Performance of the Osteoporosis Self-Assessment Tool in ruling out low bone mineral density in postmenopausal women: a systematic review.

UNLABELLED: The Osteoporosis Self-Assessment Tool (OST) is a simple test that may be of clinical value to rule-out low bone mineral density. We performed a systematic review to assess its performance in postmenopausal women. We included 36 studies. OST performed moderately in ruling-out femoral neck T-score <or= -2.5, but poorly in ruling-out lumbar spine T-score <or= -2.5. Methodological study quality was generally low.
INTRODUCTION: The Osteoporosis Self-Assessment Tool (OST) is a simple clinical decision rule based on age and weight that may be of clinical value to rule-out low bone mineral density (BMD). Our aim was to systematically assess the performance of OST in postmenopausal women.
METHODS: We searched PubMed, Embase, Web of Science, citation lists and conference proceedings for studies evaluating OST using dual X-ray absorptiometry (DXA) as reference test to measure BMD. We evaluated methodological quality using the QUADAS checklist. Our main outcome was the likelihood ratio of a negative OST result (LR-).
RESULTS: OST performed moderately in ruling-out femoral neck T-score <or= -2.5 in whites, summary LR- (sLR-) 0.19 (95% CI, 0.17-0.21) and between-study heterogeneity was low (I(2) = 7%). The corresponding performance in Asians was similar, sLR- 0.19 (0.14-0.28), but there was considerable heterogeneity (I(2) = 64%). OST performed poorly in ruling-out lumbar spine T-score <or= -2.5 in whites and Asians, sLR- 0.43 (0.31-0.59) and 0.32 (0.28-0.38), respectively. The performance in ruling-out T-score <or= -2.0 in whites was poor regardless of region (sLR- >or=0.28). Methodological study quality was generally low.
CONCLUSIONS: The clinical usefulness of OST is uncertain. OST could be useful for ruling-out femoral neck T-score <or= -2.5, but confirmatory high-quality studies are needed.