Kung Annie W C, Ho Andrew Y Y, Sedrine Wafa Ben, Reginster Jean-Yves, Ross Philip D
Department of Medicine, University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, PRC.
Osteoporos Int. 2003 Sep;14(9):716-21. doi: 10.1007/s00198-003-1428-x. Epub 2003 Jul 30.
Osteoporosis is a growing problem in Asia, and early identification of at risk subjects for preventive measures is likely the most cost-effective method for managing this disease in developing countries. Patients with low bone mineral density (BMD) have a high risk of future fracture. However, access to BMD measurements is limited in many areas of Asia, and inexpensive methods of targeting high-risk patients for BMD measurements would be valuable. We compared two methods, a simple clinical risk assessment tool, the Osteoporosis Self-assessment Tool for Asians (OSTA), and quantitative bone ultrasound (QUS) in identifying subjects with low BMD by DXA in 722 southern Chinese postmenopausal women recruited from the community in Hong Kong. Using the published cutoff value of -1 (versus 0 or higher) for OSTA to identify subjects with femoral neck BMD T-score < or =-2.5, basing on our local population peak young mean value, the sensitivity and specificity was 88% and 54% respectively. The optimal cutoff T-score of -2.35 for QUS yielded sensitivity and specificity values of 81% and 65%, respectively. The AUC for QUS was 0.78, which was not significantly different from that of 0.80 for OSTA. Both OSTA and QUS correlated significantly with BMD at the femoral neck (0.62 and 0.36, respectively, P both <0.001). When these cut-off values were used to identify subjects with either lumbar spine or femoral neck BMD T-score < or =-2.5, the sensitivity and specificity was 79% and 60%, respectively, for OSTA, and 69% and 70%, respectively, for QUS. Combining QUS with OSTA improved the sensitivity to 91%, but the specificity was reduced to 44%. We conclude that the simple clinical risk assessment tool OSTA is a free and effective method for identifying subjects at increased risk of osteoporosis, and its use could facilitate the appropriate and more cost-effective use of bone densitometry in developing countries.
骨质疏松症在亚洲正成为一个日益严重的问题，在发展中国家，早期识别高危人群并采取预防措施可能是管理这种疾病最具成本效益的方法。骨密度（BMD）低的患者未来发生骨折的风险很高。然而，在亚洲许多地区，进行骨密度测量的机会有限，因此，采用廉价方法筛选出需要进行骨密度测量的高危患者具有重要价值。我们比较了两种方法，一种简单的临床风险评估工具——亚洲人骨质疏松自我评估工具（OSTA），以及定量骨超声（QUS），以确定从香港社区招募的722名中国南方绝经后女性中通过双能X线吸收法（DXA）检测出骨密度低的受试者。根据我们当地人群年轻峰值平均值，使用已公布的OSTA临界值-1（相对于0或更高）来识别股骨颈骨密度T值≤-2.5的受试者，其灵敏度和特异度分别为88%和54%。QUS的最佳临界T值为-2.35，其灵敏度和特异度分别为81%和65%。QUS的曲线下面积（AUC）为0.78，与OSTA的0.80无显著差异。OSTA和QUS与股骨颈骨密度均显著相关（分别为0.62和0.36，P均<0.001）。当使用这些临界值来识别腰椎或股骨颈骨密度T值≤-2.5的受试者时，OSTA的灵敏度和特异度分别为79%和60%，QUS的灵敏度和特异度分别为69%和70%。将QUS与OSTA联合使用可将灵敏度提高到91%，但特异度降至44%。我们得出结论，简单的临床风险评估工具OSTA是一种免费且有效的方法，可用于识别骨质疏松症风险增加的受试者，其应用有助于在发展中国家更合理、更具成本效益地使用骨密度测定法。
