Prevalence of osteoporosis and related risk factors in UK women in the seventh decade: Osteoporosis case finding by clinical referral criteria or predictive model?
Pa. Ballard et al., Prevalence of osteoporosis and related risk factors in UK women in the seventh decade: Osteoporosis case finding by clinical referral criteria or predictive model?, OSTEOPOR IN, 8(6), 1998, pp. 535-539
The objectives of the study were: to determine the prevalence of osteoporos
is in women in their seventh decade; to determine the number of women who c
onformed to at least one of the current East Yorkshire Clinical Referral Cr
iteria for Osteoporosis; and to determine the sensitivity and specificity o
f these referral criteria in the diagnosis of osteoporosis and to compare t
his with the receiver operating characteristic (ROC) curve of a logistic re
gression model incorporating variables that were significantly associated w
ith the risk of osteoporosis. An observational study was carried out at the
Centre for Metabolic Bone Disease, Hull Royal Infirmary, on women in their
seventh decade from three general practices. Densitometric assessment of l
umbar spine and femoral neck was carried out using dual-energy X-ray absorp
tiometry (DXA) and a detailed medical history taken. The main outcome measu
res were prevalence of osteoporosis in women in their seventh decade and ef
ficacy of agreed clinical referral criteria at osteoporosis case finding. O
f 823 Caucasian women who underwent DXA, 24% proved to have osteoporosis at
hip, spine or both according to WHO criteria. A further 49% had osteopenia
detected at hip, spine or both. At least one of the referral criteria was
present in 47% of the women assessed. The sensitivity of the clinical refer
ral criteria for detection of osteoporosis was 58% with a corresponding spe
cificity of 60%. This point lies below the ROC curve (area under fitted cur
ve, A(z) = 0.73) of a logistic regression model incorporating weight, age a
t menopause and current use of hormone replacement therapy. In conclusion,
osteoporosis according to WHO criteria was found in almost 25% of women in
their seventh decade. A simple logistic regression model provided a more se
nsitive method of osteoporosis case finding than the selective screening co
mponent of the clinical referral criteria employed in our practice.