Article Figures & Data
Tables
- Table 1.
Comparison of Sociodemographic and Clinical Characteristics of Men in Development and Validation Cohorts
Univariate Factors Development Cohort (n = 1,497) Validation Cohort (n = 1,498) CAD = coronary artery disease; COPD = chronic obstructive pulmonary disease; MI = myocardial infarction. Note: Adjusted and reported using sampling and design weights from National Health and Nutrition Examination Survey III. Mean age, y (SD) 63.8 (9.4) 64.2 (9.7) Mean weigh, kg (SD) 83.1 (15.1) 82.9 (14.8) Race/ethnicity Non-Hispanic white, % 88.9 88.5 Non-Hispanic black, % 8.1 8.5 Hispanic, % 3.0 3.0 Osteoporosis, % 5.2 4.4 Marital status – unmarried, % 19.4 20.3 Less than high school education, % 36.4 36.4 Maternal hip fracture, % 9.7 8.0 Currently abstains from alcohol, % 52.6 54.9 Ever smoked tobacco, % 81.5 82.1 Sedentary activity, % 12.1 13.6 Self-rated health, fair/poor, % 24.5 22.9 Diagnosis of diabetes mellitus, % 10.4 11.0 Diagnosis of COPD, % 12.0 10.0 Diagnosis of CAD (MI), % 12.8 11.4 - Table 2.
Bivariate Analysis of Available Risk Factors and Osteoporosis in the Development Cohort (n = 1,497)
Risk Factor for Osteoporosis Odds Ratio (95%CI) P Value Note: Adjusted and reported using sampling and design weights from NHANES III. COPD = chronic obstructive pulmonary disease. * Reference category. Age <.001 ≤ 55 years 1.0* 56–74 years 5.6 (1.47–21.1) ≤ 75 years 15.1 (3.9–59.0) Weight <.001 ≤ 70 kg 27.3 (10.2–72.9) >70–80 kg 7.0 (2.2–22.5) >80 kg 1.0* Race/ethnicity .007 Non-Hispanic white 1.0* Non-Hispanic black 1.9 (1.1–3.4) Hispanic 0.5 (0.2–1.3) Marital status, unmarried 3.1 (1.5–6.2) .017 Less than high school education 1.9 (1.1–3.2) .034 Currently abstains from alcohol 2.3 (1.2–4.3) .009 Ever smoked tobacco 3.1 (1.5–6.3) .002 Sedentary activity 3.3 ( 1.7–6.6) .026 Self-rated health, poor/fair 2.6 (1.5–4.6) .012 Diagnosis of diabetes mellitus 1.2 (0.5–3.0) .756 Diagnosis of COPD 4.5 (2.5–8.3) .003 Diagnosis of myocardial infarction 2.0 (1.0–4.2) .162 Family history of maternal hip fracture 2.4 (0.6–9.3) .117 - Table 3.
Multiple Logistic Regression Models for Initial and Best-Fitting Models: Development Cohort (n = 1,454)
Variable β Coefficient Standard Error (β) Wald Statistic P Value Odds Ratio 95% CI CI = confidence interval; COPD = chronic obstructive pulmonary disease. Note: Forty-three cases excluded from analysis due to a missing value for at least 1 variable. Data adjusted and reported using sampling and design weights from NHANES III. Initial model: 6 variables Intercept −7.83 1.00 - - - - Age 3.03 .053 ≤ 55 years 0.00 - - - 1.00 - 56–74 years 1.18 0.73 - - 3.26 0.77–13.73 ≥ 75 years 1.70 0.71 - - 5.50 1.33–22.71 Weight 24.80 <.001 ≤ 70 kg 3.01 0.48 - - 20.20 7.79–52.35 >70–80 kg 1.81 0.56 - - 6.12 2.01–18.59 >80 kg 0.00 - - - 1.00 Marital status, unmarried 0.86 0.35 6.10 .015 2.37 1.18–4.73 Currently abstains from alcohol 0.85 0.033 6.53 .012 2.34 1.21–4.52 Ever smoked tobacco 1.18 0.39 8.93 .004 3.25 1.49–7.12 Diagnosis of COPD 1.18 0.36 10.99 .001 3.26 1.61–6.60 Best fitting model: 3 variables Intercept −6.28 0.87 - - - - Age 5.15 .008 ≤ 55 years 0.00 - - - 1.00 56–74 years 1.29 0.71 - - 3.64 0.89–14.81 ≥ 75 years 2.03 0.68 - - 7.58 1.95–29.50 Weight 26.25 <.001 ≤ 70 kg 3.07 0.48 - - 21.52 8.27–55.97 >70–80 kg 1.86 0.57 - - 6.44 2.08–19.90 >80 kg 0.00 – - - 1.00 Diagnosis of COPD 1.32 0.37 12.67 <.001 3.76 1.80–7.85 Risk Factor Logistic Regression β Coefficient MORES Points* COPD = chronic obstructive pulmonary disease. * Screening threshold is 6 points or greater. † Reference category. Age ≤ 55 years† 0.00 0 56–74 years 1.29 3 ≤ 75 years 2.03 4 Weight ≤ 70 kg (≤ 154 lb) 3.07 6 >70–80 kg (>154–176 lb) 1.86 4 >80 kg (>176 lb)† 0.00 0 COPD 1.32 3 - Table 5.
Simulated Screening for Osteoporosis in 10,000 Men Aged 50 Years and Older: 10-Year Hip Fracture Outcomes
Age-Groups, Years Variables 50–54 55–59 60–64 65–69 70–74 75–79 80–84 85–89 Overall * Formulas used in calculations are available upon request from the authors. DXA = dual energy x-ray absorptiometry; FP = false positive; MORES = Male Osteoporosis Risk Estimate Score; NHANES = National Health and Nutrition Examination Survey; NNS = number needed to screen; RX = diagnosis of osteoporosis and treatment with bisphosphonate therapy; no RX = diagnosis of osteoporosis and no treatment; TP = true positive. Base/case assumptions* Fracture risk27 0.034 0.057 0.091 0.133 0.215 0.328 0.362 0.333 0.135 Osteoporosis prevalence (NHANES III) 0.007 0.034 0.036 0.049 0.051 0.094 0.119 0.257 0.048 Relative risk for hip fracture with treatment18 0.63 0.63 0.63 0.63 0.63 0.63 0.63 0.63 0.63 Adherence to treatment, proportion18 0.70 0.70 0.70 0.70 0.70 0.70 0.70 0.70 0.70 Results per 10,000 men Predicted cases of osteoporosis, n 70 340 360 490 510 940 1,190 2,570 480 MORES screen: true positive 65 316 335 456 474 874 1,107 2,390 446 MORES screen: false negative 5 24 25 34 36 66 83 180 34 MORES screen: true negative 5,859 5,699 5,688 5,611 5,599 5,345 5,198 4,384 5,617 MORES screen: false positive 4,071 3,961 3,952 3,899 3,891 3,715 3,612 2,046 3,903 Referred for DXA (TP + FP), n 4,136 4,277 4,287 4,355 4,365 4,589 4,719 5,436 4,350 Predicted hip fractures: screened MORES:DXA Predicted hip fractures: true positive 1.64 13.36 22.58 44.91 75.56 212.47 296.86 589.76 44.72 Predicted hip fractures: false negative 0.17 1.36 2.29 4.56 7.68 21.58 30.15 59.91 4.54 Predicted hip fractures: total 1.81 14.71 24.87 49.47 83.24 234.05 327.02 649.67 49.26 Predicted hip fractures: unscreened 2.38 19.38 32.76 65.17 109.65 308.32 430.78 855.81 64.90 NNS MORES:DXA 7,216 917 544 278 166 62 46 27 279 Universal DXA screen Fracture RX 1.76 14.36 24.28 48.29 81.25 228.47 319.21 643.16 48.09 Fracture no RX 2.38 19.38 32.76 65.17 109.65 308.32 430.78 855.81 64.90 NNS universal DXA 16,223 1,992 1,179 592 352 125 90 45 595
Additional Files
The Article in Brief
Development and Internal Validation of the Male Osteoporosis Risk Estimation Score
Angela J. Shepherd, MD , and colleagues
Background In 2002, men accounted for about 2 million cases of osteoporosis. The purpose of this study is to develop a method to identify men at increased risk for osteoporosis and subsequent fractures who would benefit from bone density testing.
What This Study Found The Male Osteoporosis Risk Estimation (MORES) appears to perform better than currently available osteoporosis risk assessment guidelines for men. Compared with other tests, it is simpler to calculate, addresses more risk factors, and does not require extra cost.
Implications
- In men 60 years of age and older, the MORES is a simple approach to identify those at risk for osteoporosis and refer them for a bone density scan to confirm the results.
Jump to section
Related Articles
Cited By...
- Comparison of the Male Osteoporosis Risk Estimation Score (MORES) With FRAX in Identifying Men at Risk for Osteoporosis
- Validation of the Male Osteoporosis Risk Estimation Score (MORES) in a Primary Care Setting
- Determining Risk of Vertebral Osteoporosis in Men: Validation of the Male Osteoporosis Risk Estimation Score
- Current status of research on osteoporosis in COPD: a systematic review
- ASHP Therapeutic Position Statement on the Prevention and Treatment of Osteoporosis in Adults
- In This Issue: Equity Global Theme Issue on Poverty and Human Development