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VBCR - October 2014, Volume 3, No 5 - Osteoporosis
Rosemary Frei, MSc

Houston, TX—The US Preventive Services Task Force strategy captures less than 5% of postmenopausal women 50 to 54 years of age who will have a major osteoporotic fracture (MOF) within the next 10 years, according to an analysis presented at the American Society for Bone and Mineral Research 2014 Annual Meeting.

The US Task Force recommends that women younger than 65 years of age should be screened for osteoporosis if their Fracture Risk Assessment Tool (FRAX) score indicates that their 10-year MOF risk is greater than 9.3%. However, the analysis of data from 62,492 participants aged 50 to 64 years in the Women’s Health Initiative (WHI) Observational Study and Clinical Trial showed that this strategy had a sensitivity of only 25.8% for identifying women with incident MOFs.

The sensitivity was lower still—4.7%—among women in the 50 to 54 age-group. The sensitivity of the Osteoporosis Self-Assessment Tool (OST) and the Simple Calculated Osteoporosis Risk Estimation (SCORE) in women aged 50 to 54 years was also low (18.5% and 22.9%, respectively).

“What that means is that for all 3 of these tools, in these younger women, they are no better than flipping a coin in identifying who is going to have a fracture in the next 10 years,” lead investigator Carolyn J. Crandall, MD, MS, told Value-Based Care in Rheumatology. “We can’t know for sure what those risk factors are that aren’t in the tools,” she added. “The FRAX tool contains almost all known fracture-risk factors. So one potential factor we thought of was maybe they’re very vigorous and they’re falling—FRAX doesn’t capture falls.”

Dr Crandall, Professor of Medicine, David Geffen School of Medicine, University of California Los Angeles, and colleagues focused on data from the WHI between 1993 and 2008. The women included in their analysis were postmenopausal and were not taking osteoporosis medicine. Patients who were taking hormone replacement therapy were not excluded, according to the researchers.

The results indicated that the sensitivity of the strategy of the US Task Force, OST, and SCORE using baseline values for predicting the 10-year observed incidence of MOF of the spine, hip, forearm, and shoulder was relatively low. The overall sensitivity was 25.8% for the US Task Force strategy, 38.6% for SCORE, and 30.8% for OST. For women aged 50 to 54 years, it was 4.7%, 18.5%, and 22.9%, respectively.

The specificity was relatively high for women overall, at 83.3% for the US Task Force, 65.8% for SCORE, and 66.7% for OST. When the researchers adjusted the positive-result thresholds for each of the 3 strategies they found that the sensitivity increased but the specificity decreased.

“The next steps are going to be looking at the falls data from the WHI study,” Dr Crandall said. “We’re also going to try to think of what else may be increasing fracture risk. It could be something dietary, it’s possible.”

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