Decision rules useful for selecting women for bone mineral density testing

NEW YORK (Reuters Health), Aug 1 - Four previously validated decision rules are useful in clinical practice for identifying postmenopausal women likely to have osteoporosis who should undergo bone mineral density (BMD) screening, Spanish researchers report in the June issue of the Journal of Rheumatology.

Mass screening using dual energy x-ray absorptiometry (DEXA), the gold standard for BMD evaluation, is not recommended routinely due to its cost, the authors explain, but there are no clear criteria to decide which women should undergo DEXA testing.

Dr. Joan M. Nolla and colleagues from Hospital Universitari de Bellvitge, Barcelona, evaluated the utility of the Osteoporosis Risk Assessment Instrument (ORAI), Osteoporosis Self-Assessment Tool (OST), Osteoporosis Index of Risk (OSIRIS), and Body Weight Criterion (BWC) in 665 postmenopausal women referred to their bone densitometry unit.

On the basis of WHO criteria, the team found that similar percentages of women would be recommended for BMD testing using ORAI (45%), OST (46%), OSIRIS (37%), and BWC (70%), the authors report.

The overall frequency of osteoporosis in the group was 17.6%

Sensitivity for selecting women with osteoporosis was highest for BWC (83.8%) and lower but similar for the other three decision rules (58.1%-69.2%), the report indicates, whereas specificity was highest for OSIRIS (67.9%) and lowest for BWC (33.4%).

Sensitivity for all four decision rules increased with increasing patient age, whereas specificity decreased with increasing patient age. As a result, positive predictive values were highest in the 60-69 years age group, and negative predictive values were highest in the 40-49 years age group.

"Our data indicate that in younger postmenopausal women, decision rules would be useful as a screening method to rule out the presence of the disease and the need for BMD scanning," Dr. Nolla and colleagues conclude. "A population-based study would be valuable to assure the scientific reliability of our findings."

However, "The relevance of these decision rules could decrease in the future," the researchers note. "It seems that there is a progressive tendency to recommend the identification of individuals based on fracture risk rather than BMD status."

Last Updated: 2007-07-31 12:24:24 -0400 (Reuters Health)

J Rheumatol 2007;34:1307-1312.

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