Osteoporosis screening in postmenopausal women aged 50-64 years: BMI alone compared with current screening tools.

Authors

Xuezhi Jiang, Reading Hospital, Department of Obstetrics and Gynecology, Reading, PA, United States; Sidney Kimmel Medical College of Thomas Jefferson University, Department of Obstetrics and Gynecology, Philadelphia, PA
Lauren E Good, Reading Hospital, Department of Obstetrics and Gynecology, Reading, PA
Ryan Spinka, Reading Hospital, Department of Obstetrics and Gynecology, Reading, PA
Peter F Schnatz, Reading Hospital, Department of Obstetrics and Gynecology, Reading, PA, United States; Reading Hospital, Department of Internal Medicine, Reading, PA, United States; Sidney Kimmel Medical College of Thomas Jefferson University, Department of Obstetrics and Gynecology, Philadelphia, PA, United States; Sidney Kimmel Medical College of Thomas Jefferson University, Department of Internal Medicine, Philadelphia, PA,

Document Type

Article

Publication Date

1-1-2016

Abstract

OBJECTIVES: Consensus on when to initiate DXA screening for early postmenopausal women (< 65 years of age) is lacking. Low body mass index (BMI) has been proposed as one of the major risk factors for osteoporosis. This study sought to compare the predictive performance of BMI alone with 5 screening modalities (the U.S. Preventive services task force [USPSTF] FRAX threshold of 9.3%, a risk factor based approach [≥ 1 risk factors], the osteoporosis self-assessment tool [OST < 2], the osteoporosis risk assessment instrument [ORAI ≥ 9], and the simple calculated osteoporosis risk estimation [SCORE ≥ 6]) in identifying early postmenopausal women with osteoporosis.

METHODS: Postmenopausal women aged 50-64 years presenting for a DXA test were recruited between January 1, 2007, and March 1, 2009. Demographic data and osteoporosis risk factors were obtained through a telephone survey. The performance of each screening tool in predicting osteoporosis was compared.

RESULTS: Of 445 study participants, 95% were White, 38 had osteoporosis (T-score ≤ -2.5). BMI (< 28) was associated with the highest Sensitivity (95%), the lowest Negative Likelihood Ratio (LR-) of 0.14, an AUC of 0.73, and the number needed to scan (NNS) of 8. The USPSTF approach had the lowest sensitivity (24%), highest LR- (0.91), lowest AUC (0.62), and highest NNS (9). Among 5 established modalities, SCORE (≥ 6) appears to be the best (sensitivity: 92%, LR-: 0.24, AUC: 0.75, NNS: 9).

CONCLUSION: BMI (< 28) had a comparable numerical screening performance overall to the current screening modalities. BMI (< 28) could be considered a potential indicator when screening early postmenopausal White women for osteoporosis. However, a better osteoporosis screening tool remains to be developed.

Publication Title

Maturitas

Volume

83

First Page

59

Last Page

64

Recommended Citation

Jiang, X., Good, L., Spinka, R., & Schnatz, P. (2016). Osteoporosis screening in postmenopausal women aged 50-64 years: BMI alone compared with current screening tools.. Maturitas, 83, 59-64. https://doi.org/https://doi.org/10.1016/j.maturitas.2015.09.009