Wang Shu-Tong, Gu Han-Yang, Huang Zi-Chen, Li Chen, Liu Wen-Na, Li Rong
Department of Geriatrics, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, PR China.
Department of Geriatrics, General Hospital of Northern Theater Command, Shenyang, Liaoning, PR China.
Int J Nurs Stud. 2025 May;165:105029. doi: 10.1016/j.ijnurstu.2025.105029. Epub 2025 Feb 17.
The Fracture Risk Assessment Tool (FRAX, threshold ≥9.3 %), Osteoporosis Risk Assessment Instrument (ORAI, ≥9), Osteoporosis Index of Risk (OSIRIS, <1), Osteoporosis Self-Assessment Tool (OST, <2), and Simple Calculated Osteoporosis Risk Estimation (SCORE, ≥6) have been endorsed by the US Preventive Services Task Force for evaluating the need for bone mineral density measurement by dual-energy X-ray absorptiometry in postmenopausal women.
To systematically compare the sensitivity and specificity of the five osteoporosis risk assessment tools for detecting bone mineral density-defined osteoporosis.
A systematic search was conducted across the Cochrane Library, Embase, PubMed and Web of Science databases up to January 29, 2024, to identify observational studies that evaluated comparative accuracy of these tools in postmenopausal women. The Quality Assessment of Diagnostic Accuracy Studies-2 and its comparative extension were utilized to evaluate the risk of bias and applicability. Pooled odds ratios (ORs) and 95 % confidence intervals (CIs) for relative sensitivity and specificity were calculated using a multivariate random-effects model, with tool rankings determined by Surface Under the Cumulative Ranking (SUCRA).
17 studies were included, involving 9669 postmenopausal women with bone mineral density-defined osteoporosis and 34,143 without the condition. The SCORE (OR = 12.11, 95 % CI [4.46-32.86]) exhibited significantly higher sensitivity than FRAX, followed by ORAI (OR = 7.01, 95 % CI [2.84-17.31]) and OST (OR = 6.90, 95 % CI [3.07-15.52]). Compared to OSIRIS, higher sensitivity was observed for SCORE (OR = 4.92, 95 % CI [2.41-10.05]), ORAI (OR = 2.85, 95 % CI [1.63-4.99]), and OST (OR = 2.80, 95 % CI [1.58-4.97]). However, specificity was lower for SCORE (OR = 0.16, 95 % CI [0.08-0.33]), ORAI (OR = 0.26, 95 % CI [0.13-0.51]), and OST (OR = 0.28, 95 % CI [0.15-0.53]) compared to FRAX. Similarly, SCORE (OR = 0.25, 95 % CI [0.15-0.41]), ORAI (OR = 0.40, 95 % CI [0.26-0.62]), and OST (OR = 0.44, 95 % CI [0.27-0.69]) showed significantly lower specificity than OSIRIS. Based on SUCRA values, SCORE (98.2 %) ranked as the most sensitive tool, followed by ORAI (64.2 %) and OST (62.6 %), whereas FRAX (96.7 %) was the most specific, followed by OSIRIS (78.3 %).
The risk assessment tools for identifying postmenopausal women with bone mineral density-defined osteoporosis, endorsed by the US Preventive Services Task Force, can be categorized into two groups. SCORE (≥6), ORAI (≥9), and OST (<2) offer higher sensitivity, identifying more osteoporosis patients, whereas FRAX (≥9.3 %) and OSIRIS (<1) provide higher specificity, identifying those without the condition more accurately.
PROSPERO (CRD42024507532).
骨折风险评估工具（FRAX，阈值≥9.3%）、骨质疏松风险评估工具（ORAI，≥9）、骨质疏松风险指数（OSIRIS，<1）、骨质疏松自我评估工具（OST，<2）以及简易计算骨质疏松风险评估（SCORE，≥6）已得到美国预防服务工作组认可，用于评估绝经后女性进行双能X线吸收法骨密度测量的必要性。
系统比较五种骨质疏松风险评估工具检测骨密度定义的骨质疏松症的敏感性和特异性。
截至2024年1月29日，在Cochrane图书馆、Embase、PubMed和Web of Science数据库中进行系统检索，以识别评估这些工具在绝经后女性中比较准确性的观察性研究。采用诊断准确性研究质量评估-2及其比较扩展版来评估偏倚风险和适用性。使用多变量随机效应模型计算相对敏感性和特异性的合并比值比（OR）和95%置信区间（CI），并通过累积排序曲线下面积（SUCRA）确定工具排名。
纳入17项研究，涉及9669例骨密度定义为骨质疏松症的绝经后女性和34143例无该疾病的绝经后女性。SCORE（OR = 12.11，95% CI [4.46 - 32.86]）的敏感性显著高于FRAX，其次是ORAI（OR = 7.01，95% CI [2.84 - 17.31]）和OST（OR = 6.90，95% CI [3.07 - 15.52]）。与OSIRIS相比，SCORE（OR = 4.92，95% CI [2.41 - 10.05]）、ORAI（OR = 2.85，95% CI [1.63 - 4.99]）和OST（OR = 2.80，95% CI [1.58 - 4.97]）的敏感性更高。然而，与FRAX相比，SCORE（OR = 0.16，95% CI [0.08 - 0.33]）、ORAI（OR = 0.26，95% CI [0.13 - 0.51]）和OST（OR = 0.28，95% CI [0.15 - 0.53]）的特异性较低。同样，SCORE（OR = 0.25，95% CI [0.15 - 0.41]）、ORAI（OR = 0.40，95% CI [0.26 - 0.62]）和OST（OR = 0.44，95% CI [0.27 - 0.69]）的特异性显著低于OSIRIS。基于SUCRA值，SCORE（98.2%）是最敏感的工具，其次是ORAI（64.2%）和OST（62.6%），而FRAX（96.7%）是最特异的，其次是OSIRIS（78.3%）。
美国预防服务工作组认可的用于识别骨密度定义的绝经后骨质疏松症女性的风险评估工具可分为两组。SCORE（≥6）、ORAI（≥9）和OST（<2）具有较高的敏感性，能识别更多骨质疏松患者，而FRAX（≥9.3%）和OSIRIS（<1）具有较高的特异性，能更准确地识别无该疾病的患者。
PROSPERO（CRD42024507532）
