Nayak S, Edwards D L, Saleh A A, Greenspan S L
Swedish Center for Research and Innovation, Swedish Health Services, Swedish Medical Center, 747 Broadway, Seattle, WA, 98122-4307, USA,
Osteoporos Int. 2015 May;26(5):1543-54. doi: 10.1007/s00198-015-3025-1. Epub 2015 Feb 3.
We performed a systematic review and meta-analysis of the performance of clinical risk assessment instruments for screening for DXA-determined osteoporosis or low bone density. Commonly evaluated risk instruments showed high sensitivity approaching or exceeding 90% at particular thresholds within various populations but low specificity at thresholds required for high sensitivity. Simpler instruments, such as OST, generally performed as well as or better than more complex instruments.
The purpose of the study is to systematically review the performance of clinical risk assessment instruments for screening for dual-energy X-ray absorptiometry (DXA)-determined osteoporosis or low bone density.
Systematic review and meta-analysis were performed. Multiple literature sources were searched, and data extracted and analyzed from included references.
One hundred eight references met inclusion criteria. Studies assessed many instruments in 34 countries, most commonly the Osteoporosis Self-Assessment Tool (OST), the Simple Calculated Osteoporosis Risk Estimation (SCORE) instrument, the Osteoporosis Self-Assessment Tool for Asians (OSTA), the Osteoporosis Risk Assessment Instrument (ORAI), and body weight criteria. Meta-analyses of studies evaluating OST using a cutoff threshold of <1 to identify US postmenopausal women with osteoporosis at the femoral neck provided summary sensitivity and specificity estimates of 89% (95%CI 82-96%) and 41% (95%CI 23-59%), respectively. Meta-analyses of studies evaluating OST using a cutoff threshold of 3 to identify US men with osteoporosis at the femoral neck, total hip, or lumbar spine provided summary sensitivity and specificity estimates of 88% (95%CI 79-97%) and 55% (95%CI 42-68%), respectively. Frequently evaluated instruments each had thresholds and populations for which sensitivity for osteoporosis or low bone mass detection approached or exceeded 90% but always with a trade-off of relatively low specificity.
Commonly evaluated clinical risk assessment instruments each showed high sensitivity approaching or exceeding 90% for identifying individuals with DXA-determined osteoporosis or low BMD at certain thresholds in different populations but low specificity at thresholds required for high sensitivity. Simpler instruments, such as OST, generally performed as well as or better than more complex instruments.
我们对用于筛查双能X线吸收法（DXA）测定的骨质疏松症或低骨密度的临床风险评估工具的性能进行了系统评价和荟萃分析。常用的风险评估工具在不同人群的特定阈值下显示出接近或超过90%的高灵敏度，但在高灵敏度所需的阈值下特异性较低。较简单的工具，如骨质疏松症自我评估工具（OST），通常表现得与更复杂的工具一样好或更好。
本研究的目的是系统评价用于筛查双能X线吸收法（DXA）测定的骨质疏松症或低骨密度的临床风险评估工具的性能。
进行系统评价和荟萃分析。检索了多个文献来源，并从纳入的参考文献中提取和分析数据。
108篇参考文献符合纳入标准。研究在34个国家评估了许多工具，最常用的是骨质疏松症自我评估工具（OST）、简易计算骨质疏松症风险评估（SCORE）工具、亚洲人骨质疏松症自我评估工具（OSTA）、骨质疏松症风险评估工具（ORAI）和体重标准。对使用<1的截断阈值评估OST以识别美国绝经后女性股骨颈骨质疏松症的研究进行荟萃分析，得出的汇总灵敏度和特异性估计值分别为89%（95%CI 82-96%）和41%（95%CI 23-59%）。对使用3的截断阈值评估OST以识别美国男性股骨颈、全髋或腰椎骨质疏松症的研究进行荟萃分析，得出的汇总灵敏度和特异性估计值分别为88%（95%CI 79-97%）和55%（95%CI 42-68%）。经常评估的工具各自都有阈值和人群，对于这些阈值和人群，检测骨质疏松症或低骨量的灵敏度接近或超过90%，但总是以相对较低的特异性为代价。
常用的临床风险评估工具在不同人群的特定阈值下，对于识别DXA测定的骨质疏松症或低骨密度个体均显示出接近或超过90%的高灵敏度，但在高灵敏度所需的阈值下特异性较低。较简单的工具，如OST，通常表现得与更复杂的工具一样好或更好。
