Limited clinical utility of a self-evaluating risk assessment scale for postmenopausal osteoporosis: Lack of predictive value of lifestyle-related factors
S. Goemaere et al., Limited clinical utility of a self-evaluating risk assessment scale for postmenopausal osteoporosis: Lack of predictive value of lifestyle-related factors, CALCIF TIS, 65(5), 1999, pp. 354-358
The aim of this study was to assess the efficiency of a self-administered q
uestionnaire to identify subjects with postmenopausal osteoporosis in the s
etting of first line medical care. A sample of 300 postmenopausal women com
pleted the questionnaire based on 18 items. Bone mineral density at the lum
bar spine (BMD-L), total hip (BMD-H), and femoral neck (BMD-N) was used as
objective criterion for evaluation. The mean risk score was 8.2 +/- 3.21. B
MD was correlated with total risk score: r = -0.32 for BMD-L, -0.36 for BMD
-N, and -0.43 for BMD-H. Cutoff points for the risk score (equal likelihood
points) according to a T-score threshold of -2.5 were 8.6 for BMD-L and BM
D-N and 9.3 for BMD-H: specificity and sensitivity was 62% and 62%, respect
ively, for BMD-L, 65% and 62% for BMD-N, and 75% and 63% for BMD-H. Stepwis
e multiple regression analysis of the questionnaire items in relation to BM
D showed higher correlation coefficients for models including individual it
ems rather than the overall risk score. Items concerning low weight, older
age, and wrist fracture after 50 years of age were always selected as signi
ficant determinants of BMD (R = 0.43-0.55). Hormonal replacement therapy wa
s also an important determinant. Lifestyle related items did not contribute
significantly.
In conclusion, the diagnostic performance of the Is-item self-administered
questionnaire was poorer than a shortened questionnaire omitting lifestyle
factors. The clinical utility of a questionnaire should ultimately be evalu
ated in the specific optic of a chosen global strategy for prevention of os
teoporotic fractures.