Screening all postmenopausal women for low bone mineral density by dual-energy x-ray absorptiometry (DXA) is currently not recommended and not cost-effective. Risk factors for osteoporosis are evaluated to develop a simple tool for identifying those at increased risk and therefore should undergo further bone mineral density testing by DXA.
MATERIALS AND METHODS: Records of postmenopausal Filipino women, who had BMD measurements by DXA in the Department of Nuclear Medicine in a tertiary hospital from January 2010 to December 2010, were reviewed. Scores computed based on each of the three clinical prediction rules (ABONE, OST, NOF) were compared with their corresponding T-scores obtained from DXA machine. Validity of the osteoporosis risk indices was evaluated. Logistic regression analysis and receiver operating characteristic analysis were used to identify the simplest tool that would classify subjects at increased risk for low BMD.
RESULTS: The study population composed of 514 postmenopausal Filipino women with a mean age of 60 years, with DXA data for the femoral neck. The following were the results obtained regarding the validity of each of the clinical prediction rule: ABONE 92.9% specific, 20.9% sensitive, positive predictive value of 80.8%; OST 31.6% specific, 88.7%sensitive, positive predictive value of 64.9%; NOF 49.5% specific, 79.1% sensitive, positive predictive value of 69.1%. A simple algorithm based on the age and body mass index (BMI) was developed. Age, BMI osteoporosis scoring tool 59.4%specific, 67.2%sensitive, positive predictive value of 70.2%. Based on the newly developed age, BMI osteoporosis scoring tool, patients with score of 3 or more is likely three times at risk of low bone mineral density.
CONCLUSION: Based on the data gathered and analyzed, a higher percentage of osteopenia/osteoporosis was seen in the elderly (aged 66-84yrs) and in those with low BMI. These two variables performed fairly well in identifying postmenopausal Filipino women at risk for osteoporosis, hence the development of age, BMI osteoporosis scoring tool. Other clinical prediction rules including (ABONE, OST and NOF) evaluated in Caucasians and other Asian women also performed well in postmenopausal Filipino women.