Simple test predicts osteoporosis risk in men

By Will Boggs, MD

NEW YORK (Reuters Health) - A simple test, called the Male Osteoporosis Risk Estimation Score (MORES), identifies men at risk for osteoporosis who might benefit from dual-energy X-ray absorptiometry (DXA) to determine their bone mineral density, according to a report in the Annals of Family Medicine.

The test can also identify men with osteopenia -- below normal bone mineral density that has not yet progressed to osteoporosis - which would give patients the opportunity to modify their lifestyle and diet to prevent progression to osteoporosis, Dr. Angela J. Shepherd from The University of Texas Medical Branch, Galveston, told Reuters Health.

In the next 25 to 50 years, osteoporosis and the fractures that will result will be a major world health issue unless it is appropriately addressed, Shepherd said. "From Europe to China, many experts are wrestling with how to best decide which men are at risk for osteoporosis and should be tested with DXA."

Shepherd and associates used data from the National Health and Nutrition Examination Survey (NHANES) III to develop and validate a test that could be used by health professionals to identify men at increased risk for osteoporosis and fractures, and would therefore benefit from DXA testing.

The final predictive model contained only three variables: age (3 categories), weight (3 categories), and history of chronic obstructive pulmonary disease (COPD) (yes or no).

A score of 6 points or more, out of a maximum of 13 points, had a sensitivity of 93 percent and a specificity of 59 percent, which means that most of the "true positives" - those who actually had osteoporosis - were identified and more than half of the "true negatives" - those who did not have osteoporosis -- were correctly identified.

MORES yielded similar sensitivity and specificity across non-Hispanic white, non-Hispanic black, and Hispanic racial/ethnic groups, although the specificity was slightly higher in non-Hispanic whites.

The researchers estimate that using MORES in men 50 years of age or older, the number needed to screen to prevent one hip fracture in the next 10 years was 279.

We plan a clinical study that will involve up to 3000 men 60 years of age or older who attend our primary care clinics, Shepherd added. "If the MORES is validated in this clinical setting, we will repeat a similar study on a larger, multicentered scale."

"Ultimately," she concluded, "I hope that our future research will add to the limited but growing knowledge of osteoporosis in men and encourage health policy makers to undertake the arduous task of trying to figure out if there are men who should be considered for bone density testing (or whatever other measures needed) so we can ultimately prevent hip fractures."

SOURCE: Annals of Family Medicine, November/December 2007.