Three osteoporosis threat evaluation instruments underperform in youthful postmenopausal girls

Key takeaways:

• The USPSTF recommends 5 instruments for assessing osteoporosis threat amongst postmenopausal girls.
• Three instruments had been graded as poor to honest discriminators of osteoporosis threat for ladies aged 50 to 64 years.

Three threat evaluation instruments struggled to detect osteoporosis based mostly on bone mineral density T-scores amongst girls aged 50 to 64 years, researchers reported in a research revealed in JAMA Community Open.

Researchers assessed the efficiency of the Osteoporosis Self-Evaluation Instrument, the Osteoporosis Danger Evaluation Instrument and the Osteoporosis Index of Danger, that are three of the 5 scientific threat evaluation instruments that the U.S. Preventive Companies Job Drive recommends for osteoporosis screening, amongst a gaggle of postmenopausal girls youthful than aged 65 years. All three instruments had an space below the receiver working curve (AUC) of lower than 0.7, which was the brink established by the researchers for an evaluation software to be an “acceptable” discriminator for osteoporosis.

“As a result of we discovered that the three scientific threat evaluation instruments solely had honest to reasonable performances in figuring out osteoporosis, our outcomes counsel that tips that suggest utilizing these instruments in scientific observe to establish youthful postmenopausal girls in danger for osteoporosis ought to be reassessed,” Henry W. Zheng, BS, a PhD pupil in medical and imaging informatics at College of California, Los Angeles, advised Healio.

Researchers collected knowledge from 6,067 postmenopausal girls who participated within the Girls’s Well being Initiative Bone Density Substudy and weren’t utilizing osteoporosis remedy at baseline (imply age, 57.7 years). BMD was measured throughout DXA scans. Girls with a BMD T-score of –2.5 or decrease on the femoral neck, complete hip or lumbar backbone had been outlined as having osteoporosis. In an effort to be a suitable or higher discriminator of osteoporosis, a threat evaluation software wanted an AUC of 0.7 or larger.

Of the research group, 14.1% had osteoporosis at any web site and 4.9% had osteoporosis on the femoral neck.

All three threat prediction instruments had the next AUC for predicting osteoporosis on the femoral neck vs. any of the three websites. The Osteoporosis Index of Danger had the best AUC for predicting osteoporosis on the femoral neck (AUC = 0.83; 95% CI, 0.829-0.83) adopted by the Osteoporosis Self-Evaluation Instrument (AUC = 0.818; 95% CI, 0.817-0.819) and the Osteoporosis Danger Evaluation Instrument (AUC = 0.805; 95% CI, 0.805-0.806).

The rule-recommended cutoff for predicting osteoporosis is a rating of lower than 1 level for the Osteoporosis Index of Danger, a rating of greater than 8 factors for the Osteoporosis Danger Evaluation Instrument and a rating of lower than 2 factors for the Osteoporosis Self-Evaluation Instrument. When these rating thresholds had been used, the Osteoporosis Index of Danger had a sensitivity of 37.8%, a specificity of 88.8%, a constructive predictive worth of 35.6% and an AUC of 0.633 (95% CI, 0.633-0.634) for predicting osteoporosis. The Osteoporosis Danger Evaluation Instrument had a sensitivity of 53.3%, a specificity of 79.4%, a constructive predictive worth of 29.8% and an AUC of 0.663 (95% CI, 0.663-0.664). The Osteoporosis Self-Evaluation Instrument resulted in a sensitivity of 62.4%, a specificity of 68.5%, a constructive predictive worth of 24.5% and an AUC of 0.654 (95% CI, 0.654-0.655).

All three threat evaluation instruments had been categorized as having poor to honest discrimination with an AUC between 0.5 and 0.7.

Zheng mentioned the findings weren’t shocking as a result of earlier analysis discovered that one other USPSTF-recommended screening software, the Fracture Danger Evaluation Instrument, was solely modestly higher than probability at discriminating between girls with and with out osteoporosis.

The researchers concluded that the findings “solid some doubt” on the USPSTF’s suggestions for utilizing the three threat evaluation instruments to foretell osteoporosis threat in scientific observe for youthful postmenopausal girls.

“Due to the disappointing efficiency of present really helpful scientific threat evaluation instruments, future research ought to look at whether or not new instruments leveraging various approaches, comparable to machine studying, can have benefits for figuring out applicable candidates for osteoporosis screening in youthful girls,” Zheng mentioned.

For extra data:

Henry W. Zheng, BS, could be reached at henryzheng@g.ucla.edu.

Revealed by:

Sources/Disclosures

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Disclosures:
Zheng studies receiving grants from Nationwide Institute of Arthritis and Musculoskeletal and Pores and skin Illnesses. Please see the research for all different authors’ related monetary disclosures.

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