| Author | Design | N | Validated | Risk Factors Included | Outcome | Performance | Quality Rating2 | |
|---|---|---|---|---|---|---|---|---|
| Bone Density Outcomes | Slemenda, 1990 (34) | Cross-sectional | 124 | No | Age, height, weight, calcium intake, caffeine intake, alcohol and tobacco use, urinary markers of bone turnover | Correct classification of high or low BMD (lowest third of subjects) | Midshaft radius: 68% low, 77% high. Lumbar spine: 61% low, 45% high. Femoral neck: 66% low, 53% high | Poor |
| Falch, 1992 (35) | Cross-sectional | 73 | Yes | Low body weight, reduced renal phosphate reabsorption, smoking | Bone loss | Sensitivity 36%, specificity 89%, PPV 74% | Poor | |
| Ribot, 1992 (36) | Cross-sectional | 1565 | No | Weight, menopause, duration of menopause | Vertebral BMD <-2 SD | Sensitivity 73%, specificity 66% | Fair | |
| Elliot, 1993 (37) | Cross-sectional | 320 | Yes | Spine BMD: age, weight, smoking status, age at menarche. Femoral neck BMD: age, weight, family history, activity, smoking status | Low lumbar spine and femoral neck BMD (lowest third of age matched normal range) | Lumbar spine: sensitivity 86%, specificity 32%. Femoral neck: sensitivity 89%, specificity 25% | Fair | |
| Michaelsson, 1996 (38) | Cross-sectional | 175 | No | Weight >70 kg | Femoral neck BMD <-2.5 SD | Sensitivity 94%, specificity 36%, PPV 21%, NPV 97% | Fair | |
| Verhaar, 1998 (39) | Cross-sectional | 61 | No | 1. Arm span-height difference of at least 3 cm. 2. Arm span-height difference, age above or below 70, and whether arm span was below or above 160 cm | BMD <-2.5 SD and vertebral fracture | Arm span only: sensitivity 58%, specificity 56%. Arm span, age, arm span length: sensitivity 81%, specificity 64% | Poor | |
| Ballard, 1998 (40) | Cross-sectional | 1158 | No | Age, age at menopause, height, weight, gravidity, parity, current use of steroids, current HRT | Osteoporosis of femoral neck and/or spine | ROC area 0.73 | Fair | |
| Lydick, 1998 (41) | Cross-sectional | 1279 | Yes | SCORE = age (3 times first digit of age in years), weight (- 1 times weight in pounds divided by 10 and truncated to integer), race (5 if not black), estrogen use (1 if never used), rheumatoid arthritis (4 if present), history of fractures (4 for each fracture after age 45 of wrist, hip, or rib, to a maximum of 12) | Femoral neck BMD <-2 SD | Sensitivity 89%, specificity 50%; ROC area 0.81 using a score of 6, or greater | Good | |
| Goemaere, 1999 (42) | Cross-sectional | 300 | No | 18-item questionnaire of risk factors for osteoporosis (race, height loss, age, weight, smoking, coffee, alcohol, dairy product use, activity, family history, existence of comorbidities, history of wrist fracture, menopause before 45 years, corticosteroid use) | Lumbar spine, femoral neck, and hip BMD | Lumbar spine: ROC area 0.66; Femoral neck: ROC area 0.69; Hip: ROC area 0.76 | Fair | |
| Cadarette, 2000 (43) | Cross-sectional | 926 | Yes | ORAI = age (15 points if >75, 9 if 65-74, 5 if 55-64), weight (9 if <60 kg, 3 if 60-69.9 kg), current use of HRT (2 if not currently using) | Hip or lumbar spine BMD <-2.5 | Sensitivity 95%, specificity 41% using a score of >9 | Good | |
| Fracture Outcomes | Kleerekoper, 1989 (44) | Case-control | 663 | No | Model 1; total months of lactation, family history of osteoporosis, years post menopause, weight. Model 2: breast fed, surgical menopause, age at menarche, age, smoking status | Vertebral fractures | Model 1: ROC area (SE) 0.55 (0.07); sensitivity 56%; specificity 54%. Model 2: ROC 0.51 (0.042); sensitivity 63% specificity 39% | Fair |
| van Hemert, 1990 (45) | Cohort | 1014 | No | Age, metacarpal cortical area, relative cortical area, BMI, height, diameter of forearm, diameter of knee, age at menarche, age at menopause, smoking, number of children, period of lactation | Osteoporotic fractures | Sensitivity 48%, specificity 82% | Fair | |
| Cooper, 1991 (46) | Case-control | 1012 | No | Age, height, vertebral fracture after age 45, age of last menstrual period, number of children, ever use oral corticosteroid | Vertebral fractures | Sensitivity 51%, specificity 69% | Fair | |
| Wolinsky and Fitzgerald, 1994 (47) | Cohort | 368 | No | White race, female gender, living in southern U.S., age, having been hospitalized in the previous year, previous fall, body mass | Hip fractures | ROC 0.71; sensitivity 64.7%, specificity 65.7% | Fair | |
| Johnell, 1995 (48) | Case-control | 5618 | No | Late menarche, poor mental score, low BMI, low physical activity, low exposure to sunlight, and low consumption of calcium and tea | Hip fractures | Sensitivity 55%, specificity 65% | Fair | |
| Ranstam, 1996 (49) | Case-control | 7474 | No | Mental-functional risk score: knowledge of the day of week, knowledge of age, ability to wash, ability to dress | Hip fractures | A less than perfect score had a sensitivity 46%, specificity 79% | Fair | |
| Tromp, 1998 (50) | Cohort | 1469 | No | Female gender, living alone, past fractures, inactivity, height, use of analgesics | Probablility of fractures | No predictors = 0%; 4 predictors = 12.9% | Fair | |
| Burger, 1999 (51) | Cohort | 5208 | No | Model with BMD: age, gender, height, use of a walking aid, current smoking, BMD of femoral neck. Model without BMD: age, gender, height, use of a walking aid, current smoking, weight | Hip fractures | Model with BMD: ROC area 0.88; sensitivity 70%, specificity 84%. Model without BMD: ROC area 0.83; sensitivity 70%, specificity 83% | Fair |
Note:
1BMD = Bone mineral density, BMI = Body mass index, CI = Confidence interval, HRT = Hormone replacement therapy, NPV = Negative predictive value, PPV = Positive predictive value, ROC = Receiver operating characteristic (values >0.80 are usually required to consider a test to be effective), RR = Relative risk, SD = Standard Deviation, SE = Standard error.
2Based on criteria developed by the U.S. Preventive Services Task Force (22).