Osteoporosis Self-Assessment Tool For Asians Index Research Articles

Assessing the utility of osteoporosis self-assessment tool for Asians in patients undergoing hip surgery

ObjectivesDiagnosis and treatment of osteoporosis are instrumental in obtaining good outcomes of hip surgery. Measuring bone mineral density (BMD) using dual-energy X-ray absorptiometry (DXA) is the gold standard for diagnosing osteoporosis. However, due to limited access to DXA, there is a need for a screening tool to identify patients at a higher risk of osteoporosis. We analyzed the potential utility of the Osteoporosis Self-assessment Tool for Asians (OSTA) as a screening tool for osteoporosis. MethodsA total of 1378 female patients who underwent hip surgery at 8 institutions were analyzed. For each patient, the BMD of the proximal femoral region was measured by DXA (DXA-BMD), and the correlation with OSTA score (as a continuous variable) was assessed. Receiver operating characteristic (ROC) curve analysis was performed to assess the ability of OSTA score to predict osteoporosis. Lastly, the OSTA score was truncated to yield an integer (OSTA index) to clarify the percentage of patients with osteoporosis for each index. ResultsDXA-BMD showed a strong correlation with OSTA (r = 0.683; P < 0.001). On ROC curve analysis, the optimal OSTA score cut-off value of −5.4 was associated with 73.8% sensitivity and 80.9% specificity for diagnosis of osteoporosis (area under the curve: 0.842). A decrease in the OSTA index by 1 unit was associated with a 7.3% increase in the probability of osteoporosis. ConclusionsOSTA is a potentially useful tool for screening osteoporosis in patients undergoing hip surgery. Our findings may help identify high-risk patients who require further investigation using DXA.

Incidence of and Risk Factors for Screw Loosening after Iliosacral Screw Fixation for Posterior Pelvic Ring Injury.

Screw loosening is a common complication of iliosacral screw fixation, with subsequent loss of stability and fracture re-displacement. This study aimed to investigate the incidence of and risk factors for screw loosening after iliosacral screw fixation for posterior pelvic ring injury. A total of 135 patients with posterior pelvic ring injuries who were treated with iliosacral screw fixation in our department between July 2015 and April 2021 were selected for this retrospective analysis. The possible risk factors for screw loosening were investigated using univariate and multivariate logistic regression analyses of patient demographics and trauma-related and iatrogenic variables, including age, sex, body mass index, Osteoporosis Self-Assessment Tool for Asians (OSTA) index, mechanism of injury, Young-Burgess classification, site of injury, type of injury, type of screw, mode of fixation, numbers of guidewire adjustments, accuracy of screw position, and quality of fracture reduction. The incidence of screw loosening was 15.6% (n = 21). The mean duration for screw loosening was 3.2 ± 1.5 months after operation. Univariate analysis results showed that the Young-Burgess classification, type of injury, site of injury, type of screw, mode of fixation, and OSTA index might be related to screw loosening (p < 0.05). According to the multivariate logistic regression, vertical shear injuries (Odds ratios [OR] 9.80, 95% Confidence intervals [CI] [1.96-73.28], p = 0.008), type of injury (OR 0.25, 95% CI [0.13-0.79], p = 0.027), common screws (OR 6.94, 95% CI [1.53-31.40], p = 0.012), screws insertion only at the level of the first sacral segment (S1) (OR 8.79, 95% CI [1.18-65.46], p = 0.034), injury site located in the medial sacral foramina (OR 6.28, 95% CI [1.16-34.06], p = 0.033), and lower OSTA index [OR 0.41, 95% CI [0.24-0.71], p = 0.001] were significantly related to screw loosening. Vertical shear injuries, sacral fractures, injury site located in the medial sacral foramina, and lower OSTA index are significantly associated with the postoperative occurrence of screw loosening. Transiliac-transsacral screw fixation and screws insertion both at the level of the S1 and second sacral segment can prevent screw loosening.

Development and Validation of a New Clinical Diagnostic Screening Model for Osteoporosis in Postmenopausal Women.

Age and weight are not only strong predictive parameters for osteoporosis diagnosis but can also be easily acquired from patients. This study aimed to develop and validate a new diagnostic screening model for postmenopausal osteoporosis that uses only 2 parameters, viz., age and weight. The discriminative ability of the model was analyzed and compared with that of the osteoporosis self-assessment tool for Asians (OSTA) index. The age-weight diagnostic screening model was developed using a retrospective chart review of postmenopausal women aged ≥50 years who underwent dual energy X-ray absorptiometry at a tertiary hospital from November 2017 to April 2022. Logistic regression analysis was used to derive a diagnostic screening model for osteoporosis. A total of 533 postmenopausal women were included in the study. According to the highest Youden index value, a probability cut-off value of 0.298 was used in the diagnosis screening model at any site, which yielded a sensitivity of 84.3% and a specificity of 53.8%. For increased sensitivity as a screening tool, a cut-off value of 0.254 was proposed to obtain a sensitivity of 90.2% and a specificity of 42.2%. The area under receiver operating characteristic curves from all screening models were significantly higher than those from the OSTA index model (p<0.05). This study showed the feasibility of a postmenopausal osteoporosis diagnostic screening model that uses 2 strong predictors for osteoporosis diagnosis: age and weight. This age-weight diagnostic model is a simple, effective option in postmenopausal osteoporosis screening.

Correlations of the Osteoporosis Self-Assessment Tool for Asians (OSTA) and Three Panoramic Indices Using Quantitative Ultrasound (QUS) Bone Densitometry.

This study aimed to evaluate the correlation between the Osteoporosis Self-Assessment Tool for Asians (OSTA) and three panoramic indices in relation to z-score and t-score values using quantitative ultrasound (QUS) bone densitometry. The sensitivity, specificity, and area under the curve (AUC) of the OSTA index were also measured using the QUS tool to evaluate the method's performance in identifying people at risk of osteoporosis. The study employed a cross-sectional design with 387 participants (190 men, 197 women). Patients' mandibular cortical indexes (MCI), mandibular cortical widths (MCW), and panoramic mandibular indexes (PMI) were measured from panoramic images. The sensitivity, specificity, and AUC were calculated using an OSTA index cutoff of ≤-1 and a t-score of ≤-1.0 for the QUS bone densitometry. The coefficient correlation of the OSTA index with the z-score (r = -0.563, p < 0.001) and t-score (r = -0.740, p < 0.001) shows a higher value than the MCI, MCW, and PMI, per the QUS. The sensitivity, specificity, and AUC values with a cutoff t-score of ≤-1.0 per the QUS in men was 90%, 50%, and 0.812, and in women, 96.8%, 30%, and 0.862. The OSTA index is a simple method that can be used in general dental practice.

The Diagnostic Value of the Osteoporosis Self-assessment Tool for Asians in Vietnamese Postmenopausal Women

Introduction: Osteoporosis is a common disease that affects many women in the postmenopausal period. Dual-energy X-ray absorptiometry (DXA) is a simple and noninvasive method used to diagnose osteoporosis. The Osteoporosis Self-Assessment Tool for Asians (OSTA) is an osteoporosis risk assessment toolkit, used for menopausal women in Asia. This study aimed to evaluate the diagnostic values of the OSTA index in determining the risk of osteoporosis in postmenopausal women.&#x0D; Material and Methods: This cross-sectional study was conducted on 919 postmenopausal women to determine the value of OSTA in osteoporosis risk assessment. The bone density was measured using the DXA method in the lumbar spine and femoral neck.&#x0D; Results: Based on the ROC curve, the sensitivity and specitivity of OSTA were 70.3% and 63.6% at the cut-off of ≤ -1.4 at the femoral neck or lumber spine or both (p = 0.005) . At a cut-off point of ≤-1 at one of two position or both, the OSTA index showed a specificity of 87.23%, sensitivity of 66.08%, positive predictive value of 46.90%, and negative predictive value of 93.78% in predicting the osteoporosis risk.&#x0D; Conclusions: The OSTA index is a simple tool that is highly sensitive and specific in predicting the risk of osteoporosis in postmenopausal women.

Comparison of the Osteoporosis Self-Assessment Tool for Asians and the fracture risk assessment tool - FRAX to identify densitometric defined osteoporosis: A discriminatory value analysis in a multi-ethnic female population in Southeast Asia

ObjectivesThe accuracy of FRAX® as a screening tool to identify osteoporosis and how it compares with tools such as Osteoporosis Self-Assessment Tool for Asians (OSTA), in Southeast Asian women has so far been unexplored. We aimed to determine the FRAX® thresholds that accurately identify densitometric osteoporosis and to compare its performance with that of OSTA for this purpose. MethodsSingaporean postmenopausal women (n = 1056) were evaluated. FRAX® Major Osteoporotic Fracture Probability (MOFP), Hip Fracture Probability (HFP) scores, and OSTA indices were calculated. Receiver operating characteristic (ROC) curves were constructed and via the Youden index, the optimal cut-off points of balanced sensitivity and specificity for dual energy X-ray absorptiometry (DXA)-defined osteoporosis were identified and the performance characteristics were compared. ResultsA FRAX® MOFP threshold of ≥3.7% had sensitivity, specificity, positive predictive value and negative predictive value of 0.78 (0.73–0.83), 0.63 (0.59–0.66), 0.4 (0.36–0.44), and 0.9 (0.87–0.92), respectively in identifying osteoporosis. The corresponding values for a HFP threshold of ≥0.6% were 0.85 (0.80–0.89), 0.58 (0.55–0.62), 0.39 (0.35–0.43), and 0.92 (0.9–0.94) and that for an OSTA index cut-off of ≤ −1.2 were 0.76 (0.70–0.81), 0.74 (0.71–0.77), 0.48 (0.43–0.54), and 0.91 (0.88–0.93). The area under the ROC curves were 82.8% (79.9%–85.6%), 77.6% (74.2%–81%), and 79.6% (76.5%–82.8%) for OSTA, MOFP, and HFP thresholds respectively. ConclusionsFRAX® and OSTA perform comparably in identifying osteoporosis in our population. OSTA has only 2 parameters and may be simpler to use. However, FRAX® may also have a role in primary screening to identify the postmenopausal woman to be referred for DXA scanning and may help facilitate fracture risk reduction discussions with the patient.

Osteoporosis Self-Assessment Tool As a Screening Tool for Predicting Osteoporosis in Elderly Chinese Patients With Established Rheumatoid Arthritis

Osteoporosis Self-Assessment Tool for Asians (OSTA) is an indicator for assessing osteoporosis in postmenopausal women. The aim of this study was to investigate the value of OSTA index on predicting osteoporosis in elderly Chinese patients with established rheumatoid arthritis (RA). A total of 320 patients with RA and 158 normal individuals were recruited from January 2015 to October 2017. Bone mineral density (BMD) at the femur and lumbar spine was measured by dual-energy X-ray absorptiometry. RA group and control group were divided into low risk (values≥−1), medium risk (values between −4 and −1), and high risk (values ≤−4) group according to the value of OSTA index. One-way analysis of variance showed that BMD at all detected regions among the 3 groups were obviously different (p < 0.0001). Incidences of osteoporosis among different OSTA groups were 21.76% (47/216), 56.41% (44/78), and 80.77% (21/26), separately (x2 = 67.389, p < 0.0001). In RA group including premenspausal or postmenspausal female subgroup, prevalences of osteoporosis among different OSTA groups were different (p < 0.05–0.0001). We also found a positive linear correlation between OSTA index and BMD (p < 0.0001) both in RA and in control groups. Logistic regression revealed OSTA index (odds ratio = 0.734, p < 0.0001, 95% confidence interval: 0.657–0.819) was a protective factor for occurrence of RA-induced osteoporosis. OSTA had the highest discriminatory power, with an estimated Area Under Curve (AUC) of 0.750 (95% confidence interval 0.694–0.807, p < 0.0001), sensitivity of 76.9% and specificity of 66.5%. Our findings indicated that OSTA index was closely associated with BMD in RA patients, the degree of correlation was much stronger than age or BMI. OSTA index was a predictor for osteoporosis in RA, but it might have little relationship with disease status in RA.

Effectiveness of Osteoporosis Self-Assessment Tool for Asians in Screening for Osteoporosis in Healthy Males Over 40 Years Old in China

In this study, we evaluated the effectiveness of the Osteoporosis Self-assessment Tool for Asians (OSTA) in screening for osteoporosis in the elderly male population in the Chengdu area, China. The Lunar Prodigy Advance bone densitometer was used to measure the bone mineral density of 11,039 healthy males over the age of 40 years. Men with OSTA scores of >−1, −4 < OSTA ≤ −1, or ≤−4 were assigned to the low-risk, moderate-risk, or high-risk group, respectively. The T-scores measured with dual-energy X-ray absorptiometry at the different sites were compared across the groups. The bone mineral density of the lumbar spines L1–L4, the left femur, and other sites decreased gradually with age. With increasing age, the screening sensitivity of OSTA for osteoporosis in the lumbar spine and femur gradually increased, whereas its specificity decreased. The areas under the receiver operating characteristic curves for the OSTA index in different age groups and at different sites were 0.644–0.831. Therefore, the OSTA index demonstrated some value in screening for osteoporosis in men over the age of 50 years. Significant differences in its effectiveness were observed among different age groups.

Prevalence of osteoporosis in schizophrenia patients using the osteoporosis self-assessment tool for Asians

Objective: The aims of the current study were to investigate the prevalence and socio-demographic correlates of risk of osteoporosis in Singapore among patients with schizophrenia using the osteoporosis self-assessment tool for Asians (OSTA).Method: Data for the current study was drawn from a clinical database maintained at the Institute of Mental Health Singapore. The OSTA index was used to calculate the risk for osteoporosis among those aged 50 years and above.Results: A total of 2569 patients were included in the study. About 34.6% met the criteria for osteoporosis using the OSTA cut-off of ≤ −1. Among the males 22.8% met criteria for high risk and 1.5% met criteria for very high risk, while among women 28.2% were at intermediate risk and 14.9% were at high risk of osteoporosis. The logistic regression analysis showed that older age and female gender were significantly associated with a higher risk of osteoporosis, while those with a history of hypertension and hyperlipidemia were less likely to be associated with a risk of osteoporosis.Conclusion: The OSTA could be a useful, inexpensive and quick tool to both identify those with osteoporosis as well as to measure the effectiveness of interventions meant to alleviate it.

Osteoporosis Self-Assessment Tool for Asians Can Predict Neurologic Prognosis in Patients with Isolated Moderate Traumatic Brain Injury.

ObjectivesOsteoporosis Self-Assessment Tool for Asians (OSTA) has been proved to be a simple and effective tool for recognizing osteoporosis risk. Our previous study has demonstrated that the preoperative OSTA index was a good prognostic predictor for stage II and III colon cancer patients after surgery. We aim to evaluate the value of OSTA index in prognostication of isolated traumatic brain injury with moderate severity (GCS 9-13).MethodsWe retrospectively reviewed all patients visiting Kaohsiung Medical University Hospital emergency department due to isolated moderate traumatic brain injury from Jan. 2010 to Dec. 2012. Background data (including the OSTA index), clinical presentations, management and outcomes (ICU admission days, total admission days, complications, Glasgow outcome score (GOS) at discharge, mortality) of the patients were recorded for further analysis. Our major outcome was good neurologic recovery defined as GOS of 5. Pearson chi-square test and the Mann-Whitney U test were used to compare demographic features. Multiple logistic regression was used to identify independent risk factors.Results107 isolated moderate TBI patients were studied. 40 patients (37.4%) showed good recovery and 10 (9.3%) died at discharge. The univariate analysis revealed that younger age, higher OSTA index, lower ISS, lower AIS-H, and avoidance to neurosurgery were associated with better neurologic outcome for all moderate TBI patients. Multivariate analysis revealed that lower ISS, higher OSTA, and the avoidance of neurosurgery were independent risk factors predicting good neurologic recovery.ConclusionHigher ISS, lower OSTA index and exposure to neurosurgery were the independent risk factors for poorer recovery from isolated moderate TBI. In addition to labeling the cohort harboring osteoporotic risk, OSTA index could predict neurologic prognosis in patients with isolated moderate traumatic brain injury.

Self-assessment Tool to Identify Primary Osteoporosis in Chinese Elderly Males

Validation of the effectiveness of the Osteoporosis Self-Assessment Tool for Asians (OSTA) in identifying elderly males at increased risk of primary osteoporosis has been seldom reported in China. A cross-sectional study was conducted to assess the performance of the OSTA in 245 healthy males aged ≥50 years for routine bone mineral density (BMD) scanning by dual-energy X-ray absorptiometry. The ability of OSTA to discriminate low BMD as defined by a T score ≤ −2.5 at different sites (femoral neck, total hip, and lumbar spine) was evaluated using receiver operating characteristic (ROC) curve analysis. ROC curves were generated to determine the optimal cutoff points, sensitivity, specificity, and areas under the ROC curves. Of the study participants, 14% had osteoporosis, and the prevalence of osteoporosis increased progressively with age. The area under the ROC curves of the OSTA index to identify osteoporosis in the femoral neck site was 0.712 ( p < 0.0001). The sensitivity and specificity of the optimal OSTA index (cutoff = 1) to identify osteoporosis based on femoral neck BMD in all males were 84% and 49%, respectively. The sensitivity of OSTA increased with age, whereas its specificity decreased with age. Sensitivity and specificity values of 70% and 68%, respectively, were obtained in 50-year-old to 69-year-old males. The OSTA index may be a useful tool for identifying primary osteoporosis as defined by dual-energy X-ray absorptiometry at the femoral neck site in males aged ≥50 years, especially in males aged <70 years.

Performance of the Osteoporosis Self-Assessment Tool for Asians (OSTA) in Screening Osteoporosis Among Middle-Aged and Old Women in the Chengdu Region of China

The purpose of this study was to assess the performance of an osteoporosis self-assessment tool for Asians (OSTA) for screening middle-aged and old healthy women in the Chengdu region of China. OSTA scores were used to evaluate the effect of age on the development of osteoporosis. A total of 15,752 healthy women older than 40 yr, who reside in the Chengdu region, were assigned to 9 age groups divided by 5-yr intervals. Bone mineral density of the lumbar vertebrae, L1–L4, and the left hip was measured with a GE Lunar Prodigy advance dual-energy X-ray absorptiometry system (GE Healthcare, Cincinnati, OH). All subjects were classified into 3 categories according to OSTA cutoff values. The OSTA values used to define the categories were ≥−1, >−4 and <−1, and ≤−4. The accuracy of the OSTA index was compared with T-scores measured by dual-energy X-ray absorptiometry at various skeletal sites. All statistical analyses were performed using SPSS, version 17.0 (SPSS, Inc., Chicago, IL). The detection rate of osteoporosis and osteopenia at the lumbar vertebrae and the femur was found to increase with age. Furthermore, the sensitivity of OSTA value for detection of osteoporosis also gradually enhanced with subject age. In contrast, the specificity gradually decreased with age. The sensitivity and negative predictive value of the OSTA index for detecting osteoporosis gradually increased with higher OSTA cutoff values, and the specificity and positive predictive value appeared to gradually decline. It was concluded that the OSTA is a useful screening tool to detect osteoporosis in middle-aged and old women in the Chengdu region of China. Furthermore, specific OSTA cutoff values should be selected for screening individuals who belong to different age groups.

Diagnostic value of osteoporosis self-assessment tool for Asians (OSTA) and quantitative bone ultrasound (QUS) in detecting high-risk populations for osteoporosis among elderly Chinese men.

This study aims to evaluate an osteoporosis self-assessment tool for Asians (OSTA) and quantitative bone ultrasound (QUS) and their combination in detecting populations at high risk for osteoporosis, and to determine the best cutoff value for the diagnosis of osteoporosis among elderly Chinese men. A group of Chinese men, aged ≥ 60 years, recruited from the health checkup population of Zhongshan Hospital, Fudan University, were included. The OSTA index was calculated from age and weight. Bone mineral density (BMD) at left hip (femoral neck, internal, and total hip) and lumbar spine (L1-L4, L-Total) was measured with dual-energy X-ray absorptiometry (DXA), and calcaneal BMD was measured with QUS. Receiver operating characteristic analysis was used to determine the best cutoff values, sensitivity, and specificity. The area under the curve (AUC) between the different screening tools was compared. Our study included 472 men with mean age of 78.0 years. The prevalence of osteoporosis was 27.7%.The best cutoff for OSTA was -3.5 for predicting men with osteoporosis at any site; this yielded a sensitivity and specificity of 47.3% and 76.8%, respectively. The AUC for OSTA was 0.676. The optimal cutoff for QUS-T score was -1.25, with a sensitivity of 80.4% and specificity of 59.7%. The AUC for QUS-T score was 0.762. Combining QUS with OSTA improved the specificity to 92.9% but reduced sensitivity to 36.1%. A new variable derived from a combination of OSTA and the QUS-T score gave a better performance, with sensitivity of 70.1% and specificity of 72.1%; the AUC for this variable was 0.771, which was greater than OSTA but not different from QUS alone. In conclusion, OSTA and QUS, respectively, and their combination may help find populations at high risk for osteoporosis, which could be an alternative method for diagnosing osteoporosis, especially in areas where DXA measurement is not accessible.

Validation of an osteoporosis self-assessment tool to identify primary osteoporosis and new osteoporotic vertebral fractures in postmenopausal Chinese women in Beijing

BackgroundThis study aimed to validate the effectiveness of the Osteoporosis Self-assessment Tool for Asians (OSTA) in identifying postmenopausal women at increased risk of primary osteoporosis and painful new osteoporotic vertebral fractures in a large selected Han Chinese population in Beijing.MethodsWe assessed the performance of the OSTA in 1201 women. Subjects with an OSTA index > -1 were classified as the low risk group, and those with an index ≤ -1 were classified as the increased risk group. Osteoporosis is defined by a T-score ≤ 2.5 standard deviations according to the WHO criteria. All painful, new vertebral fractures were identified by X-ray and MRI scans with correlating clinical signs and symptoms. We determined the sensitivity, specificity, and area under the receiver operating characteristic (ROC) curve for correctly selecting women with osteoporosis and painful new vertebral fractures.ResultsOf the study subjects, 29.3% had osteoporosis, and the prevalence of osteoporosis increased progressively with age. The areas under the ROC curves of the OSTA index (cutoff = -1) to identify osteoporosis in the femoral neck, total hip, and lumbar spine were 0.824, 0.824, and 0.776, respectively. The sensitivity and specificity of the OSTA index (cutoff = -1) to identify osteoporosis in healthy women were 66% and 76%, respectively. With regard to painful new vertebral fractures, the area under the ROC curve relating the OSTA index (cutoff = -1) to new vertebral fractures was 0.812.ConclusionsThe OSTA may be a simple and effective tool for identifying the risk of osteoporosis and new painful osteoporotic vertebral fractures in Han Chinese women.

Osteoporosis Self-assessment Tool for Asians as a simple risk index of identifying a poor prognosis in women surgically treated for colorectal cancer

BackgroundOsteoporosis and colorectal cancer (CRC) in older women are considered enormous public health burdens. The effects of osteoporosis on the oncologic outcome of CRC surgery are poorly understood. We evaluated the use of the Osteoporosis Self-assessment Tool for Asians (OSTA) for predicting postoperative outcome in older women after receiving surgical treatment of CRC. Materials and methodsThe present single-institution retrospective study analyzed patients who had undergone surgery for CRC in 2002–2008. To characterize the major population of women with osteoporosis, which consists of postmenopausal women, only patients aged 50 years and older were analyzed. Their OSTA scores were evaluated for correlations with cancer-specific survival after surgery for CRC by performing univariate, multivariate, and survival analyses. ResultsDuring a 7-year period, 440 women were studied. The cancer-specific mortality and overall mortality rate was 28.4% and 33.4%, respectively. The univariate analyses revealed that significant predictors of cancer-specific mortality after CRC surgery were the International Union Against Cancer (UICC) stage, OSTA category, histologic grading, lymph node metastases, and tumor invasion depth. After risk adjustment, the UICC stage and OSTA risk index were independent predictors of mortality. A comparison of OSTA risk index among patients with different UICC stages showed that the accuracy of the index in predicting cancer-specific survival after CRC surgery was greatest for patients with stage II and III disease. ConclusionsThe UICC stage and OSTA risk status showed independent positive associations with postoperative mortality in aged female patients with CRC. Moreover, the OSTA index had a particularly strong association with cancer-specific mortality in patients with UICC stage II and III.

Diagnostic values of self-assessment tool for Asians for osteoporosis in aged men

To evaluate the diagnostic values of osteoporosis self-assessment tool for Asians (OSTA) in aged men. Bone mineral density (BMD) was measured by dual energy X-ray absorptiometry (DXA) in 382 male outpatients. Their data were collected. After excluding such influencing factors of BMD as diseases or drugs, they were divided into 3 groups according to the WHO osteoporosis diagnosis value or age. The correlation between OSTA index and BMD was analyzed by Spearman correlation. The concordance of OSTA and BMD were calculated and analyzed by a four-fold table. The prevalence of osteoporosis was 9.42% and osteopenia 42.67%. Age increased gradually in the osteoporosis, osteopenia and normal bone mass groups. But OSTA index, BMD (including lumbar vertebrae L(1-4), femoral neck, trochanter and hip) and weight decreased gradually in those groups. The percent of normal bone mass decreased with advancing age. And the percentages were 60.68%, 51.97% and 33.33% respectively. Osteoporosis increased in the older group (> 80 years old) and the percentage was 24.64% accounting for 94.44% of all osteoporotic subjects. Judging by the OSTA index, the rate of low osteoporotic risk decreased with advancing age. But the rates of mid-risk and high-risk increased. The correlation coefficients of OSTA index and BMD in femoral neck, trochanter, hip and L(1-4) was 0.33, 0.28, 0.29 and 0.06 respectively. And the correlation between OSTA index and BMD had statistical significance except for L(1-4). The sensitivity, specificity, coincidence and Youden index of OSTA index with a T score cutoff of -1 of BMD were 56.28%, 64.48%, 60.21% and 0.21 respectively versus 86.11%, 57.80%, 60.47% and 0.44 with a T score cutoff of -2.5. Correlation exists between OSTA index and BMD. The sensitivity, specificity and coincidence of OSTA index are excellent based upon the standard of BMD by DXA. It is a useful and simple diagnostic tool of osteoporosis.

An assessment of the use of quantitative ultrasound and the Osteoporosis Self-Assessment Tool for Asians in determining the risk of nonvertebral fracture in postmenopausal Chinese women

This cross-sectional study aims to assess the effectiveness of a simple, noninvasive scoring system, the Osteoporosis Self-Assessment Tool for Asians (OSTA), and quantitative bone ultrasound (QUS) in assessing nonvertebral fracture risk in Chinese postmenopausal women. A group of 513 community-dwelling women including 271 postmenopausal individuals participated in this study. Speed of sound (SOS m/s) at the radius, phalanx, and tibia were assessed by using the Omnisense prototype (Sunlight Ltd., Israel). Body height and weight were measured, and body mass index (BMI) and OSTA indices were calculated. Self-reported fractures were identified using a structured questionnaire. Phalanx SOS was significantly lower among postmenopausal women with a history of nonvertebral fracture occurred after menopause than those without (3755 m/s vs. 3841 m/s, P = 0.017, adjusted for age and weight), with an AUC of 0.66. The AUC of the OSTA for predicting nonvertebral fracture occurred after menopause was 0.64. SOS at the radius, phalanx, and tibia showed a positive correlation with OSTA index (r = 0.376-0.401, P < 0.001). The prevalence of nonvertebral fractures also increased significantly with the decreasing order of OSTA index (chi2 = 5.432, P = 0.02). The OSTA values of <or=-1 and phalanx QUS T-score of <or=-1.95 can differentiate postmenopausal nonvertebral fracture with sensitivity of 75% and 81%, respectively, and specificity of 48% and 40%, respectively. Combining OSTA and phalanx QUS yielded a sensitivity of 83% and a specificity of 84% to detect postmenopausal nonvertebral fracture, with an AUC of 0.64. We conclude that OSTA and phalanx QUS are simple and effective clinical tools for identifying postmenopausal women at increased risk of nonvertebral fractures and can thereby facilitate the appropriate and more cost-effective use of bone densitometry to prevent osteoporotic fractures in developing countries.

Correlation of osteoporosis screening by quantitative ultrasound of calcaneus and Osteoporosis Self-Assessment Tool for Asians in Taiwanese.

The Osteoporosis Self-Assessment Tool for Asians (OSTA) index, originally developed for use in postmenopausal Asian populations, is an inexpensive, simple tool based on age and body weight. Calcaneal quantitative ultrasound (QUS) is another simple and low-cost instrument used to prescreen osteoporotic subjects. This study investigated the correlation between these 2 screening methods. OSTA indices were calculated in a total of 3,456 women aged 40 to 95 years (mean, 59.5 +/- 11.7 years) selected from a national epidemiological survey of calcaneal QUS in Taiwan. Age was multiplied by -0.2 and body weight by 0.2. Both values were truncated to yield integers, which were then added together, and compared to the QUS results. When the risk category was defined as OSTA index < or = -1, and low QUS value as t-score < or = -2.5, the sensitivity and the specificity of the index were 84.0% and 61.0%, respectively, and the area under the curve was 0.81. According to the OSTA research group's classification, the high-risk subgroup (index < -4) represented 10.7% of the women 40 years or older, the intermediate-risk subgroup (index -1 to -4) 35.0%, and the low-risk subgroup (index > -1) 54.3%. The prevalence of low QUS values was high among the high-risk category (48.5%), and significantly trended downwards among the moderate- and low-risk categories (21.1% vs 4.4%). As the age of the population increased, there was an increasing false-negative rate (p < 0.001) when using OSTA > -1 to predict the normal QUS value. The OSTA index, a simple and free risk assessment tool, can be used to estimate the prevalence of low QUS values in Asian women and may help to increase awareness and prevention of low bone mineral density.

The implication of assessing a polymorphism in estrogen receptor alpha gene in the risk assessment of osteoporosis using a screening tool for osteoporosis in Asians.

Both genetic and environmental factors interact to determine bone mass and the risk for developing postmenopausal osteoporosis. Recently, an Asian-specific tool, the Osteoporosis Self-Assessment Tool for Asians (OSTA), has been developed to assess the risk of osteoporosis in women. An index is calculated by multiplying the difference in body weight in kilograms and age in years by 0.2 and disregarding the decimal digits. The risk of osteoporosis is classified as high, intermediate or low according to the OSTA index less than -4, -4 to -1 and greater than -1. In the present study we examined how a single nucleotide polymorphism (SNP) in exon 8 of the estrogen receptor alpha (ERalpha) gene affected the predictive value of the OSTA index. Subjects consisted of 358 postmenopausal women who were at least 55 years old. BMDs were measured by DXA, and the SNP in the ERalpha gene was assessed by PCR-RFLP. When considering both the OSTA index and ERalpha genotype in a logistic regression model, it was found that both the OSTA index and the ERalpha genotype independently contributed to the risk of osteoporosis. The odds ratios were 1.58 (95% CI 1.26-1.91) and 2.51 (95% CI 1.42-4.44) for one unit decrement in the OSTA index and each copy of the A allele of the ERalpha genotype, respectively. The joint effect conformed more to a multiplicative model of interaction than an additive model. This suggests that persons with the high-risk genotype are at far greater risk of developing osteoporosis with advancing age or decreasing body weight, the two variables from which the OSTA index is derived. Targeting preventive measures for osteoporosis subjects with risk factors and also disease-susceptibility alleles is likely to be more cost effective.