Bansal S, Pecina J L, Merry S P, Kennel K A, Maxson J, Quigg S, Thacher T D
Fremont Family Care, Fremont, NE, USA.
Osteoporos Int. 2015 Apr;26(4):1429-33. doi: 10.1007/s00198-015-3026-0. Epub 2015 Jan 23.
The US Preventative Services Task Force (USPSTF) recommends consideration for screening for osteoporosis in women under age 65 who have an estimated 10-year major osteoporotic fracture risk of 9.3 % or higher. We found that this threshold for osteoporosis screening in women ages 50-64 years old has a low sensitivity to detect osteoporosis.
The US Preventative Services Task Force (USPSTF) recommends consideration of dual-energy X-ray absorptiometry (DXA) in women under ages 50-64 with a major osteoporotic fracture (MOF) risk of 9.3 % or higher, as estimated by the fracture risk assessment tool (FRAX) tool. We assessed the performance of the 9.3 % MOF risk threshold for detecting osteoporosis and evaluated whether DXA indication appeared appropriate, based on USPSTF criteria and other risk factors, at our institution.
We performed a retrospective record review of women ages 50-64.5 years old to determine clinical factors and FRAX scores of women undergoing a DXA at our institution over a 6-month period after the USPSTF recommendations were released and evaluated the sensitivity and specificity of the 9.3 % MOF threshold to detect densitometric osteoporosis. Additionally, using the USPSTF criteria and several additional risk factors, we evaluated the extent of potentially inappropriate DXA use in women ages 50 to 64 years in a large primary care practice in an academic medical center.
The analysis included 465 DXA tests. The overall sensitivity and specificity of a FRAX-calculated MOF risk ≥9.3 % was 37 and 74 %, respectively, for the detection of osteoporosis. The receiver operator characteristic curve (ROC) demonstrated an area under the curve of 0.58. Lowering the FRAX risk threshold to 5.5 % would increase the sensitivity of detecting osteoporosis in our population from 37 to 80 % while reducing the specificity from 74 to 27 %. Out of 465 DXAs, 371 (79.8 %) were classified as appropriately ordered per our pre-specified criteria. Of the 120 women with osteoporosis at the hip and/or spine based on T-score values of -2.5 or less, 14 DXAs (11.7 %) were classified as potentially inappropriate based on a FRAX-predicted MOF risk less than 9.3 % and lack of additional pre-specified risk factors.
We found that the USPSTF-recommended MOF risk threshold of 9.3 % for osteoporosis screening in women ages 50-64 years old has a low sensitivity to detect osteoporosis.
美国预防服务工作组（USPSTF）建议，对于估计10年主要骨质疏松性骨折风险为9.3%或更高的65岁以下女性，考虑进行骨质疏松症筛查。我们发现，这个50 - 64岁女性骨质疏松症筛查的阈值在检测骨质疏松症方面敏感性较低。
美国预防服务工作组（USPSTF）建议，对于根据骨折风险评估工具（FRAX）估计主要骨质疏松性骨折（MOF）风险为9.3%或更高的50 - 64岁女性，考虑进行双能X线吸收法（DXA）检查。我们评估了9.3%的MOF风险阈值在检测骨质疏松症方面的表现，并根据USPSTF标准和其他风险因素，评估了在我们机构DXA检查指征是否合适。
我们对50 - 64.5岁的女性进行了回顾性记录审查，以确定在美国预防服务工作组发布建议后的6个月内，在我们机构接受DXA检查的女性的临床因素和FRAX评分，并评估9.3%的MOF阈值检测密度测定骨质疏松症的敏感性和特异性。此外，我们使用USPSTF标准和其他几个风险因素，评估了在一个学术医疗中心的大型初级保健机构中，50至64岁女性中潜在不适当使用DXA的程度。
分析包括465次DXA检查。FRAX计算的MOF风险≥9.3%检测骨质疏松症的总体敏感性和特异性分别为37%和74%。受试者操作特征曲线（ROC）显示曲线下面积为0.58。将FRAX风险阈值降低到5.5%，将使我们人群中检测骨质疏松症的敏感性从37%提高到80%，同时特异性从74%降低到27%。在465次DXA检查中，根据我们预先指定的标准，371次（79.8%）被分类为医嘱开具适当。在基于T值为-2.5或更低而诊断为髋部和/或脊柱骨质疏松症的120名女性中，14次DXA检查（11.7%）基于FRAX预测的MOF风险低于9.3%且缺乏额外预先指定的风险因素而被分类为潜在不适当。
我们发现，美国预防服务工作组推荐的50 - 64岁女性骨质疏松症筛查的9.3%的MOF风险阈值在检测骨质疏松症方面敏感性较低。
