Schneyer Christine R, Lopez Helio, Concannon Mary, Hochberg Marc C
Division of Endocrinology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
J Bone Miner Res. 2008 Jan;23(1):151-8. doi: 10.1359/jbmr.071005.
Osteoporosis public health measures are hindered by the inability to easily identify subclinical disease. We have now estimated state-specific osteoporosis prevalences using a simple formula (OST Index) to analyze age and weight of 62,882 older women; the prevalences determined are similar to those based on BMD. This new method has potential use for guiding implementation of osteoporosis prevention/treatment programs.
Although osteoporosis-related fractures are a major U.S. public health issue, population-based prevention programs have not yet been developed. One contributing factor has been lack of a suitable screening test to detect asymptomatic high-risk individuals.
We estimated state-specific prevalences of postmenopausal osteoporosis using the Osteoporosis Self-Assessment Tool Index (OST Index; [self-reported weight in kg - age] x 0.2) to analyze data from 62,882 women >or=50 yr of age who participated in the 2002 Behavioral Risk Factor Surveillance System (BRFSS). The OST Index, designed to assess an individual's risk of disease, has previously been shown to have modest positive and high negative predictive value for osteoporosis defined by BMD criteria. Based on this index, women from each state were distributed among high-, moderate-, and low-risk OST categories. Calculated percentages for each category were weighted to U.S. Census Bureau population projections for 2002. By adjusting results to reflect previously validated percentages of women with osteoporosis in each risk category, we estimated the prevalence of postmenopausal osteoporosis in each state.
Our calculated weighted prevalence estimates agreed closely with those of the National Osteoporosis Foundation derived from actual femoral neck BMD measurements obtained in the third National Health and Nutrition Examination Survey (1988-1994) and projected to U.S. census state population predictions for 2002. Comparison of unweighted BRFSS-OST results and NHANES BMD data revealed similar percentages of osteoporosis among all women >or=50 yr of age (BRFSS, 18.5%; NHANES, 18.0%; p = 0.47) and also among white women (BRFSS, 19.0%; NHANES, 20.0%; p = 0.28). However, the percentages of osteoporosis among blacks and Hispanics did not correspond, at least partly because of the lack of race-specific reference standards for BMD measurements and OST index ranges.
Analysis of readily available BRFSS data with the OST index formula is a simple, no-cost technique that provides state prevalence estimates of postmenopausal osteoporosis that could be used to guide allocation of resources to statewide osteoporosis prevention programs.
由于无法轻松识别亚临床疾病，骨质疏松症的公共卫生措施受到阻碍。我们现在使用一个简单公式（OST指数）估算了各州特定的骨质疏松症患病率，该公式用于分析62882名老年女性的年龄和体重；所确定的患病率与基于骨密度（BMD）的患病率相似。这种新方法在指导骨质疏松症预防/治疗项目的实施方面具有潜在用途。
尽管与骨质疏松症相关的骨折是美国主要公共卫生问题，但尚未制定基于人群的预防项目。一个促成因素是缺乏合适的筛查测试来检测无症状的高危个体。
我们使用骨质疏松症自我评估工具指数（OST指数；[自我报告的体重（千克）-年龄]×0.2）估算绝经后骨质疏松症的各州特定患病率，以分析来自62882名年龄≥50岁且参与2002年行为危险因素监测系统（BRFSS）的女性的数据。OST指数旨在评估个体的疾病风险，先前已证明其对根据BMD标准定义的骨质疏松症具有适度的阳性预测价值和较高的阴性预测价值。根据该指数，每个州的女性被分为高、中、低风险OST类别。对每个类别的计算百分比根据美国人口普查局2002年的人口预测进行加权。通过调整结果以反映每个风险类别中先前验证的骨质疏松症女性百分比，我们估算了每个州绝经后骨质疏松症的患病率。
我们计算的加权患病率估计值与国家骨质疏松症基金会的估计值非常接近，后者是根据第三次国家健康和营养检查调查（1988 - 1994年）中实际获得的股骨颈BMD测量值，并推算至2002年美国人口普查州人口预测得出的。对未加权的BRFSS - OST结果与NHANES BMD数据的比较显示，在所有年龄≥50岁的女性中骨质疏松症的百分比相似（BRFSS为18.5%；NHANES为18.0%；p = 0.47），在白人女性中也是如此（BRFSS为19.0%；NHANES为20.0%；p = 0.28）。然而，黑人和西班牙裔女性中骨质疏松症的百分比并不对应，至少部分原因是缺乏用于BMD测量和OST指数范围的种族特异性参考标准。
使用OST指数公式分析现成的BRFSS数据是一种简单、无成本的技术，可提供绝经后骨质疏松症的各州患病率估计值，可用于指导将资源分配到全州范围的骨质疏松症预防项目。
