Comparison of the Male Osteoporosis Risk Estimation Score (MORES) With FRAX in Identifying Men at Risk for Osteoporosis

Alvah R. Cass; Angela J. Shepherd; Rechelle Asirot; Manju Mahajan; Maimoona Nizami

doi:10.1370/afm.1945

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Finding men at risk for fracture
Robert A. Adler

Published on: 14 July 2016

Published on: (14 July 2016)

Finding men at risk for fracture
Robert A. Adler, Physician
The study of Cass et al concludes that a simple score based on weight, age, and presence of COPD is a better way to determine which men do not need a DXA measurement because the risk of osteoporosis is very low. Certainly the MORES number is easier to calculate than FRAX, and the data are reassuring. The authors might have compared their data with OST [1], which uses weight and age only, and the MScore [2], which used 5...
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The study of Cass et al concludes that a simple score based on weight, age, and presence of COPD is a better way to determine which men do not need a DXA measurement because the risk of osteoporosis is very low. Certainly the MORES number is easier to calculate than FRAX, and the data are reassuring. The authors might have compared their data with OST [1], which uses weight and age only, and the MScore [2], which used 5 factors: age, weight, history of gastrectomy, emphysema, or 2 fractures since age 40. Another tool, MOST [3], added quantitative ultrasound to age and weight and also predicted osteoporosis by DXA.
While all of these relatively simple instruments do a good job in predicting osteoporosis by DXA or keep men who do not need a DXA from getting one, the bigger question is how to predict fracture. In both men and women, the majority of fractures occur in patients who have T-scores between -1 and -2.5, called osteopenia or low bone mass. The reason for this is that there are so many more individuals in this category compared to those with osteoporosis by DXA. FRAX was developed to predict fracture risk in such patients. Because there are fewer osteoporosis studies in men, FRAX may not work as well in men as in women. Nonetheless, the study of Cass et al is important to remind those providing primary care that men fracture, and after hip fracture are more likely to die. Thus, if MORES helps get at risk men to DXA and some on to therapy, it is a valuable tool.
References
1. Adler RA, et al. Performance of the osteoporosis self-assessment screening tool for osteoporosis in American men. Mayo Clin Proc 2003;78:723-727.
2. Zimering MB, et al. Validation of a novel risk estimation tool for predicting low bone density in Caucasian and African American men veterans. J Clin Densitom 2007; 10:289-297.
3. Lynn HS, et al. An evaluation of osteoporosis screening tools for the osteoporotic fractures in men (MrOS) study. Osteoporos Int 2008; 19:1087-1092.
Competing interests: None declared
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Competing Interests: None declared.