Alvah R Cass1, Angela J Shepherd2, Rechelle Asirot3, Manju Mahajan4, Maimoona Nizami5. 1. Department of Family Medicine, The University of Texas Medical Branch, Galveston, Texas acass@utmb.edu. 2. Department of Family Medicine, The University of Texas Medical Branch, Galveston, Texas. 3. Peacehealth Medical Group, Eugene, Oregon. 4. Covenant Clinic, Oelwein, Iowa. 5. Kingwood Medical Center, Kingwood, Texas.
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.
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.
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