Davis S R, Tan A, Bell R J
Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Level 6 The Alfred Centre, 99 Commercial Road, Melbourne, VIC, 3004, Australia.
Osteoporos Int. 2015 Jun;26(6):1705-12. doi: 10.1007/s00198-015-3046-9. Epub 2015 Jan 29.
This study establishes a profile for women at midlife, referred for a dual energy X-ray absorptiometry (DXA), most likely to have osteoporosis, and from this, a pre-DXA screening tool has been developed. These findings inform much needed evidence-based guidelines for targeted and effective screening for osteoporosis and osteoporotic fracture prevention in women at midlife.
There is no consensus as to whether women at midlife should undergo screening dual energy X-ray absorptiometry (DXA) to identify osteoporosis (T-score < -2.5).
We investigated the prevalence of osteoporosis in women, aged 40-65 years, referred to 42 community-based Australian radiology centres, and identified the characteristics that best predict osteoporosis in women having a screening DXA.
One thousand four hundred and two women completed the study questionnaire and had DXA reports available. After excluding women with an established indication for a DXA (58 %), users of bone-specific medication (10.5 %) and cancer (7.6 %), 466 women were classified as having a screening DXA. Forty of these women had osteoporosis at the lumbar spine (n = 32, 6.9 %) or femoral neck (n = 17, 3.6 %). Three predictors of osteoporosis (postmenopausal, nonuse of hormonal therapy and body mass index) were identified and incorporated into the Monash Osteoporosis Risk Score for women at midlife (MORS). In the screened study population, the MORS had a sensitivity of 70 % and specificity of 66 %, with a positive predictive value of 16.2 % and negative predictive value of 95.9 % for osteoporosis.
Very few women referred for a screening DXA scan will be found to have osteoporosis. The MORS, a simple decision tool, would have identified 70 % of the women in our screening DXA study population and would have eliminated over 60 % of the screening DXA studies. Hence, use of the MORS may reduce unnecessary DXA scans and facilitate identification of the majority of cases of osteoporosis in women aged 40 to 65 years.
本研究建立了前来进行双能X线吸收测定法（DXA）检查的中年女性中最有可能患骨质疏松症的特征档案，并据此开发了一种DXA检查前的筛查工具。这些发现为中年女性骨质疏松症的针对性和有效筛查以及骨质疏松性骨折预防提供了急需的循证指南。
对于中年女性是否应接受双能X线吸收测定法（DXA）筛查以确定骨质疏松症（T值＜-2.5），尚无共识。
我们调查了被转诊至澳大利亚42个社区放射中心的40至65岁女性的骨质疏松症患病率，并确定了在进行筛查DXA检查的女性中最能预测骨质疏松症的特征。
1402名女性完成了研究问卷并获得了DXA报告。排除有DXA检查既定指征的女性（58%）、使用骨特异性药物的女性（10.5%）和癌症患者（7.6%）后，466名女性被归类为进行筛查DXA检查。其中40名女性在腰椎（n = 32，6.9%）或股骨颈（n = 17，3.6%）处患有骨质疏松症。确定了骨质疏松症的三个预测因素（绝经后、未使用激素治疗和体重指数），并将其纳入中年女性莫纳什骨质疏松风险评分（MORS）。在筛查的研究人群中，MORS对骨质疏松症的敏感性为70%，特异性为66%，阳性预测值为16.2%，阴性预测值为95.9%。
接受筛查DXA扫描的女性中很少会被发现患有骨质疏松症。MORS作为一种简单的决策工具，在我们的筛查DXA研究人群中可以识别出70%的女性，并可以消除超过60%的筛查DXA检查。因此，使用MORS可能会减少不必要的DXA扫描，并有助于识别40至65岁女性中大多数骨质疏松症病例。
