Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Osteoporosis International
Published in: Osteoporosis International 9/2007

01-09-2007 | Original Article

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

Authors: B. Rud, J. Hilden, L. Hyldstrup, A. Hróbjartsson

Published in: Osteoporosis International | Issue 9/2007

Login to get access

Abstract

Summary

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 ≤ −2.5, but poorly in ruling-out lumbar spine T-score ≤ −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 ≤ −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 ≤ −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 ≤ −2.0 in whites was poor regardless of region (sLR- ≥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 ≤ −2.5, but confirmatory high-quality studies are needed.
Appendix
Available only for authorised users
Literature
1.
Black DM, Thompson DE, Bauer DC et al (2000) Fracture risk reduction with alendronate in women with osteoporosis: the Fracture Intervention Trial. J Clin Endocrinol Metab 85:4118–4124PubMedCrossRef
2.
Chesnut III CH, Skag A, Christiansen C et al (2004) Effects of oral ibandronate administered daily or intermittently on fracture risk in postmenopausal osteoporosis. J Bone Miner Res 19:1241–1249CrossRef
3.
Ettinger B, Black DM, Mitlak BH et al (1999) Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. JAMA 282:637–645PubMedCrossRef
4.
Harris ST, Watts NB, Genant HK et al (1999) Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. JAMA 282:1344–1352PubMedCrossRef
5.
McClung MR, Geusens P, Miller PD et al (2001) Effect of risedronate on the risk of hip fracture in elderly women. N Engl J Med 344:333–340PubMedCrossRef
6.
Reginster JY, Seeman E, De Vernejoul MC et al (2005) Strontium ranelate reduces the risk of nonvertebral fractures in postmenopausal women with osteoporosis. J Clin Endocrinol Metab 90:2816–2822PubMedCrossRef
7.
8.
Nelson HD, Helfand M, Woolf SH et al (2002) Screening for postmenopausal osteoporosis: a review of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 137:529–541PubMed
9.
Morris CA, Cabral D, Cheng H et al (2004) Patterns of bone mineral testing. Current guidelines, testing rates, and interventions. J Gen Intern Med 19:783–790PubMedCrossRef
10.
Cummings SR, Melton LJ (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet 359:1761–1767PubMedCrossRef
11.
Cadarette SM, Jaglal SB, Kreiger N et al (2000) Development and validation of the Osteoporosis Risk Assessment Instrument to facilitate selection of women for bone densitometry. CMAJ 162:1289–1294PubMed
12.
Koh LK, Sedrine WB, Torralba TP et al (2001) A simple tool to identify Asian women at increased risk of osteoporosis. Osteoporos Int 12:699–705PubMedCrossRef
13.
Lydick E, Cook K, Turpin J et al (1998) Development and validation of a simple questionnaire to facilitate identification of women likely to have low bone density. Am J Manag Care 4:37–48PubMed
14.
Sedrine WB, Chevallier T, Zegels B et al (2002) Development and assessment of the Osteoporosis Index of Risk (OSIRIS) to facilitate selection of women for bone densitometry. Gynecol Endocrinol 16:245–250PubMedCrossRef
15.
Sen SS, Rives VP, Messina OD, Morales-Torres J et al (2005) A risk assessment tool (OsteoRisk) for identifying Latin American women with osteoporosis. J Gen Intern Med 20:245–250PubMedCrossRef
16.
Cummings SR, Bates D, Black DM (2002) Clinical use of bone densitometry: scientific review. JAMA 288:1889–1897PubMedCrossRef
17.
Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO study group. WHO technical report series 843. Geneva. 1994
18.
Whiting P, Rutjes AW, Reitsma JB et al (2003) The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol 3:25PubMedCrossRef
19.
Jaeschke R, Guyatt GH, Sackett DL (1994) Users’ guides to the medical literature III. How to use an article about a diagnostic test. B: What are the results and will they help me in caring for my patients? JAMA 271:703–707PubMedCrossRef
20.
21.
22.
Devillé WL, Buntinx F. Guidelines for conducting systematic reviews of studies evaluating the accuracy of diagnostic tests. In: Knottnerus A (ed) The Evidence Base of Clinical Diagnosis. 1st ed. London: BMJ Books; 2002:145–165
23.
Higgins JP, Thompson SG, Deeks JJ et al (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560PubMedCrossRef
24.
Thompson SG, Sharp SJ (1999) Explaining heterogeneity in meta-analysis: a comparison of methods. Stat Med 18:2693–2708PubMedCrossRef
25.
Higgins JP, Thompson SG (2004) Controlling the risk of spurious findings from meta-regression. Stat Med 23:1663–1682PubMedCrossRef
26.
Deeks JJ, Macaskill P, Irwig L (2005) The performance of tests of publication bias and other sample size effects in systematic reviews of diagnostic test accuracy was assessed. J Clin Epidemiol 58:882–893PubMedCrossRef
27.
Glas AS, Lijmer JG, Prins MH et al (2003) The diagnostic odds ratio: a single indicator of test performance. J Clin Epidemiol 56:1129–1135PubMedCrossRef
28.
Moses LE, Shapiro D, Littenberg B (1993) Combining independent studies of a diagnostic test into a summary ROC curve: data-analytic approaches and some additional considerations. Stat Med 12:1293–1316PubMed
29.
Richy F, Deceulaer F, Ethgen O et al (2004) Development and validation of the ORACLE score to predict risk of osteoporosis. Mayo Clin Proc 79:1402–1408PubMed
30.
Cho J-J (2005) Evaluation of two screening decision rules for osteoporosis of menopause or perimenopause women in Korea [Abstract]. Osteoporos Int 13(Suppl 3):S68
31.
Nguyen TV, Center JR, Pocock NA et al (2004) Limited utility of clinical indices for the prediction of symptomatic fracture risk in postmenopausal women. Osteoporos Int 15:49–55PubMedCrossRef
32.
Lu CY, Cai YH, Wei SQ (2005) Concordance rate of Osteoporosis Self-Assessment Tool for Asians and dual energy X-ray absorptiometry in diagnosis of osteoporosis [Abstract]. Osteoporos Int 16(Suppl 3):S39
33.
Wallace LS, Ballard JE, Holiday D et al (2004) Evaluation of decision rules for identifying low bone density in postmenopausal African-American women. J Natl Med Assoc 96:290–296PubMed
34.
Sen SS, Geling O, Ross PD et al (2002) Validating the Osteoporosis Self-Assessment Tool in New Zealand [Abstract]. Osteoporos Int 13(Suppl 3):S38
35.
Cook RB, Collins D, Tucker J et al (2005) Comparison of questionnaire and quantitative ultrasound techniques as screening tools for DXA. Osteoporos Int 16:1565–1575PubMedCrossRef
36.
Pongchaiyakul C, Nguyen ND, Pongchaiyakul C et al (2004) Development and validation of a new clinical risk index for prediction of osteoporosis in Thai women. J Med Assoc Thai 87:910–916PubMed
37.
Ongphiphadhanakul B, Chanprasertyothin S, Payattikul P et al (2003) The implication of assessing a polymorphism in estrogen receptor alpha gene in the risk assessment of osteoporosis using a screening tool for osteoporosis in Asians. Osteoporos Int 14:863–867PubMedCrossRef
38.
Mossman EA, Luckey M, McClung MR (2003) The Osteoporosis Self-Assessment Tool (OST) performs differently in younger versus older postmenopausal women [Abstract]. J Bone Miner Res 18(Suppl 2):S358
39.
Gourlay ML, Miller WC, Richy F et al (2005) Performance of osteoporosis risk assessment tools in postmenopausal women aged 45–64 years. Osteoporos Int 16:921–927PubMedCrossRef
40.
Cadarette SM, Jaglal SB, Murray et al (2001) Evaluation of decision rules for referring women for bone densitometry by dual-energy X-ray absorptiometry. JAMA 286:57–63PubMedCrossRef
41.
Fujiwara S, Masunari N, Suzuki G et al (2001) Performance of osteoporosis risk indices in a Japanese population. Ther Res Clin Exp 62:586–594CrossRef
42.
Geusens P, Hochberg MC, van der Voort DJ et al (2002) Performance of risk indices for identifying low bone density in postmenopausal women. Mayo Clin Proc 77:629–637PubMedCrossRef
43.
Richy F, Gourlay M, Ross PD et al (2004) Validation and comparative evaluation of the osteoporosis self-assessment tool (OST) in a Caucasian population from Belgium. QJM 97:39–46PubMedCrossRef
44.
Rud B, Jensen JE, Mosekilde L et al (2005) Performance of four clinical screening tools to select peri- and early postmenopausal women for dual X-ray absorptiometry. Osteoporos Int 16:764–772PubMedCrossRef
45.
Moons KG, Grobbee DE et al (2002) When should we remain blind and when should our eyes remain open in diagnostic studies? J Clin Epidemiol 55:633–636PubMedCrossRef
46.
47.
Whiting PF, Westwood ME, Rutjes AW et al (2006) Evaluation of QUADAS, a tool for the quality assessment of diagnostic accuracy studies. BMC Med Res Methodol 6:9PubMedCrossRef
48.
Kanis JA, Seeman E, Johnell O et al (2005) The perspective of the international osteoporosis foundation on the official positions of the international society for clinical densitometry. J Clin Densitom 8:145–147PubMedCrossRef
49.
50.
Kanis JA, Delmas P, Burckhardt P et al (1997) Guidelines for diagnosis and management of osteoporosis. The European Foundation for Osteoporosis and Bone Disease. Osteoporos Int 7:390–406PubMedCrossRef
51.
Neer RM, Arnaud CD, Zanchetta JR et al (2001) Effect of parathyroid hormone (1–34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med 344:1434–1441PubMedCrossRef
52.
Lijmer JG, Mol BW, Heisterkamp S et al (1999) Empirical evidence of design-related bias in studies of diagnostic tests. JAMA 282:1061–1066PubMedCrossRef
53.
Gaugris S, Tenenhouse A, Desjardin B et al (2005) Validating the Osteoporosis Self-Assessment Tool (OST) in Canada [Abstract]. Osteoporos Int 16(Suppl 3):S18
54.
Siew-Leng L, Pui-San W, Shamal DD (2005) Assessment of osteoporosis risk in postmenopausal women in Singapore [Abstract]. J Clin Densitom 8:237
55.
Cadarette SM, McIsaac WJ, Hawker GA et al (2004) The validity of decision rules for selecting women with primary osteoporosis for bone mineral density testing. Osteoporos Int 15:361–366PubMedCrossRef
56.
Choi H, Park YJ, Lee CM et al (2004) The validation and comparisional study of several risk indices for prediction of osteoporosis in peri- and postmenopausal Korean women [Abstract]. Osteoporos Int 15(Suppl 1):S27
57.
Gambacciani M, Genazzani AR (2004) Osteoporosis screening: comparison of the heel ultrasound measurement to calculated risk assessment tools [Abstract]. Osteoporos Int 15(Suppl 1):S36
58.
Geater S, Leelawattana R, Geater A (2004) Validation of the OSTA index for discriminating between high and low probability of femoral neck and lumbar spine osteoporosis among Thai postmenopausal women. J Med Assoc Thai 87:1286–1292PubMed
59.
Mossman EA, DeFrancisco T-score, Strot S et al (2004) OST versus weight alone in groups defined by clinical guidelines [Abstract]. J Clin Densitom 7:234
60.
Poriau S, Geusens P, Van den Bosch F et al (2004) Osteoporosis screening: comparison of heel ultrasound measurement to calculated risk assessment tools (OST) [Abstract]. J Bone Miner Res 20(Suppl 2):S378
61.
Taguchi A, Suei Y, Sanada M et al (2004) Validation of dental panoramic radiography measures for identifying postmenopausal women with spinal osteoporosis. Am J Roentgenol 183:1755–1760
62.
Chan SP, Yeap SS, Hew FL et al (2003) The Osteoporosis Self-Assessment Tool For Asians (OSTA): Validation in Malaysia [Abstract]. Bone 32(Suppl 5):S176
63.
Kung AW, Ho AY, Sedrine WB et al (2003) Comparison of a simple clinical risk index and quantitative bone ultrasound for identifying women at increased risk of osteoporosis. Osteoporos Int 14:716–21PubMedCrossRef
64.
Lesnyak Y, Ershova O, Menshikova L et al (2003) Performance of the Osteoporosis Risk Assessment tool (OST) in Russian women [Abstract]. Osteoporos Int 14(Suppl 7):S53
65.
Mellström D, Rubinsky S, Waern E et al (2003) Validating The Osteoporosis Self-Assessment Tool (OST) in Sweden [Abstract]. Osteoporos Int 14(Suppl 7):S80
66.
Park HM, Sedrine WB, Reginster JY et al (2003) Korean experience with the OSTA risk index for osteoporosis: a validation study. J Clin Densitom 6:247–250PubMedCrossRef
67.
Koh LKH (2002) Identifying osteoporosis in a cohort of Singapore women using as simple clinical tool. Osteoporos Int 13(Suppl 1):S116
68.
Ben Sedrine W, Huang Q-R, Reginster J-Y (2001) Using the OSTA index to identify women at increased risk of osteoporosis: a validation study in China. Arth Rheum 44(9 Suppl):S258
Metadata
Title
Performance of the Osteoporosis Self-Assessment Tool in ruling out low bone mineral density in postmenopausal women: a systematic review
Authors
B. Rud
J. Hilden
L. Hyldstrup
A. Hróbjartsson
Publication date
01-09-2007
Publisher
Springer-Verlag
Published in
Osteoporosis International / Issue 9/2007
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-006-0319-3

Other articles of this Issue 9/2007

Osteoporosis International 9/2007 Go to the issue

Editorial

Individualization of osteoporosis risk

Erratum

Low bone mineral density in COPD patients related to worse lung function, low weight and decreased fat-free mass

Original Article

Adiponectin is a predictor of bone mineral density in middle-aged premenopausal women

Original Article

Effect of seasonality and weather on fracture risk in individuals 65 years and older

Original Article

Polymorphisms in the vitamin D receptor gene are associated with muscle strength in men and women

Original Article

An approach for identifying postmenopausal women age 50–64  years at increased short-term risk for osteoporotic fracture