Performance of decision algorithms for the identification of low bone mineral density in Portuguese postmenopausal...

Although several algorithms have been proposed to select postmenopausal women PMW for dual-energy x-ray absorptiometry DEXA measurements information on their utility in clinical practice is scarce. Our aim was to assess the utility and the economic repercussion of the use of five of these algorithms in Portuguese postmenopausal women.

We included 588 PMW and selected five simple algorithms ORAI ABONE Body Weight Criterion OSTA and a modified version of OSTA (OST). Sensitivities specificities predictive values areas under the receiver operating characteristic curve (AUROC) and economic estimates were computed.

Sensitivities ranged between 71.2%-80.8% and AUROC between 0.611-0.674. In PMW aged > or = 65 years (Y) the use of any of the algorithms would cause extra costs or a residual saving. In PMW aged > or = 55 and < 65Y considering total savings ABONE had the best performance but considering savings per preventable fracture, ORAI assumed the lead, followed by BWC. In the age group > or = 40 and < 55Y, the most profitable option considering total savings would be not doing DEXA to anyone; considering savings per preventable fracture, BWC figures as the most useful.

This study provides evidence for the validity of all the selected tools as useful algorithms to select PMW for DEXA. On the basis of our results and considering the importance of simplicity in the applicability of an algorithm we would suggest the following strategy in Portuguese PMW: 1) Aged > or = 65Y: perform DEXA irrespective of other risk factors. 2) Aged < 65Y: perform DEXA if body weight < 70Kg.