) face an increased risk of fragile fractures and should be actively screened to mitigate this vulnerability. Given the limitations of dual-energy X-ray absorptiometry (DXA), it is possible to identify high-risk osteoporosis groups through simple self-assessment tools for further BMD measurements.

PURPOSE: This study aims to evaluate the sex- and age-specific sensitivity and specificity of these simple tools for predicting osteoporosis risk to enhance the overall management of osteoporosis risk in the community.

METHODS

This study enrolled subjects surveyed from epidemiological cohorts in Taiwan. Osteoporosis risk was assessed via the OSTA (for Asian women), and the OSTAi and MOSTAi (for Taiwanese women and men). Osteoporosis was defined as the lowest T-score ≤  - 2.5 based on the BMD of the lumbar spine and hip, as measured via DXA. The OSTAi and MOSTAi algorithms were used to analyze the self-assessment performance via receiver operating characteristic (ROC) and area under the curve (AUC) analyses.

RESULTS

A total of 1976 participants were enrolled in the study; 52.8% were women, with a mean age of 65.4 years. The sensitivity and specificity for detecting osteoporosis were as follows: MOSTAi (sensitivity/specificity = 0.53/0.72), OSTA (0.71/0.77), and OSTAi (0.77/0.73). The eOSTAi demonstrated favorable sensitivity in women, with AUCs of 0.8200 for osteoporosis and 0.7643 for osteopenia. In men, eMOSTAi showed fair sensitivity (AUC = 0.6690 for osteoporosis and 0.5626 for osteopenia). The cutoffs of the eOSTAi and eMOSTAi for detecting osteoporosis decreased with age.

CONCLUSION

The cutoff of OSTAi is suitable for self-assessment of osteoporosis in Taiwanese women. However, for men, the cutoff of MOSTAi may need to be adjusted. Considering the differences in the prevalence of osteoporosis in the community, it is recommended that the cutoff be set according to gender and age.