A clinical decision rule to enhance targeted bone mineral density testing in healthy mid-life women

作者：Hawker G^*; Mendel A; Lam M A; Akhavan P S; Cancino Romero J; Waugh E; Jamal S; Mian S; Jaglal S

来源：Osteoporosis International, 2012, 23(7): 1931-1938.

DOI：10.1007/s00198-011-1862-0

• Bone densitometry
• Bone mineral density
• Osteoporosis
• Prediction rule

The rates of bone mineral density testing for osteoporosis among healthy mid-life women are high, although their osteoporosis or fracture risk is low. To reduce unnecessary testing, we created and evaluated a tool to guide bone density testing based on the woman's age, weight, fracture history, and menopausal status.
This study aims to improve case finding of mid-life women with low bone mass on bone mineral density (BMD) assessment.
Among healthy women aged 40-60 years having their first BMD test, osteoporosis risk factors were assessed by questionnaire and BMD by dual-energy X-ray absorptiometry. The combination of risk factors that best discriminated women with/without low bone mass (T-score a parts per thousand currency signaEuro parts per thousand a'2.0) was determined from the logistic regression model area under the curve (AUC) and internally validated using bootstrapping. Using the model odds ratios, a clinical prediction rule was created and its discriminative properties assessed and compared with that of the osteoporosis self-assessment tool (OST). Sensitivity analyses examined results for pre-/peri- and post-menopausal women, separately.
Of 1,664 women referred for baseline BMD testing, 433 with conditions known to be associated with bone loss were excluded. Of 1,231 eligible women, 944 (77%) participated and 87 (9.2%) had low bone mass (35 pre-/peri- and 52 post-menopausal). Four risk factors for low bone mass were identified and incorporated into a clinical prediction rule. Selecting women for BMD testing with weight of a parts per thousand currency sign70 kg or any two of age > 51, years' post-menopause of a parts per thousand yen1, and history of fragility fracture after age 40 was associated with 93% sensitivity to identify women with low bone mass, compared with 47% sensitivity for an OST score of a parts per thousand currency sign1 (AUC 0.75 versus OST AUC 0.69, p = 0.04). Results restricted to post-menopausal women were similar.
Among healthy mid-life women receiving a baseline BMD test, few had low bone mass, supporting the need for guidance about testing. A prediction rule with four risk factors had improved sensitivity over the OST. Further validation is warranted.

• 出版日期2012-7