Identifying women with low bone mass: a systematic review of screening tools

Several osteoporosis risk-factor screening tools have been developed to identify women at increased risk of low bone mineral density, who would most benefit from dual x-ray absorptiometry (DXA) screening. The purpose of this systematic review was to assess the effectiveness of these screening tools in determining postmenopausal Caucasian women at risk of developing osteoporosis. Appropriate databases and sources of primary studies were identified. A systematic review of the literature using a comprehensive search strategy was employed, and all citations were stored. Exclusion criteria were established, and critical quality was assessed. Study characteristics were tabulated and comparisons made. Upon reviewing the evidence, 6 screening tools (Simple Calculated Osteoporosis Risk Estimation, the Osteoporosis Risk Assessment Instrument, the Osteoporosis Self-Assessment Tool [OST], the body weight criterion, the Osteoporosis Index of Risk, and Age, Body Size, No Estrogen) were identified. Studies show that these screening tools are useful in identifying postmenopausal Caucasian women in need of DXA screening and possible intervention for osteoporosis. For clinical and community practice, the OST is the simplest approach to determine individuals at risk of osteoporosis and in need of DXA screening. There is still a need for further development and validation of screening tools in both men and ethnicities other than Caucasian.