Screening for Osteoporosis in Older Men: Operating Characteristics of Proposed Strategies for Selecting Men for BMD Testing

Susan J. Diem, Katherine W. Peters, Margaret L. Gourlay, John T. Schousboe, Brent C. Taylor, Eric S. Orwoll, Jane A. Cauley, Lisa Langsetmo, Carolyn J. Crandall, Kristine E. Ensrud, The Osteoporotic Fractures In Men Research Group

Research output: Contribution to journalArticlepeer-review

27 Scopus citations


Background: The optimal approach for selecting men for bone mineral density (BMD) testing to screen for osteoporosis is uncertain. Objective: To compare strategies for selecting older men for screening BMD testing. Design: Prospective cohort study. Participants: A total of 4043 community-dwelling men aged ≥70 years at four US sites. Main Measures: BMD at the total hip, femoral neck, and lumbar spine using dual-energy x-ray absorptiometry (DXA). Sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, and area under the receiver operating curve (AUC) of the Osteoporosis Self-Assessment Tool (OST) and Fracture Risk Assessment Tool (FRAX) without BMD to discriminate between those with and without osteoporosis as defined by World Health Organization (WHO) diagnostic criteria, and between those recommended and not recommended for pharmacologic therapy based on the National Osteoporosis Foundation (NOF) guidelines. Key Results: Among the cohort, 216 (5.3%) had a BMD T-score ≤ −2.5 at the femoral neck, total hip, or lumbar spine, and 1184 (29.2%) met criteria for consideration of pharmacologic therapy according to NOF guidelines. The OST had better discrimination (AUC 0.68) than the FRAX (AUC 0.62; p = 0.004) for identifying T-score-defined osteoporosis. Use of an OST threshold of <2 resulted in sensitivity of 0.83 and specificity of 0.36 for the identification of osteoporosis, compared to sensitivity of 0.59 and specificity of 0.59 for the use of FRAX with a cutoff of 9.3% 10-year risk of major osteoporotic fracture. Conclusions: The OST performs modestly better than the more complex FRAX in selecting older men for BMD testing to screen for osteoporosis; the use of either tool substantially reduces the proportion of men referred for BMD testing compared to universal screening. Of 1000 men aged 70 and older in this community-based cohort, the use of an OST cutoff of <2 to select men for BMD testing would result in 654 men referred for BMD testing, of whom 44 would be identified as having osteoporosis, and nine with osteoporosis would be missed.

Original languageEnglish (US)
Pages (from-to)1235-1241
Number of pages7
JournalJournal of general internal medicine
Issue number11
StatePublished - Nov 1 2017

Bibliographical note

Funding Information:
The Osteoporotic Fractures in Men (MrOS) Study is supported by funding from the National Institutes of Health. Support is provided by the following: National Institute on Aging (NIA), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), National Center for Advancing Translational Sciences (NCATS), and NIH Roadmap for Medical Research (under grant numbers U01 AG027810, U01 AG042124, U01 AG042139, U01 AG042140, U01 AG042143, U01 AG042145, U01 AG042168, U01 AR066160, and UL1 TR000128). Dr. Gourlay is supported by the NIA, grant number R01 AG046294. The funding agencies had no direct role in the conduct of the study; the collection, management, analysis, or interpretation of the data; or preparation or approval of the manuscript.

Publisher Copyright:
© 2017, Society of General Internal Medicine.


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