Diagnostic Accuracy of Different Screening Tools for Identifying Osteoporosis Risk Among Post-Menopausal Filipino Women Aged 45–65 Years

Abstract

Abstract Early screening of osteoporosis decreases fracture risk. Several identified clinical risk factors led to the development of screening tools to estimate osteoporosis risk. Bone Mineral Densitometry (BMD) as a diagnostic tool for screening is not practical because of high cost and poor availability. The extensively studied osteoporosis screening tools are: Simple Calculated Osteoporosis Risk Estimation (SCORE), the Osteoporosis Risk Assessment Instrument (ORAI), the Age Bulk One or Never Estrogen (ABONE), body weight (WEIGHT), and the Osteoporosis Risk Index (OSIRIS). These tools were developed and validated in Caucasians. Validation of these tools for specific populations is necessary because of the observed variations in BMD across geographic and ethnic groups. To date, the utility of these screening tools in the Philippines is unknown. We conducted a cross-sectional analysis of all patients who underwent BMD screening for osteoporosis in a tertiary hospital from January 2015 to September 2020. The study participants were postmenopausal Filipino women aged 45 to 65 years. The subjects had no history of osteopenia, osteoporosis, hip or spine fractures, use of osteoporosis medications, renal insufficiency, bilateral oophorectomy, hysterectomy, or early menopause. We identified demographic and clinical risk factors. These risk factors were used to calculate the risk score of five osteoporosis risk assessment tools: ORAI, ABONE, WEIGHT, OSTA, and ORISIS. Using the DEXA T-score as an external criterion, the sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios, and diagnostic accuracy for each tool were calculated. Included were 1869 subjects with a mean age of 57.9 + 4.3 years old. Osteoporosis, with a T-score of <-2.5 at the lumbar or femoral neck area, was seen in 665 (35.58%). Risk factors such as weight, height, BMI, menopausal years, history of previous fractures, and intake of oral calcium supplements correlated significantly with a higher risk (OR=1.025, 95%CI: 0.974–1.079; OR=1.059, 95%CI: 0.84–1.338; OR=1.063, 95%CI: 0.817–1.383; OR=1.74, 95%CI: 1.198–2.528; and OR=1.088, 95%CI: 0.869–1.319), of having osteoporosis in the said population. ORAI and WEIGHT have the highest probability of identifying patients with a sensitivity of 88.42% and 91.28%, and accuracy of 85.71% and 87.98%. Both performed equally in screening for osteoporosis in this setting. However, ABONE, OSTA, and ORISIS underestimated the number of high-risk osteoporosis patients, because of their low sensitivity and diagnostic accuracy. Both ORAI and WEIGHT are simple and easy to calculate and can serve as an initial screening tool to identify Filipino postmenopausal women who are at high risk for osteoporosis. A prospective study with a correlation of fracture occurrences may provide evidence for the value of these tools as a screening test.