Risk assessment instruments for screening bone mineral density in a Mediterranean population

Table 1 Criteria for clinical decision rules and osteoporotic risk factors

SCORE	Age, body weight (kg), race, hormone therapy use, fracture history, history of rheumatoid arthritis
ORAI	Age, body weight (kg), hormone therapy use
OST	Age, body weight (kg)
BW	Body weight (kg)
OSIRIS	Age, body weight (kg), hormone therapy use, fracture history
ABONE	Age, body size, lack of estrogen

SCORE: Simple calculated osteoporosis risk estimation; ORAI: Osteoporosis risk assessment instrument; OST: Osteoporosis self-assessment tool; BW: Body weight; OSIRIS: Osteoporosis index of risk; ABONE: Age, body size, no estrogen.

Table 2 Receiver operating curve analysis using international guidelines

	AUC	95%CI		Sensitivity	Specificity	P-value
SCORE1	---	---	---	---	---	---
ORAI1	0.608	0.57	0.65	0.716	0.498	< 0.0005
ABONE1	0.628	0.59	0.67	0.650	0.610	< 0.0005
ΒW2	0.535	0.49	0.58	0.400	0.667	0.109
OST2	0.586	0.54	0.63	0.515	0.312	< 0.0005
OSIRIS2	0.600	0.56	0.64	0.631	0.570	< 0.0005

¹Osteoporosis risk T-score < -2;

²Osteoporosis status T-score < -2.5. AUC: Area under the curve; SCORE: Simple calculated osteoporosis risk estimation; ORAI: Osteoporosis risk assessment instrument; ABONE: Age, body size, no estrogen; BW: Body weight; OST: Osteoporosis self-assessment tool; OSIRIS: Osteoporosis index of risk.

Table 3 Receiver operating curve analysis using Greek population values for osteoporosis risk

	Area	95%CI		Cut-off	Sensitivity	Specificity	PPV	NPV	P-value
SCORE1	0.613	0.576	0.650	20.75 >	61%	60%	46%	73%	< 0.0005
ORAI1	0.640	0.603	0.676	9.5 >	72%	52%	46%	76%	< 0.0005
				10.5 >	62%	62%	48%	74%
ABONE1	0.631	0.595	0.668	1.5 >	65%	41%	32%	85%	< 0.0005
OST1	0.643	0.607	0.678	-2.9 >	77%	46%	45%	78%	< 0.0005
BW1	0.592	0.555	0.630	70.5 <	51%	61%	42%	68%	< 0.0005
OSIRIS1	0.609	0.572	0.645	0.5 <	59%	59%	44%	71%	< 0.0005

¹High risk for osteoporosis: T-score ≤ -2. SCORE: Simple calculated osteoporosis risk estimation; ORAI: Osteoporosis risk assessment instrument; ABONE: Age, body size, no estrogen; OST: Osteoporosis self-assessment tool; BW: Body weight; OSIRIS: Osteoporosis index of risk; PPV: Positive predictive value; NPV: Negative predictive value.

Table 4 Receiver operating curve analysis using Greek population values for osteoporosis status

	Area	95%CI		Cut-off	Sensitivity	Specificity	PPV	NPV	P-value
SCORE1	0.678	0.640	0.717	20.75 >	72%	60%	36%	87%	< 0.0005
ORAI1	0.632	0.591	0.673	10.5 >	65%	60%	33%	85%	< 0.0005
ABONE1	0.618	0.576	0.659	1.5 >	66%	60%	48%	75%	< 0.0005
OST1	0.644	0.604	0.684	-2.9 >	80%	43%	30%	87%	< 0.0005
BW1	0.591	0.549	0.633	75.5 <	69%	41%	26%	81%	< 0.0005
OSIRIS1	0.641	0.601	0.681	0.5 <	63%	57%	31%	83%	< 0.0005
				1.5 <	76%	44%	30%	86%	< 0.0005

¹Osteoporosis status: T-score ≤ -2.5. SCORE: Simple calculated osteoporosis risk estimation; ORAI: Osteoporosis risk assessment instrument; ABONE: Age, body size, no estrogen; OST: Osteoporosis self-assessment tool; BW: Body weight; OSIRIS: Osteoporosis index of risk; PPV: Positive predictive value; NPV: Negative predictive value.

Table 5 Multiple logistic regression model (T-score ≤ -2)

	Reference category	Odds ratio	95%CI		P-value
SCORE	20.75 <	1.36	0.96	1.91	0.081
ORAI	10.5 <	1.30	0.8	2.09	0.287
ABONE	1.5 <	1.64	1.00	2.70	0.051
OST	-2.9 <	1.81	1.14	2.88	0.012
BW	70.5 >	1.05	0.75	1.47	0.772
OSIRIS	0.5 >	0.78	0.52	1.16	0.214

SCORE: Simple calculated osteoporosis risk estimation; ORAI: Osteoporosis risk assessment instrument; ABONE: Age, body size, no estrogen; OST: Osteoporosis self-assessment tool; BW: Body weight; OSIRIS: Osteoporosis index of risk.

Table 6 Multiple logistic regression model (T-score ≤ -2.5)

	Reference category	Odds ratio	95%CI		P-value
SCORE	20.75 <	2.87	1.92	4.29	< 0.0005
ORAI	10.5 <	1.42	0.81	2.48	0.215
ABONE	1.5 <	0.95	0.53	1.70	0.865
OST	-2.9 <	1.55	0.90	2.65	0.115
BW	70.5 >	1.10	0.76	1.60	0.600
OSIRIS	0.5 >	0.88	0.56	1.39	0.586

SCORE: Simple calculated osteoporosis risk estimation; ORAI: Osteoporosis risk assessment instrument; ABONE: Age, body size, no estrogen; OST: Osteoporosis self-assessment tool; BW: Body weight; OSIRIS: Osteoporosis index of risk.