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Evaluation of Decision Rules to Identify Postmenopausal Women for Intervention Related to Osteoporosis

机译：评估确定绝经后妇女与骨质疏松症相关干预的决策规则

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Decision rules for intervention that utilize screening tools for bone mineral density (BMD) testing and incorporating the BMD findings and other risk factors to identify high-risk women to prevent fracture have not been evaluated. We examine the sensitivity and specificity of decision rules for intervention based on two pre-BMD screening tools: Simple Calculated Osteoporosis Risk Estimation (SCORE) and a Study of Osteoporotic Fractures (SOF)-based tool. Women 60 years of age and older without previous osteoporosis diagnosis were randomly selected from a managed care population and invited to receive a BMD test. Four hundred sixteen women had complete information and were included in the study. Women were classified as high risk requiring intervention using three different criteria: World Health Organization (t-score -2.5 or less), National Osteoporosis Foundation (t-score -2.0 or less, or -1.5 or less with one or more risk factors), and the SOF-based criteria (prior fracture; or age 60-64 with t-score less than -2.5 or age 65 or older with z-score less than -0.43 and five or more risk factors). SCORE identified 82% of the women as appropriate for BMD testing, whereas the SOF-based tool identified 26%. Sensitivity and specificity were 89.8%-96.5% and 23.8%-34.8%, respectively, for the decision rule using SCORE as the screening tool and 30.5%-84.9% and 76.0%-95.8%, respectively, for the decision rule based on SOF screening criteria. SCORE correctly identified more women who were at high risk for intervention, whereas the SOF-based tool correctly identified more women who do not meet intervention criteria. The appropriate selection of a screening tool depends upon the objective for intervention and trade-off between not identifying women for BMD testing who are at high risk and identifying more women for BMD testing who are at low risk.
机译：尚未评估利用筛查工具进行骨矿物质密度（BMD）测试并结合BMD结果和其他风险因素来识别高风险女性以防止骨折的干预决策规则。我们基于两种BMD预先筛查工具检查了干预决策规则的敏感性和特异性：简单计算的骨质疏松症风险估算（SCORE）和基于骨质疏松性骨折研究（SOF）的工具。从管理良好的护理人群中随机选择60岁及以上未曾诊断出骨质疏松症的女性，并邀请他们接受BMD测试。 416名女性拥有完整的信息，并被纳入研究。使用三种不同的标准将妇女归为需要干预的高风险人群：世界卫生组织（t分数为-2.5或以下），国家骨质疏松基金会（t分数为-2.0或以下，或-1.5或以下且有一个或多个危险因素） ，以及基于SOF的标准（骨折前；或t得分低于-2.5的60-64岁，z得分低于-0.43且有五个或更多危险因素的65岁或65岁以上）。 SCORE确定了82％的女性适合进行BMD测试，而基于SOF的工具确定了26％。以SCORE为筛选工具的决策规则的敏感性和特异性分别为89.8％-96.5％和23.8％-34.8％，基于SOF的决策规则的敏感性和特异性分别为30.5％-84.9％和76.0％-95.8％筛选条件。 SCORE可以正确识别出更多处于高干预风险的女性，而基于SOF的工具可以正确识别出更多不符合干预标准的女性。筛查工具的适当选择取决于干预目标和权衡因素之间的权衡，即不识别风险较高的BMD测试女性和识别风险较低的BMD测试女性。

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