Performance Of Osteoporosis Self-assessment Tool Research Articles

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 < 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.

The performance of osteoporosis self-assessment tool for Asians (OSTA) in identifying the risk of osteoporosis among Malaysian population aged 40years and above.

Osteoporosis self-assessment tool for Asians (OSTA) is a convenient screening algorithm used widely to identify patients at risk of osteoporosis. Currently, the number of studies validating OSTA in Malaysian population is limited. This study aimed to validate the performance of OSTA in identifying subjects with osteoporosis determined with DXA. This cross-sectional study recruited 786 Malaysians in Klang Valley, Malaysia. Their bone health status was assessed by DXA and OSTA. The association and agreement between OSTA and bone mineral density assessment by DXA were determined by Pearson's correlation and Cohen's kappa, respectively. Receiver operating characteristics (ROC) curves were used to determine the sensitivity, specificity, and area under the curve (AUC) for OSTA. OSTA and DXA showed a fair association in the study (r = 0.382, κ = 0.159, p < 0.001). OSTA (cutoff < - 1) revealed a sensitivity of 32.3%, specificity of 92.3%, and AUC of 0.618 in identifying subjects with suboptimal bone health. The sensitivity of OSTA (cutoff < - 4) in determining subjects at risk of osteoporosis was better among women (sensitivity = 20%) than men (sensitivity = 0%). Modified OSTA cutoff values improved the sensitivity of OSTA in identifying subjects with suboptimal bone health (men = 81.0% at cutoff 3.4, women = 82.8% at cutoff 2.0) and osteoporosis (men = 81.8% at cutoff 1.8, women = 81.3% at cutoff 0.8). OSTA with its original cutoff values is ineffective in identifying individuals at risk for osteoporosis. Adjusting the cutoff values significantly increases the sensitivity of OSTA, thus highlighting the need to validate this instrument among the local population before using it for osteoporosis screening clinically.

Performance of Osteoporosis Self-Assessment Tool (OST) in Predicting Osteoporosis-A Review.

Bone health screening plays a vital role in the early diagnosis and treatment of osteoporosis to prevent fragility fractures among the elderly and high-risk individuals. Dual-energy X-ray absorptiometry (DXA), which detects bone mineral density, is the gold standard in diagnosing osteoporosis but is not suitable for screening. Therefore, many screening tools have been developed to identify individuals at risk for osteoporosis and prioritize them for DXA scanning. The Osteoporosis Self-assessment Tool (OST) is among the first tools established to predict osteoporosis in postmenopausal women. It can identify the population at risk for osteoporosis, but its performance varies according to ethnicity, gender, and age. Thus, these factors should be considered to ensure the optimal use of OST worldwide. Overall, OST is a simple and economical screening tool to predict osteoporosis and it can help to optimize the use of DXA.

Performance of osteoporosis self-assessment tool in detecting low bone mineral density in menopausal women

BackgroundThe osteoporosis self-assessment tool (OST) is a simple screening tool to assess risk of osteoporosis and to select high risk women for dual-energy x-ray absorptiometry (DXA) examination. This study aimed to evaluate OST performance in detecting low bone mineral density (BMD) in menopausal women.MethodsA cross-sectional study involving 60 menopausal women aged 50-65 years. The OST score was calculated from: [weight (kg) – age (yr)] x 0.2. Subjects were classified by OST score into low risk (OST ³2) and high risk (OST&lt; 2) groups. BMD was determined by DXA at 3 bone locations (L1-L4, femoral neck, and total hip). DXA T-scores were categorized into: normal BMD (T-score &gt;-1) and low BMD (T-score £-1). Independent t-test was used to compare subject characteristics between OST groups. Diagnostic performance of OST was evaluated by measuring sensitivity, specificity, positive &amp; negative predictive value (PPV, NPV), positive &amp; negative likelihood ratio (PLR, NLR) and receiver-operating characteristic (ROC). Significance was set at p&lt;0.05.ResultsSubject characteristics and BMD between groups were significantly different (p&lt;0.05). Most subjects (44/73.3%) had high risk of low BMD (OST &lt; 2). Low BMD (T score £-1) was found in 43 subjects (71.7%) at L1-L4, 41 subjects (68.3%) at femoral neck, and 37 subjects (61.7%) at total hip. Diagnostic performance of OST was significant at total hip BMD (sensitivity=0.946, AUC=0.777).Conclusion We conclude that use of the OST score in menopausal women is effective and has adequate sensitivity and specificity. The highest diagnostic performance of OST is on total hip BMD.

Performance of Osteoporosis Self-assessment Tool for Asian (OSTA) for Primary Osteoporosis in Post-menopausal Malay Women.

The Osteoporosis Self-Assessment Tool for Asians (OSTA) score has been developed to identify women at risk of osteoporosis. It can be used as a screening tool for patients at risk who would benefit from bone mineral density measurement and treatment. It was developed based on data from eight countries including Malaysia. However, most subjects were of Chinese (59%). This study evaluated the performance of OSTA among 152 post-menopausal Malay women. OSTA score calculation and DEXA scan were performed. Our results showed that the OSTA score is a good predictor of patients at risk of osteoporosis based on BMD measurements at the proximal femur. Instrument sensitivity was 87.5%, specificity was 95.8%, positive predictive value (PPV) was 0.538, negative predictive value (NPV) was 0.993, and the area under the receiver operating characteristic curve (ROC) was 0.895. We conclude that use of the OSTA score in postmenopausal Malay women is effective and has adequate sensitivity and specificity. Osteoporosis; post menopause; Malay; screening; OSTA.

Individualization of osteoporosis risk

Anti-fracture therapy is often pursued in individuals with osteoporosis or low bone mineral density with or without a prior fracture [1–3], because they are at high risk of subsequent fracture [4, 5]. In recent years, there has been a proliferation of clinical prediction rules, including clinical risk indices and scores, for identifying individuals with osteoporosis. The main problem with these clinical prediction rules is that they categorize individuals into low-risk versus high-risk groups based on some arbitrary threshold. As a result, when this risk stratification-based approach is applied to an individual, its prognostic performance is often poor. Among the clinical indices for predicting osteoporosis, the Osteoporosis Self-Assessment Tool (OST) [6] is perhaps the simplest score and has perhaps been the most widely studied. However, the clinical usefulness of this score in different populations has not been systematically studied. In this issue, Rud and colleagues [7] systematically summarize some key prognostic properties of the OST score across different Asian and Caucasian populations. They especially focus on the prognostic value of OST in ruling out osteoporosis (i.e., LR−). Their meta-analysis showed that the overall LR− was 0.19 (95% confidence interval: 0.17 and 0.21) with considerable heterogeneity between populations. Although Rud and colleagues do not report other prognostic measures of the OST score in their paper, it is possible to estimate the LR+, sensitivity, specificity, and summary receiver operating characteristic curve (sROC) from the data (Table 1). These results suggest that in both Asian and Caucasian populations, the OST score has good sensitivity, but poor specificity, and moderate discriminatory value (i.e., with sROC being between 0.74 and 0.79). The odds for OST positivity among women with osteoporosis is 11 times (in Asians) and 7.8 times (in Caucasians) higher than the odds for positivity among women without osteoporosis. This diagnostic odds ratio is much lower than the criterion required for an “adequate test”. However, these results are broadly consistent with prognostic values of the simple calculated osteoporosis risk estimation (SCORE), osteoporosis risk assessment instrument (ORAI) and National Osteoporosis Foundation guidelines, which were also found to have poor specificity and high sensitivity [8]. When the prevalence of osteoporosis is 17% (which is observed in Caucasian populations [7]) and given the observed LR− and LR+ in Table 1, it can be estimated that if an individual is classified as “low risk” by OST, the probability that the individual has no osteoporosis is 0.96; and if the individual is classified as “high risk”, the probability that the individual has osteoporosis is only ~0.25. In other words, the OST score is useful in ruling out the possibility of osteoporosis, but it performs badly in ruling in the possibility of osteoporosis. The best positive and negative predictive values are achieved when the sensitivity is around 70% and specificity is approximately 80% (Fig. 1). However, in all studies reviewed, the OST score has a sensitivity of >90% and specificity of <57%. Several factors contribute to the relatively poor performance of OST. First, the prevalence of osteoporosis in the populations under review, and the relationships between age, weight and BMD is not constant across the population. For example, the prevalence of osteoporosis varied between 7 to 21%, with and the LR− being between 0.02 and 0.49 among the Asian populations under review. Indeed, a Osteoporos Int (2007) 18:1153–1156 DOI 10.1007/s00198-007-0415-z

Performance of the osteoporosis risk assessment tool in Moroccan men

Measuring bone mineral density (BMD) is a widely accepted strategy for identifying subjects with an increased risk of fracture. However, because of limited availability of BMD technology in some communities and cost considerations, it has been proposed that BMD measurements be targeted to subjects with risk factors for osteoporosis. Osteoporosis self-assessment tool (OST) using age and weight have been developed to identify women who are more likely to have low BMD and thus undergo BMD testing. To study the performance of OST in identifying osteoporotic white men in Morocco. We analysed in an epidemiological cross-sectional study the records for 229 white Moroccan men seen at an out-patient rheumatology centre. OST was compared to bone density T scores and the ability of OST to identify men with osteoporosis (T < -2.5) was evaluated. Using an OST score < 2 to recommend dual X-ray absorptiometry (DXA) referral, sensitivity ranged from 63% at the lumbar spine to 87% at the total hip to detect BMD T scores of -2.5 and specificity from 58 to 59%. The negative predictive value was high at all skeletal sites (87-98%), demonstrating the usefulness of the OST to identify patients who have normal BMD and should not receive DXA testing. The performance of OST among men in Morocco was similar to that reported earlier for the other samples in Asian countries and the USA. The OST is an effective and efficient tool to help target high-risk men for DXA measurement.

Performance of the Osteoporosis Self-Assessment Tool in ruling out low bone mineral density in postmenopausal women: a systematic review

The Osteoporosis Self-Assessment Tool (OST) is a simple test that may be of clinical value to rule-out low bone mineral density. We performed a systematic review to assess its performance in postmenopausal women. We included 36 studies. OST performed moderately in ruling-out femoral neck T-score <or= -2.5, but poorly in ruling-out lumbar spine T-score <or= -2.5. Methodological study quality was generally low. The Osteoporosis Self-Assessment Tool (OST) is a simple clinical decision rule based on age and weight that may be of clinical value to rule-out low bone mineral density (BMD). Our aim was to systematically assess the performance of OST in postmenopausal women. We searched PubMed, Embase, Web of Science, citation lists and conference proceedings for studies evaluating OST using dual X-ray absorptiometry (DXA) as reference test to measure BMD. We evaluated methodological quality using the QUADAS checklist. Our main outcome was the likelihood ratio of a negative OST result (LR-). OST performed moderately in ruling-out femoral neck T-score <or= -2.5 in whites, summary LR- (sLR-) 0.19 (95% CI, 0.17-0.21) and between-study heterogeneity was low (I(2) = 7%). The corresponding performance in Asians was similar, sLR- 0.19 (0.14-0.28), but there was considerable heterogeneity (I(2) = 64%). OST performed poorly in ruling-out lumbar spine T-score <or= -2.5 in whites and Asians, sLR- 0.43 (0.31-0.59) and 0.32 (0.28-0.38), respectively. The performance in ruling-out T-score <or= -2.0 in whites was poor regardless of region (sLR- >or=0.28). Methodological study quality was generally low. The clinical usefulness of OST is uncertain. OST could be useful for ruling-out femoral neck T-score <or= -2.5, but confirmatory high-quality studies are needed.