Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN, USA.
J Gen Intern Med. 2017 Nov;32(11):1235-1241. doi: 10.1007/s11606-017-4153-4. Epub 2017 Aug 16.
The optimal approach for selecting men for bone mineral density (BMD) testing to screen for osteoporosis is uncertain.
To compare strategies for selecting older men for screening BMD testing.
Prospective cohort study.
A total of 4043 community-dwelling men aged ≥70 years at four US sites.
BMD at the total hip, femoral neck, and lumbar spine using dual-energy x-ray absorptiometry (DXA). Sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, and area under the receiver operating curve (AUC) of the Osteoporosis Self-Assessment Tool (OST) and Fracture Risk Assessment Tool (FRAX) without BMD to discriminate between those with and without osteoporosis as defined by World Health Organization (WHO) diagnostic criteria, and between those recommended and not recommended for pharmacologic therapy based on the National Osteoporosis Foundation (NOF) guidelines.
Among the cohort, 216 (5.3%) had a BMD T-score ≤ -2.5 at the femoral neck, total hip, or lumbar spine, and 1184 (29.2%) met criteria for consideration of pharmacologic therapy according to NOF guidelines. The OST had better discrimination (AUC 0.68) than the FRAX (AUC 0.62; p = 0.004) for identifying T-score-defined osteoporosis. Use of an OST threshold of <2 resulted in sensitivity of 0.83 and specificity of 0.36 for the identification of osteoporosis, compared to sensitivity of 0.59 and specificity of 0.59 for the use of FRAX with a cutoff of 9.3% 10-year risk of major osteoporotic fracture.
The OST performs modestly better than the more complex FRAX in selecting older men for BMD testing to screen for osteoporosis; the use of either tool substantially reduces the proportion of men referred for BMD testing compared to universal screening. Of 1000 men aged 70 and older in this community-based cohort, the use of an OST cutoff of <2 to select men for BMD testing would result in 654 men referred for BMD testing, of whom 44 would be identified as having osteoporosis, and nine with osteoporosis would be missed.
选择男性进行骨密度 (BMD) 检测以筛查骨质疏松症的最佳方法尚不确定。
比较选择老年男性进行 BMD 检测筛查的策略。
前瞻性队列研究。
来自美国四个地点的共 4043 名 70 岁以上的社区居住男性。
使用双能 X 射线吸收法 (DXA) 测量全髋、股骨颈和腰椎的 BMD。骨质疏松症自我评估工具 (OST) 和骨折风险评估工具 (FRAX) 不结合 BMD 区分根据世界卫生组织 (WHO) 诊断标准有和无骨质疏松症的患者，以及根据国家骨质疏松症基金会 (NOF) 指南建议和不建议药物治疗的患者的灵敏度、特异性、阳性预测值、阴性预测值、阳性似然比、阴性似然比和受试者工作特征曲线下面积 (AUC)。
队列中，216 名（5.3%）男性股骨颈、全髋或腰椎的 BMD T 评分≤-2.5，1184 名（29.2%）符合 NOF 指南药物治疗的考虑标准。OST 对 T 评分定义的骨质疏松症的识别优于 FRAX（AUC 0.68 比 0.62；p=0.004）。OST 阈值<2 用于识别骨质疏松症的敏感性为 0.83，特异性为 0.36，而 FRAX 截断值为 9.3%时，10 年主要骨质疏松性骨折风险的敏感性为 0.59，特异性为 0.59。
OST 在选择老年男性进行 BMD 检测筛查骨质疏松症方面的表现略优于更复杂的 FRAX；与普遍筛查相比，使用这两种工具均可显著减少推荐进行 BMD 检测的男性比例。在这个基于社区的队列中，1000 名 70 岁及以上的男性中，使用 OST 截断值<2 来选择男性进行 BMD 检测，将导致 654 名男性被推荐进行 BMD 检测，其中 44 名将被诊断为骨质疏松症，9 名将被漏诊骨质疏松症。
