The Journal of Bone and Joint Surgery (American). 2007;89:765-772.
doi:10.2106/JBJS.F.00347
© 2007 The Journal of Bone and Joint Surgery, Inc.
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The Osteoporosis Self-Assessment Screening Tool: A Useful Tool for the Orthopaedic Surgeon

John G. Skedros, MD1, Christian L. Sybrowsky, MD1 and Gregory J. Stoddard, MPH2

1 Utah Bone and Joint Center, 5323 South Woodrow Street, Suite 202, Salt Lake City, UT 84107. E-mail address: jskedros{at}utahboneandjoint.com
2 Division of Clinical Epidemiology, University of Utah School of Medicine, 30 North 1900 East, Room AC229, Salt Lake City, UT 84132

Investigation performed at the Utah Bone and Joint Center, Affiliated with the Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah

Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants of less than $10,000 from the Utah Osteoporosis Center and the Orthopaedic Research and Education Foundation. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).

Background: Simple and effective methods are needed to identify patients at risk for osteoporosis or osteoporosis-related fracture so that they can be screened with use of dual x-ray absorptiometry and counseled for treatment. Currently, we use a cumbersome survey assessing thirty-two risk factors. A much simpler score based on the Osteoporosis Self-Assessment Screening Tool (OST score) has been established as highly sensitive and specific in women, but similar data are lacking for men. This score is calculated by subtracting the age of the patient in years from the weight in kilograms and multiplying the result by 0.2. Our goal was to test the hypothesis that the OST score is more sensitive and specific than our extensive risk-assessment survey in men.

Methods: Using axial dual x-ray absorptiometry analysis, we evaluated a cohort of men who had either responded to our newspaper advertisement or were seen as patients in our orthopaedic clinic. Patients filled out the risk-assessment survey at the time of scanning. Osteoporosis was defined as a T-score of –2.5 or less in the lumbar spine, hip, or femoral neck.

Results: Twenty-seven (17%) of 158 white men, with a mean age of 67.5 years and a mean weight of 85.3 kg, had osteoporosis. After analysis of the thirty-two risk factors, two remained as significant independent predictors in the final multivariable model (p = 0.042 and p = 0.015). This model had an area under the receiver operating characteristic curve of 0.68 (>0.70 is considered to provide acceptable discrimination). The OST scores ranged from –6 (greatest risk) to 16 (least risk). With use of the OST score to predict osteoporosis, the area under the receiver operating characteristic curve was 0.76. The cutoff of an OST score of <2 provided the largest area under the receiver operating characteristic curve (0.74), with test characteristics for an OST score of <2 including a sensitivity of 85%, specificity of 64%, positive predictive value of 31%, and negative predictive value of 96%.

Conclusions: The Osteoporosis Self-Assessment Screening Tool score is superior to a broad risk-factor analysis in the identification of men at risk for osteoporosis or osteoporotic fractures. We have found it simple to use in our clinic to determine which patients should undergo dual x-ray absorptiometry screening.

Level of Evidence: Diagnostic Level I. See Instructions to Authors for a complete description of levels of evidence.


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