osteoporosis; screening; diagnosis; risk factors; bone mineral density
Abstract :
[en] A simple questionnaire would be useful to identify individuals most in need of bone mineral density (BMD) testing. We designed a new predictive model and risk assessment instrument based on an extensive review of the literature evaluating risk factors for osteoporosis, and tested its performance in a large cohort of postmenopausal women in whom BMD was measured by dual x-ray absorptiometry. In total, 1303 postmenopausal women from an outpatient osteoporosis clinic participated in this study. The Osteoporosis Index of Risk (OSIRIS) is based on four variables: age, body weight, current hormone replacement therapy use and history of previous low impact fracture. The sensitivity and specificity for an OSIRIS value of +1 were respectively 78.5% and 51.4%. The AUC under the ROC curve of OSIRIS was 0.71. Three categories were arbitrarily created using OSIRIS, with cutoff of +1 and -3. The low risk category (OSIRIS > +1) represented 41% of all women; only 7% of the women in this category had osteoporosis. The prevalence of osteoporosis was very high (66%) among the group at high risk (OSIRIS < -3 representing 15% of all women). The prevalence of osteoporosis was 39% in the intermediate risk group (-3 < OSIRIS < +1, 44% of all women). In conclusion, OSIRIS is a simple index based on four easy-to-collect variables from postmenopausal women, it shows a high degree of accuracy, and performed well for classifying the degree of risk of osteoporosis in western European women of Caucasian lineage. Based on this instrument it is possible to propose a strategy that would initiate treatment in women with very high risk, postpone BMD measurement in women with low risk and limit BMD measurement to women with intermediate risk of osteoporosis, this would spare more than 55% of the densitometry bill compared with a mass screening scenario.
Disciplines :
Reproductive medicine (gynecology, andrology, obstetrics) Endocrinology, metabolism & nutrition
Author, co-author :
Sedrine, W. B.
Chevallier, T.
Zegels, Brigitte ; Université de Liège - ULiège > Département des sciences de la santé publique > Epidémiologie et santé publique
Kvasz, Angela ; Centre Hospitalier Universitaire de Liège - CHU > Médecine de l'appareil locomoteur
Micheletti, M. C.
Gelas, B.
Reginster, Jean-Yves ; Université de Liège - ULiège > Département des sciences de la santé publique > Epidémiologie et santé publique
Language :
English
Title :
Development and assessment of the Osteoporosis Index of Risk (OSIRIS) to facilitate selection of women for bone densitometry
Publication date :
June 2002
Journal title :
Gynecological Endocrinology
ISSN :
0951-3590
eISSN :
1473-0766
Publisher :
Parthenon Publishing Group, Lancaster, United Kingdom
Gillet P., Reginster J.Y. (1999) Increased number of hip fractures. Lancet 353:3160-3161.
Van der Voort D.J.M., Dinant G.J., Rinkens P.E.L.M. (2000) Constructions of an algorithm for quick detection of patients with low bone mineral density and its applicability in daily general practice. J Clin Epidemiol 53:1095-1103.
Lydick E., Cook K., Turpin J. (1998) Development and validation of a simple questionnaire to facilitate identification of women likely to have low bone density. Am J Man Care 4:37-48.
Weinstein L., Ullery B., Bourguignon C. (1999) A simple system to determine who needs osteoporosis screening. Obstet Gynecol 93:757-760.
Von Mühlen D., Visby Lunde A., Barrett-Connor E., Bettencourt R. (1999) Evaluation of the simple calculated osteoporosis risk estimation (SCORE) in older Caucasian women: The Rancho Bernardo Study. Osteoporos Int 10:79-84.
Cadarette S., Jaglal S., Kreiger N. (2000) Development and validation of the osteoporosis risk assessment instrument to facilitate selection of women for bone densitometry. Can Med Ass J 162:1289-1294.
Cadarette S., Jaglal S., Murray T. (1999) Validation of the simple calculated osteoporosis risk estimation (SCORE) for patient selection for bone densitometry. Osteoporos Int 10:85-90.
Reginster J.Y., Janssen C., Deroisy R. (1995) Bone mineral density of the spine and the hip measured with dual energy X-ray absorptiometry: Normal range and fracture threshold for Western European (Belgian) postmenopausal females. Clin Rheumatol 14:68-75.
Koh L., Sedrine W.B., Torralba T. (2001) A simple tool to identify Asian women at increased risk of osteoporosis. Osteoporos Int 12:699-705.
Ballard P., Purdie D., Langton C. (1998) Prevalence of osteoporosis and related risk factors in UK women in the seventh decade: Osteoporosis case finding by clinical referral criteria or predictive model?. Osteoporos Int 8:535-539.
Johnell O., Gullberg B., Kanis J. (1995) Risk factors for hip fracture in European women: The MEDOS study. J Bone Miner Res 10:1802-1815.
Ooms M., Lips P., Van Lingen A., Valkenburg H. (1993) Determinants of bone mineral density and risk factors for osteoporosis in healthy elderly women. J Bone Miner Res 8:669.
Ribot C., Pouilles J.M., Bonneu M., Tremollières M. (1992) Assessment of the risk of postmenopausal osteoporosis using clinical factors. Clin Endocrinol 38:225-228.
(1996) Clinical practice guidelines for the diagnosis and management of osteoporosis. Can Med Ass J 155:1113-1133.
Reginster J.Y., Deroisy R., Lecart M.P. (1996) Prévention de l'ostéoporose à Liège: Histoire d'un PIGEPS: Dix ans après. Santé Publique 2:139-150.