Original Article
Performance of the Osteoporosis Self-assessment Screening Tool for Osteoporosis in American Men

https://doi.org/10.4065/78.6.723Get rights and content

Objective

To determine whether the Osteoporosis Self-assessment Tool (OST) can predict central bone mineral density in men, as defined by dual energy x-ray absorptiometry (DXA).

Patients and Methods

We applied the OST index to men in pulmonary (evaluated January-May 2001) and rheumatology (evaluated November 2001-March 2002) clinics at a veterans hospital. The calculated OST risk index is based on weight and age.

Results

In 181 men, we arbitrarily defined osteoporosis as a DXA T score of −2.5 or less in the spine, total hip, or femoral neck. The mean age and weight of the men were 64.3 years and 91.2 kg; 15.6% had osteoporosis by DXA. The OST index ranged from −5 to 19, from which we categorized risk as follows: low, 4 or greater; moderate, −1 to 3; and high, −2 or less. Only 2.0% of men with a low-risk OST index had osteoporosis, whereas 27.0% with a moderate risk and 72.7% with a high risk had osteoporosis. Using an OST cutoff score of 3, we predicted osteoporosis with a sensitivity of 93% and a specificity of 66%. When patients were studied by age in decades, race, or current glucocorticoid use, the predictive value of the OST was maintained.

Conclusion

The OST is an easy method to predict osteoporosis by DXA.

Section snippets

PATIENTS AND METHODS

We used data from 2 identical cross-sectional studies7, 8 conducted among patients enrolled in a pulmonary clinic (evaluated from January-May 2001) and a rheumatology clinic (evaluated November 2001-March 2002) at a single Veterans Affairs medical center. The studies evaluated the usefulness of screening methods to predict osteoporosis as defined by DXA. Only patients who had not previously undergone DXA were eligible to participate. After signing an informed consent form, the patients filled

RESULTS

A total of 181 men (124 white, 54 black, 3 other) filled out a questionnaire and underwent DXA. Characteristics of the study patients are listed in Table 1. The mean age was 64.3 years, and the mean weight was 91.2 kg. The OST risk index varied between −5 and 19. The percent distribution of the patients according to their OST risk index (mean index, 5±5) is shown in Figure 1.

By defining osteoporosis as a T score of −2.5 or less in the spine, total hip, or femoral neck, an OST cutoff of 3

DISCUSSION

In Asian women, the OST has performed as well as or better than more complicated osteoporosis screening tools (Simple Calculated Osteoporosis Risk Estimation [SCORE] and Osteoporosis Risk Assessment Instrument [ORAI]).1, 2, 3, 4, 5 In Asian women,5 the sensitivity was 91% and the specificity 45%, with an AUC of 0.790. Validation of the OST in white women6 showed similar results among the various screening tools, but the OST was the easiest to administer. The simplicity of the tool makes it more

CONCLUSION

The OST was valid in male veterans from 2 subspecialty clinics. The OST appears to be an excellent method to identify men at high and low risk of osteoporosis, as defined by DXA.

Acknowledgments

We acknowledge the help of Philip D. Ross, PhD, of Merck & Co, Inc, who suggested that we test the OST in men.

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This study was sponsored by an unrestricted grant from Merck & Co, Inc.

1

Dr Tran is now with the Kaiser Permanente Colorado Region, Denver.

2

Dr Adler has received research grants from Merck & Co, Inc, Eli Lilly and Company, Novartis, and Procter & Gamble and is a speaker or consultant for Merck & Co, Inc, Eli Lilly and Company, Novartis, and Procter & Gamble.

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