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

Ann Fam Med. 2016 Jul;14(4):365-9. doi: 10.1370/afm.1945.

Abstract

Purpose: We wanted to compare the male osteoporosis risk estimation score (MORES) with the fracture risk assessment tool (FRAX) in screening men for osteoporosis.

Methods: This study reports analysis of data from the Third National Health and Nutrition Examination Survey (NHANES III), a nationally representative sample of the US population, comparing the operating characteristics of FRAX and MORES to identify men at risk for osteoporosis using a subset of 1,498 men, aged 50 years and older, with a valid dual-energy x-ray absorptiometry (DXA) scan. DXA-derived bone mineral density using a T score of -2.5 or lower at either the femoral neck or total hip defined the diagnosis of osteoporosis. Outcomes included the operating characteristics, area under the receiver-operator characteristic curve, and agreement of the FRAX and MORES.

Results: Sixty-seven (4.5%) of the 1,498 men had osteoporosis of the hip. The sensitivity, specificity, and area under the curve (AUC) for the MORES were 0.96 (95% CI, 0.87-0.99), 0.61 (95% CI, 0.58-0.63), and 0.87 (95% CI, 0.84-0.91), respectively. The sensitivity, specificity, and AUC for the FRAX were 0.39 (95% CI, 0.27-0.51), 0.89 (95% CI, 0.88-0.91), and 0.79 (95% CI, 0.75-0.84) respectively. Agreement was poor.

Conclusions: Compared with the MORES, the FRAX underperformed as a screening strategy for osteoporosis using the threshold score suggested by the US Preventive Services Task Force (USPSTF). An integrated approach that uses the MORES to determine which men should have a DXA scan and the FRAX to guide treatment decisions, based on the risk of a future fracture, identified 82% of men who were candidates for treatments based on National Osteoporosis Foundation guidelines.

Keywords: mass screening; osteoporosis; sensitivity and specificity.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Absorptiometry, Photon / methods*
  • Aged
  • Bone Density*
  • Cross-Sectional Studies
  • Humans
  • Male
  • Mass Screening / methods*
  • Middle Aged
  • Nutrition Surveys
  • Osteoporosis / diagnostic imaging*
  • Osteoporosis / prevention & control
  • Risk Assessment / methods*
  • Sensitivity and Specificity