Osteoporosis Self-Assessment Tool Research Articles

Prevalence of osteoporosis and associated factors among people aged 50 years and older in the Madhesh province of Nepal: a community-based cross-sectional study

BackgroundThe high prevalence of osteoporosis has increased the economic burden on the health system globally. The burden of osteoporosis and its associated factors have not been adequately assessed in community settings in the Nepalese context thus far. Therefore, this study aimed to assess the prevalence of osteoporosis and its associated factors, lifestyle behaviors, and dietary calcium intake.MethodsA community-based cross-sectional study was conducted among 395 people aged 50 years and older in the Madhesh Province of Nepal between July 2022 and August 2023. The Osteoporosis Self-assessment Tools for Asians (OSTA) index was used to measure osteoporosis. A structured questionnaire was used to collect sociodemographic information, anthropometric data, lifestyle behavior, daily dietary calcium intake, and frequency of calcium-rich food consumption. A food frequency questionnaire and 24-hour recall methods were used to assess dietary intake. The chi-square test, binary logistic regression and Mann‒Whitney U test were applied to measure the association between predictors and the outcome of interest.ResultsThe prevalence of no risk, moderate risk and high risk of osteoporosis were 38.7%, 39%, and 22.3% respectively. The risk of osteoporosis was higher in females (aOR = 5.18, CI: 2.10-12.75, p < 0.001) and increased risk with advancing age (aOR = 32.49, CI: 14.02–75.28, p < 0.001). Similarly, underweight was associated with increased odds of having osteoporosis (aOR = 13.42, CI = 4.58–39.30, p < 0.001). The incidence of osteoporosis was strongly associated with daily calcium intake of 225 mg (100, 386).ConclusionThis study revealed a high prevalence of osteoporosis among people aged 50 years and older due to the combined effect of being underweight and having inadequate calcium intake. Nutritional counselling services encourage people to consume sufficient calcium-rich food and adopt an appropriate lifestyle behaviours to maintain healthy body weight so that osteoporosis and osteoporotic fractures could be prevented. Further research can explore the impact of socioeconomic status and medical comorbidities on a large scale.

Association Between Osteoporosis Self-Assessment Tool for Asians and Airflow Limitation in Japanese Post-Menopausal Women.

This study aimed to reveal the association between the osteoporosis self-assessment tool for Asians (OSTA) and airflow limitation (AL) in post-menopausal Japanese women. This cross-sectional study included 1580 participants undergoing a comprehensive health examination using spirometry and dual-energy X-ray absorptiometry. The OSTA was calculated by subtracting the age in years from the body weight (BW) in kilograms, and the result was multiplied by 0.2. The OSTA risk level was defined as low (>-1), moderate (-4 to -1), or high (<-4). AL was defined as forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) <0.7. The association between the OSTA and AL was assessed using logistic regression analysis. The prevalence of AL was significantly higher in the high OSTA group (15.3%) than in the low OSTA group (3.1%) (p<0.001). In multiple linear regression analysis, the OSTA was independently associated with FEV1/FVC. In logistic regression models adjusted for smoking status, alcohol consumption, current use of medication for diabetes, hyperglycemia, rheumatoid arthritis, second-hand smoke, and ovary removal showed a significantly higher risk of AL (odds ratio: 5.48; 95% confidence interval: 2.90-10.37; p<0.001) in participants with OSTA high risk than in those with OSTA low risk. These results suggest that the OSTA high risk indicates reduced BMD at the femoral neck and presence of AL in Japanese post-menopausal women aged ≥45 years.

Impact of osteoporotic risk in men undergoing transcatheter aortic valve replacement: a report from the LAPLACE-TAVI registry.

Low body weight and advanced age are among the best predictors of osteoporosis. Osteoporosis Self-Assessment Tool (OST) values are calculated by a simple formula [(body weight in kilograms - age in years) × 0.2] to identify patients at increased risk of osteoporosis. In our recent single-center study, we demonstrated an association between OST and poor outcomes in postmenopausal women after transcatheter aortic valve replacement (TAVR). We aimed to investigate the impact of osteoporotic risk in men with aortic stenosis who underwent TAVR in a large cohort. In this multi-center study, 1,339 men who underwent TAVR between April 2010 and July 2023 were retrospectively analyzed. Women were excluded from the present study. All patients were deemed appropriate for TAVR after a review by a multidisciplinary team. Baseline characteristics of patients were compared by dividing patients into three tertiles, based on the OST value: ≤ -6.16, -6.16 to -4.14, and -4.14 < for tertiles 1, 2, and 3, respectively. Primary endpoint was all-cause mortality after TAVR. Tertile 1 (patients with the lowest OST values) included older patients with smaller body mass index, lower hemoglobin and albumin levels. In addition, they had greater clinical frailty scale, slower 5-meter walk test, weaker hand grip strength, and more cognitive impairment, indicating increased frailty. They were more severely symptomatic, with lower ejection fractions, smaller aortic valve areas, and more tricuspid regurgitation than were patients in the other two groups. Multivariate analysis revealed that OST tertiles 3 was associated with decreased risk of all-cause mortality (hazard ratio, 0.66; 95% confidence interval, 0.48-0.90), compared with OST tertile 1 as a reference. For OST tertiles 1, 2, and 3, the estimated 1-year survival rates of all-cause mortality post-TAVR were 83.6% ± 1.9%, 91.1% ± 1.4%, and 93.1% ± 1.3%, respectively, (log-rank, p <0.001). In conclusions, in men as same as women, osteoporotic risk assessed by OST values was overlapped with increased frailty. The simple OST formula was useful for predicting all-cause mortality in patients undergoing TAVR in large registry datasets.

An assessment of the probability of patients experiencing bone pain for early prioritization to the rehabilitation clinic

Background: As a result of DEXA and risk factor-based evaluation, which rank patients according to their osteoporosis risk, risk assessment instruments such as the Osteoporosis Self-assessment Tool, Risk Assessment Instrument, and Simple Calculated Risk Estimation were created. Aims: In two phases, the precision of evaluation instruments will be assessed: pre-test, post-test, and pre-diagnostic DEXA will be utilised to determine the accuracy of the assessment tools and pre-test, respectively. Methods: From September to November 2021, this study examines osteoporosis patients at Prince Rashid bin Al-Hasan Military Hospital in Jordan. Bayes' theorem and osteoporosis screening methodologies are utilised to calculate the post-test probability of patients. Evaluation of AUROC and performance metrics will be conducted utilising a ROC curve. The term of the investigation is 2021-2021. Results: The gender distribution of the 206 patients examined in the study was 5.87:1. AUCs SEMs for the binary logistic regression models incorporating independent variables (OST, ORAI, and BAQ) varied in response to the probability of FRAX≥3% versus &lt;3%. FRAX% exhibited the following sensitivity indices: 0.02, 75%, 41.36%, 66.36%, and 41.03%. The innovative quotient (BAQ), which represents the ratio of body weight to age, had respective pre-test probabilities of 0.789±0.033, 0.484±0.042, and 0.254±0.037. Conclusion: The research examined the probability of BLR_BAQ after the test was conducted using OST and ORAI references. Significant AUROCs were observed for all three osteoporosis instruments; however, the performance of the post-test probabilities for FRAX≥3% of the BLR_BAQ model was subpar, as evidenced by both the standards and ORAI inference.

High Body Fat as a Predictor of Osteoporosis Risk in Postmenopausal Women: Insights From a Community-Based Cross-Sectional Study in Rural South India.

Osteoporosis poses a significant health burden, particularly among postmenopausal women. While obesity in the form of BMI has been implicated in various health conditions, the relationship between waist-hip ratio (WHR) and osteoporosis remains debated. This study aims to estimate the prevalence of osteoporosis risk and explore the association between WHR and osteoporosis risk among postmenopausal women in rural South India. A community-based cross-sectional study was conducted in the Chengalpattu district of Tamil Nadu. The study enrolled 435 postmenopausal women aged 45 years and above and the data were collected on socio-demographic characteristics, anthropometric measurements, and osteoporosis risk assessment using the Osteoporosis Self-assessment Tool for Asian Women (OSTA) scale. Logistic regression analysis was performed to identify factors associated with osteoporosis risk with 95%CI. The mean (SD) age of participants was 54.5 (8.6) years, 87% were married, 33% were illiterate with mean (SD) WHR of 0.88 (0.1). Around 80.5% of the participants were categorized as low risk, 16.1% as intermediate risk, and 3.5% as high risk based on OSTA scores. Older age, lower educational attainment, and higher waist-hip ratio were significantly associated with increased osteoporosis risk. This community-based study found a 20% osteoporosis risk among postmenopausal women using the OSTA scale, with age, lower education, and waist-hip ratio as key determinants. Early identification and interventions, particularly targeting older and obese individuals, are crucial to alleviate the burden and complications of osteoporosis.

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.

Real world fracture prediction of fracture risk assessment tool (FRAX), osteoporosis self-assessment tool for Asians (OSTA) and one-minute osteoporosis risk test: An 11-year longitudinal study

IntroductionFractures affect people's quality of life especially in the elders. One of the most important risk factors is osteoporosis. There are many screening tools to predict osteoporosis and fractures. We aimed to compare the predictive validity of three commonly used screening tools: fracture risk assessment tool (FRAX), osteoporosis self-assessment tool for Asians (OSTA) and one-minute osteoporosis risk test. Among them, OSTA and one-minute osteoporosis risk test were originally developed to predict osteoporosis risks and FRAX was to predict fracture risks. MethodsThis is an 11-year longitudinal study. We enrolled 708 senior people from health examinees in Taiwan in 2010. A standardized questionnaire and blood tests were provided. Annual telephone interview was conducted to assess the real fracture status. We calculated risk scores of FRAX, OSTA, and one-minute osteoporosis risk test and compared with real-world fracture records. ResultsThe mean age of the participants were 74.9 (SD 6.4). There were 356 (50.3 %) men. From 2010 to 2020, a total of 105 (14.8 %) persons suffered from fractures. Compared to people without fractures, people with fractures had higher FRAX major osteoporotic fracture risk scores (14.0 % ± 7.6 % vs.11.3 % ± 5.7 %), higher hip fracture risk scores, and higher OSTA risk (5.9 % ± 1.4 % vs. 5.3 % ± 1.3 %). Cox regression analysis showed that hazard ratios for fracture of high FRAX risk was 1.53 (95 % confidence interval (CI) 1.05–2.21), and for high OSTA risk was 1.37 (95 % CI 1.04–1.82). ConclusionsOnly OSTA and FRAX scores were satisfactory in predicting 10-year fractures.

The performance of osteoporosis self-assessment tool for Asians (OSTA) in assessing the risk of osteoporosis in postmenopausal women aged 45 years and older

Objectives: Application of the OSTA (Osteoporosis Self-Assessment Tool for Asians) in assessing the risk of osteoporosis in postmenopausal women aged 45 years and older; Evaluation of the relationship between OSTA and bone mineral density measured by dual-energy X-ray absorptiometry (DEXA). Subjects and methods: A cross-sectional descriptive study was performed on 430 postmenopausal women aged 45 years and older who were treated at Hue University of Medicine and Pharmacy Hospital from 9/2021 to 6/2022. Bone mineral density was measured by dual-energy X-ray absorptiometry (DEXA). Diagnosis and classification of osteoporosis are based on the T-score (WHO 1994). Calculating the OSTA according to the formula: OSTA = 0.2 x [weight (kg) - age (years)]. Results: The average OSTA value is -2.97 ± 3.35, the minimum value is -12.8, and the maximum value is 7.0. Osteoporosis risk ratios according to the OSTA (using cut-offs 0 and -3) were: high risk (46.1%), moderate risk (35.3%), and low risk (18.6%). The predictive value of osteoporosis risk of the OSTA was ranked as good with the area under the curve (AUC) of 0.823 (p &lt; 0.001). At cut-off -3, the OSTA has a sensitivity of 70.3%, and a specificity of 78.4%. At cut-off 0, the OSTA has a sensitivity of 96.8%, and a specificity of 33.1%. The prevalence of osteoporosis in the high-, intermediate- and low-risk groups (using cut-offs 0 and -3) was 69.2%, 28.3%, and 6.3%, respectively. Conclusion: OSTA can be used as a simple and convenient tool for self-assessment or screening for osteoporosis risk. Key words: OSTA, osteoporosis, post-menopause.

Fracture risk prediction in old Chinese people-a narrative review.

With aging, the burden of osteoporotic fracture (OF) increases substantially, while China is expected to carry the greatest part in the future. The risk of fracture varies greatly across racial groups and geographic regions, and systematically organized evidence on the potential predictors for fracture risk is needed for Chinese. This review briefly introduces the epidemiology of OF and expands on the predictors and predictive tools for the risk of OF, as well as the challenges for their potential translation in the old Chinese population. There are regional differences of fracture incidence among China. The fracture incidences in Hong Kong and Taiwan have decreased in recent years, while it is still increasing in mainland China. Although the application of dual-energy X-ray absorptiometry (DXA) is limited among old Chinese in the mainland, bone mineral density (BMD) by DXA has a predictive value similar to that worldwide. Other non-DXA modalities, especially heel QUS, are helpful in assessing bone health. The fracture risk assessment tool (FRAX) has a good discrimination ability for OFs, especially the FRAX with BMD. And some clinical factors have added value to FRAX, which has been verified in old Chinese. In addition, although the application of the osteoporosis self-assessment tool for Asians (OSTA) in Chinese needs further validation, it may help identify high-risk populations in areas with limited resources. Moreover, the translation use of the muscle quality and genetic or serum biomarkers in fracture prediction needs further works. More applicable and targeted fracture risk predictors and tools are still needed for the old Chinese population.

Machine learning-based prediction of osteoporosis in postmenopausal women with clinical examined features: Aquantitative clinical study.

Osteoporosis is a skeletal disease that is commonly seen in older people but often neglected due to its silent nature. To overcome the issue of osteoporosis in men and women, we proposed an advanced prediction model with the help of machine learning techniques which can help to identify the potential occurrence of this bone disease by its advanced screening tools. To achieve more reliable and accurate results, various machine-learning techniques were applied to the presented data sets. Moreover, we also compared the performance of our results with other existing algorithms to solely focus on the advanced features of the proposed methodology. The two data sets, the clinical tests of patients in Taiwan and medical reports of postmenopausal women in Korea through Korean Health and Nutrition Examination Surveys (2010-2011) were considered in this study. To predict bone disorders, we utilized the data about females and developed a system using artificial neural networks, support vector machines, and K-nearest neighbor. To compare the performance of the model Area under the Receiver Operating Characteristic Curveand other evaluation metrics were compared. The achieved results from all the algorithms and compared them with Osteoporosis Self-Assessment Tool for Asiansand the results were noticeably better and more reliable than existing systems due to the involvement of ML. Using machine learning techniques to predict these types of diseases is better because physicians and patients can take early action to prevent the consequences in advance.

Development and validation of osteoporosis risk assessment score in patients with heart failure: comparison with the osteoporosis self-assessment tool for Asians.

Osteoporosis is prevalent and is associated with poor prognosis in patients with heart failure (HF). However, bone mineral density measurement by a dual-energy X-ray absorptiometry (DEXA) scan is not always available in a daily clinical setting or large-scale population-based studies. A single-centre, cross-sectional observational study was conducted with 387 patients [median age: 77 years (interquartile range: 68-83 years); 37% women]. Bone mineral densities were measured by DEXA scans, and osteoporosis was diagnosed as ≤-2.5 standard deviation of the bone mineral densities in healthy young adults. Osteoporosis risk assessment score (ORAS) was developed using significant predictors from a logistic regression model for osteoporosis and was subsequently validated. Osteoporosis was found in 103 (27%) of the 387 HF patients. Multivariate logistic regression analyses yielded the ORAS based on sex, body mass index, handgrip strength, and anti-coagulant therapy utilization. The C-index of ORAS in the developmental set (0.796, 95% confidence interval: 0.747-0.845) was similar to the bootstrap validation of the prediction model (0.784) and tended to be higher than that of the osteoporosis self-assessment tool for Asians (OSTA). A nomogram of ORAS, established on the basis of the final logistic regression model, demonstrated 100% sensitivity at the lowest score (35 points), with an optimal cut-off point of 127 points, yielding 85% sensitivity and 62% specificity. Osteoporosis risk assessment score exhibits superior predictive performance to OSTA in predicting osteoporosis in HF patients, establishing itself as a valuable tool for early detection in both daily clinical practice and large-scale population-based studies.

A novel primary osteoporosis screening tool (POST) for adults aged 50 years and over.

This study aimed to develop and validate a simple primary osteoporosis screening tool (POST) based on adults aged 50 years and older. This study included participants aged ≥50 from the National Health and Nutrition Examination Survey. Osteoporosis was defined according to bone mineral density values. The POST was developed based on methods from previous studies. Moreover, we plotted the receiver operating characteristic curves to calculate the area under the curve (AUC) and determine the optimal cut-off value according to the weighted Youden index. In addition, we compared the performances in identifying individuals with osteoporosis between the POST and the Osteoporosis Self-assessment Tool (OST). Finally, we also assessed the performance of the POST in the Chinese population. Finally, a total of 6665 individuals were included in this study. The AUC values of the POST for identifying individuals with osteoporosis in the development cohort and the validation cohort were 0.81 (95% CI: 0.79-0.83) and 0.81 (95% CI: 0.77-0.84), respectively. Moreover, a POST-score ≥7 was determined as the threshold to identify individuals with osteoporosis, in which the sensitivity was greater than 90%. In addition, the POST showed significantly higher sensitivity than the OST. Finally, the POST showed an AUC of 0.75 (95% CI: 0.65-0.85) among 94 Chinese subjects aged ≥50 years old. POST is a convenient and effective tool for osteoporosis screening among adults aged 50 years and over, which might provide new methodological support for future osteoporosis screening.

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.

Analysis of Influencing Factors of Vertebral Height Loss After Pedicle Screw Fixation of Thoracolumbar Fracture.

Retrospective case-control study. To explore the related factors of vertebral height loss (VHL) after pedicle screw fixation of thoracolumbar fracture and to determine the optimum prediction point. With the widespread application of thoracolumbar fracture internal fixation, VHL after the operation is increasingly presented. However, there is no unified conclusion on the specific cause of VHL and how to predict it. A total of 186 patients were selected and divided into the loss group (n = 72) and the not-loss group (n = 114) according to whether the fractured vertebral height was lost after the operation. The two groups were compared concerning sex, age, body mass index, osteoporosis self-assessment tool for Asians (OSTA), fracture types, number of fractured vertebrae, preoperative Cobb angle and compression degree, number of screws, and extent of vertebral restore. Univariate analysis and Multivariate logistic regression analysis were performed to identify the independent factors for the VHL with the receiver operating characteristic curve and the optimal prediction value was calculated according to area under the curve. Multivariate logistic regression analysis showed that OSTA ( P < 0.05) and preoperative vertebral compression ( P < 0.05) were significantly correlated with postoperative VHL, which were independent risk factors for postoperative VHL. The OSTA of 2.32 and the preoperative vertebral compression degree of 38.5% were the best prediction points for postoperative VHL based on the Youden Index analysis. The OSTA and preoperative vertebral compression were independent risk factors for VHL. The risk of postoperative VHL was significantly higher when the OSTA was ≤2.32 or the preoperative vertebral compression was ≥38.5%. Level III.

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.

Impact of osteoporotic risk in women undergoing transcatheter aortic valve replacement.

Low body weight and advanced age are reported to be among the best predictors of osteoporosis, and osteoporosis self-assessment tool (OST) values are calculated using a simple formula to identify postmenopausal women at increased risk of osteoporosis. In our recent study, we demonstrated an association between fractures and poor outcomes in postmenopausal women following transcatheter aortic valve replacement (TAVR). In this study, we aimed to investigate the osteoporotic risk in women with severe aortic stenosis and determined whether an OST could predict all-cause mortality following TAVR. The study population comprised 619 women who underwent TAVR. Compared to a quarter of patients with diagnosis of osteoporosis, 92.4% of participants were at high risk of osteoporosis based on OST criteria. When divided into tertiles based on OST values, patients in tertile 1 (lowest OST) displayed increased frailty, a higher incidence of multiple fractures, and greater Society of Thoracic Surgeons scores. Estimated all-cause mortality survival rates 3years post-TAVR were 84.2 ± 3.0%, 89.5 ± 2.6%, and 96.9 ± 1.7% for OST tertiles 1, 2, and 3, respectively (p = 0.001). Multivariate analysis showed that the OST tertile 3 was associated with decreased risk of all-cause mortality compared with OST tertile 1 as the referent. Notably, a history of osteoporosis was not associated with all-cause mortality. Patients with high osteoporotic risk are highly prevalent among those with aortic stenosis according to the OST criteria. OST value is a useful marker for predicting all-cause mortality in patients undergoing TAVR.

Race and Ethnicity and Fracture Prediction Among Younger Postmenopausal Women in the Women’s Health Initiative Study

The best approach to identify younger postmenopausal women for osteoporosis screening is uncertain. The Fracture Risk Assessment Tool (FRAX), which includes self-identified racial and ethnic information, and the Osteoporosis Self-assessment Tool (OST), which does not, are risk assessment tools recommended by US Preventive Services Task Force guidelines to identify candidates for bone mineral density (BMD) testing in this age group. To compare the ability of FRAX vs OST to discriminate between younger postmenopausal women who do and do not experience incident fracture during a 10-year follow-up in the 4 racial and ethnic groups specified by FRAX. This cohort study of Women's Health Initiative participants included 67 169 women (baseline age range, 50-64 years) with 10 years of follow-up for major osteoporotic fracture (MOF; including hip, clinical spine, forearm, and shoulder fracture) at 40 US clinical centers. Data were collected from October 1993 to December 2008 and analyzed between May 11, 2022, and February 23, 2023. Incident MOF and BMD (in a subset of 4607 women) were assessed. The area under the receiver operating characteristic curve (AUC) for FRAX (without BMD information) and OST was calculated within each racial and ethnic category. Among the 67 169 participants, mean (SD) age at baseline was 57.8 (4.1) years. A total of 1486 (2.2%) self-identified as Asian, 5927 (8.8%) as Black, 2545 (3.8%) as Hispanic, and 57 211 (85.2%) as White. During follow-up, 5594 women experienced MOF. For discrimination of MOF, AUC values for FRAX were 0.65 (95% CI, 0.58-0.71) for Asian, 0.55 (95% CI, 0.52-0.59) for Black, 0.61 (95% CI, 0.56-0.65) for Hispanic, and 0.59 (95% CI, 0.58-0.59) for White women. The AUC values for OST were 0.62 (95% CI, 0.56-0.69) for Asian, 0.53 (95% CI, 0.50-0.57) for Black, 0.58 (95% CI, 0.54-0.62) for Hispanic, and 0.55 (95% CI, 0.54-0.56) for White women. For discrimination of femoral neck osteoporosis, AUC values were excellent for OST (range, 0.79 [95% CI, 0.65-0.93] to 0.85 [95% CI, 0.74-0.96]), higher for OST than FRAX (range, 0.72 [95% CI, 0.68-0.75] to 0.74 [95% CI, 0.60-0.88]), and similar in each of the 4 racial and ethnic groups. These findings suggest that within each racial and ethnic category, the US FRAX and OST have suboptimal performance in discrimination of MOF in younger postmenopausal women. In contrast, for identifying osteoporosis, OST was excellent. The US version of FRAX should not be routinely used to make screening decisions in younger postmenopausal women. Future investigations should improve existing tools or create new approaches to osteoporosis risk assessment for this age group.

Validation of Three Tools for Estimating the Risk of Primary Osteoporosis in an Elderly Male Population in Beijing.

This cross-sectional study estimated three clinical tools including the Osteoporosis Self-Assessment Tool for Asians (OSTA), Body Mass Index (BMI), and Beijing Friendship Hospital Osteoporosis Self-assessment Tool for Elderly Male (BFH-OSTM) for identifying primary osteoporosis and found optimal cut-off values in an elderly Han Beijing male population. We conducted a cross-sectional study, enrolling 400 community-dwelling elderly Han Beijing males aged ≥50 from 8 medical institutions. Osteoporosis was diagnosed as a T-score of -2.5 standard deviations or lower than that of the average young adult in different diagnostic criteria [lumbar spine (L1-L4), femoral neck, total hip, WHO]. BFH-OSTM, OSTA, and BMI were assessed for predicting OP by receiver operating characteristic (ROC) curves. Sensitivity, specificity, and areas under the ROC curves (AUC) were determined. Ideal thresholds for the omission of screening BMD were proposed. The prevalence of osteoporosis ranged from 9.25% to 19.0% according to different diagnostic criteria. The present study indicated the highest discriminating ability was BFH-OSTM in different criteria. The AUCs of OSTA and BMI were 0.748 and 0.770 in WHO criteria, which suggested limiting predictive value for identifying OP in elderly Beijing males. The AUC of BFH-OSTM to predict OP based on WHO criteria was 0.827, yielding a sensitivity of 65.8% and specificity of 82.7%, respectively. With a cost of missing 6.5% of osteoporosis patients, BFH-OSTM could reduce 73.5% of participants in screening BMD tests. BFH-OSTM may be a simple and effective tool for identifying OP in the elderly male population in Beijing to omit BMD screening reasonably.

Use of the Osteoporosis Self-Assessment Tool as a Screening Tool for Osteoporosis in Saudi Postmenopausal Women.

Osteoporosis is commonly referred to as the "silent disease," as bone loss is gradual and asymptomatic. In older women and men, osteoporosis can lead to increased bone fragility, thus increasing the risk of fractures. These fractures are associated with healthcare costs, physical disabilities, impaired quality of life, and mortality. Therefore, the study's main objective was to assess the applicability of the osteoporosis self-assessment tool (OST) in predicting osteoporosis in Saudi postmenopausal women who are 60 years of age and older and to give a thorough understanding of how such a method can aid in the early diagnosis of osteoporosis in Saudi Arabia and give physicians enough time to treat it. Methods: This study was done at King Abdulaziz Medical City, Riyadh, Saudi Arabia, where we included postmenopausal Saudi women 60 years of age and older who took the bone mineral density (BMD) test in the family medicine department. The approximate target population in this group, between the years 2016 and 2022, was 2969 patients. All data was taken from the BestCare database at King Abdulaziz Medical City in Riyadh. Data weretyped in an Excel sheet (Redmond, USA), then transferred to the R Studio software. The data collection method was chart review, so no informed consent was needed from patients. Names and medical record numbers were not stored. Results: The study included 2969 participants. According to the bone mineral density (BMD) T score results, 490 participants (16.5%) were normal, 1746 participants (58.8%) had osteopenia, and 733 participants (24.7%) suffered from osteoporosis. BMD T scores for normal, osteopenia, and osteoporosis participants were -0.6 (-0.9, -.3), -1.8 (-2.1), and -3 (-3.5, -2.7), consecutively. Estimated OSTI scores for those patients were 2 (0, 4), 1 (-2, 3), and -1 (-4, 1), consecutively. According to the OSTI score for normal participants, 4.29% were classified as being at high risk of osteoporosis. A high risk of osteoporosis was identified in 0.74% of those with osteopenia. 27.83% of osteoporosis patients were classified as being at high risk of osteoporosis. To differentiate normal individuals from those with osteopenia, the cutoff value with optimal sensitivity was 3.5. At such a cutoff value, the test sensitivity was 81.04%. To differentiate normal participants from those with osteoporosis, the cutoff value with optimal sensitivity was 2.5. At such a cutoff value, the test sensitivity was 86.49%. To differentiate osteopenia from osteoporosis patients, the cutoff threshold with optimal sensitivity was 1.5. At such a threshold, sensitivity was 78.44%. Conclusion: OSTA is a simple and validated tool that can identify subjects at increased risk of osteoporosis. Its use could facilitate a more cost-effective use of BMD; by avoiding measurements in low-risk groups.

Osteoporosis Screening Values of Osteoporosis Self-Assessment Tool for Asians Index and Body Mass Index in Middle-Aged and Elderly Tibetan Population in Tibet

To analyze the screening value of osteoporosis self-screening tool for Asia (OSTA) and body mass index (BMI) for osteoporosis (OP) in middle-aged and elderly Tibetan population in the Tibetan region. Data on demographic information, bone mineral density (BMD), and other information of 627 middle-aged and elderly people were collected. Analysis of the correlation between OSTA index, BMI and BMD, and receiver operating characteristic (ROC) curve was performed to evaluate the OP screening effects. OSTA index and BMI were correlated with BMD in both female and male populations ( P<0.05). In both male and female populations, OSTA index screening results for OP yielded higher area under the curve ( AUC) than BMI did, with the AUC for female OSTA index being 0.886 and that for female BMI being 0.785, while that for male OSTA index being 0.957 and that for male BMI being 0.834. When comparing the different age groups, the AUC of OSTA index and BMI of the middle-age group was higher than those of the quasi-elderly group and the elderly group, with the AUC of OSTA index and BMI of the middle-age being 0.939 and 0.858, those of the quasi-elderly group being 0.860 and 0.813, and those of the elderly group being 0.750 and 0.650, respectively. When the optimal cut-off value of diagnosis with OSTA index was －2.20, the sensitivity and specificity were both 100%. When the optimal cut-off value for diagnosis with BMI was 17.512 kg/m2, the sensitivity and specificity were both 100%. OSTA index and BMI have different OP screening effects in different middle-aged and elderly Tibetan populations, and OSTA index shows better effects for OP screening than BMI does.