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Annals of Family Medicine 5:540-546 (2007)
© 2007 Annals of Family Medicine, Inc.
doi: 10.1370/afm.753
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Development and Internal Validation of the Male Osteoporosis Risk Estimation Score

Angela J. Shepherd, MD, Alvah R. Cass, MD, SM, Carol A. Carlson, BA and Laura Ray, MA

The University of Texas Medical Branch, Galveston, Tex

CORRESPONDING AUTHOR: Angela J. Shepherd, MD, 301 University Blvd, Galveston TX 77555-1123, ajshephe{at}utmb.edu

PURPOSE We wanted to develop and validate a clinical prediction rule to identify men at risk for osteoporosis and subsequent hip fracture who might benefit from dual-energy x-ray absorptiometry (DXA).

METHODS We used risk factor data from the National Health and Nutrition Examination Survey III to develop a best fitting multivariable logistic regression model in men aged 50 years and older randomized to either the development (n = 1,497) or validation (n = 1,498) cohorts. The best fitting model was transformed into a simplified scoring algorithm, the Male Osteoporosis Risk Estimation Score (MORES). We validated the MORES, comparing sensitivity, specificity, and area under the receiver operating characteristics (ROC) curve in the 2 cohorts and assessed clinical utility with an analysis of the number needed-to-screen (NNS) to prevent 1 additional hip fracture.

RESULTS The MORES included 3 variables—age, weight, and history of chronic obstructive pulmonary disease—and showed excellent predictive validity in the validation cohort. A score of 6 or greater yielded an overall sensitivity of 0.93 (95% CI, 0.85–0.97), a specificity of 0.59 (95% CI, 0.56–0.62), and an area under the ROC curve of 0.832 (95% CI, 0.807–0.858). The overall NNS to prevent 1 additional hip fracture was 279 in a cohort of men representative of the US population.

CONCLUSIONS Osteoporosis is a major predictor of hip fractures. Experts believe bisphosphonate treatment in men should yield results similar to that in women and reduce hip fracture rates associated with osteoporosis. In men aged 60 years and older, the MORES is a simple approach to identify men at risk for osteoporosis and refer them for confirmatory DXA scans.

Key Words: Osteoporosis • men’s health • bone density




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TRACK Comments:

Read all TRACK Comments

Osteoporosis in men: a neglected issue
Jean-Yves REGINSTER
Annals of Family Medicine, 26 Nov 2007 [Full text]
Screening Osteoporosis Risk
Francisco R. Lafita MD, FACP, et al.
Annals of Family Medicine, 27 Nov 2007 [Full text]
Comparison of screening tools in men
Robert A. Adler
Annals of Family Medicine, 28 Nov 2007 [Full text]
Author's response
Angela J Shepherd, et al.
Annals of Family Medicine, 29 Nov 2007 [Full text]
Another Risk Factor?
Alan G Cocks
Annals of Family Medicine, 2 Dec 2007 [Full text]
Re Celiac Disease and osteoporosis
Angela J Shepherd, et al.
Annals of Family Medicine, 11 Dec 2007 [Full text]
Re: Dr. Adler's comments
Angela J Shepherd, et al.
Annals of Family Medicine, 11 Dec 2007 [Full text]
Response to Dr. Lafita and Dr. Garcia
Alvah R Cass, et al.
Annals of Family Medicine, 11 Dec 2007 [Full text]

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