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Postmenopausal bone density referral decision rules: correlation with clinical fractures
Gina S Wei1, Jeffrey L Jackson
1Medicine-Educational Programs, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
Objective:
To test decision rules for bone mineral density (BMD) against fractures.
Methods:
We surveyed postmenopausal women in a military primary care clinic and tested three national clinical decision rules (Osteoporosis Risk Assessment Instrument; age, body size, no estrogen; weight) for correlation with fracture history. Outcome measures included relative risk (RR), area under the receiver operating characteristics curve (aROC), sensitivity, and specificity.
Results:
Patients were 69 years old on average, 53% were Caucasian, 38% were African American, and 15% had a history of fractures. Caucasian women (RR, 1.8; 95% confidence interval [CI], 1.1-3.1) and those older than 65 years (RR, 2.0; 95% CI, 1.2-3.5) had higher prevalence of fractures. The Osteoporosis Risk Assessment Instrument decision rule had the highest aROC (0.65; 95% CI, 0.57-0.731 and sensitivity (sensitivity, 0.83; specificity, 0.31). Age, Body Size, No Estrogen had the next highest aROC (0.63; 95% CI, 0.54-0.71) and sensitivity (sensitivity, 0.74; specificity, 0.46). Weight criterion was the most specific (aROC, 0.60; 95% CI, 0.52-0.68; sensitivity, 0.64; specificity, 0.56).
Conclusions:
Current postmenopausal bone density referral decision rules only modestly correlate with clinical fractures.
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