The Development, Application Evaluation And Comparison Research Of A Primary Osteoporosis Risk Screening Tool

OBJECTIVE: The purpose of this study was to investigate the risk factorsof primary osteoporosis,to develop and validate a primary osteoporosis riskscreening tool for community-dwelling middle and old aged women, to providean effective and applied means for primary osteoporosis second-leverprevention,to provide scientific evidences for community nursing practiceand health promoting efforts;to be a matting for perfecting more researchesof screening osteoporosis risk people by means of comparing some screeningtools commonly used in other countries.DESIGN: This research was composed of two parts. The first part was aboutthe development and validation of a primary osteoporosis risk screeningtool, trying to provide a localized tool for screening the risk of primaryosteoporosis . A sample of 174 healthy community-dwelling middle and oldaged women was randomly selected with the stratified sampling mothod toserve as the research target; in the mean while, another sample of 64 middleand old aged women was randomly selected with the accidental sampling mothodfrom comprehensive hospital clinics to validate the application of the tool.The second part was to compare some screening tools commonly used in othercountries such as SCORE,ORAI,OSTA,OSIRIS,and the Self-Test recommendedby the Chinese Osteoporosis Froum , so as to examine the applicability ofthe localization of the foreign screening tools, and to preliminarilyselect suitable local screening tools for vicinal people. The study useda similar screening test design, refering to the gold standard diagnosisof osteoporosis using dual x-ray absorptiometry to measure bone mineraldensity, the subjects were sent to undergo bone density measurement aftercompleting a questionnaire.RESULTS: ⑴72.3% risk factors were significant correlated with more thanone bone density metrical sites, correlation coefficient are between 0.116and 0.535; univariate ANOVA showed that 58.8% risk factors have someinfluence on different BMD metrical sites.⑵Stepwise regression analysisrevealed that age(Beta=-0.562),weight(Beta=0.448),family fracturehistory( Beta=-0.492),pregnant times (Beta=0.294),menopause time(Beta=-0.339)and exercise during 18-30years old(Beta=0.187)weresignificant influences of the BMD,which can explain 62.1% of BMD'sdiversifications.⑶Our screening tool has preferable screening value(AUC=0.835,95%CI:0.777~0.892).Using -1 as a cutoff it had 91.67% (95%CI:85.28%~98.05%)sensitivity,58.82%(95%CI:49.27%~68.37%)specificity,61.11%(95%CI:52% ~70.31%)positive predictive value and 90.91% (95%CI:84%~98%) negative predictive value for selecting low bone mineral density(T≤-2.0SD).⑷Our screening tool also has better value used in validationcohort (AUC=0.845, 95%CI:0.747~0.942), which achieved 100% (95%CI:100%~100%)sensitivity,48.48%(95%CI:31.43%~65.54%)specificity,64.58%(95%CI:51%~78.11%)positive predictive value and 100%(95%CI:100%~100%)negative predictive value for selecting low bone mineral density.⑸Comparison Research of screening osteoporosis in community showed that thesensitivity, specificity, positive predictive value and negativepredictive value was 83.33%(95%CI:74.72%~91.94%),64.71%(95%CI:55.43%~73.98%) ,62.5%(95%CI:53%~72.18%)and 84.62%(95%CI:77%~93%)using theSCORE;was 37.50%(95%CI:26.32%~48.68%),97.06%(95%CI:93.78%~100%),90%(95%CI:79%~100%)and 68.75%(95%CI:61%~76%)using the OSTA;was 100%(95%CI:100%~100%),20.59%(95%CI:12.74% ~28.44%),47.06%(95%CI:39%~54.97%)and 100%(95%CI:100%~100%)using the ORAI;was 95.83%(95%CI:91.22%~100%),23.53%(95%CI:15.30%~31.76%),46.94%(95%CI:39%~55.01%)and 88.89%(95%CI:77%~100%)using the OSIRIS;was 95.83%(95%CI:91.22%~100%),32.35%(95%CI:23.27%~41.43%),50%(95%CI:42%~58.34%)and91.67%(95%CI:83%~100%)using the Self-Test.⑹Comparison Research ofscreening osteoporosis in clinc showed that the sensitivity , specificity,positive predictive value and negative predictive value was90.32%(95%CI:79.91% ~100%),72.73%(95%CI: 57.53%~ 87.92%),75.68%(95%CI:62%~89.50%)and 88.89%(95%CI:77%~100%)using the SCORE;was 70.97%(95%CI:54.99%~86.95%),75.76%(95%CI:61.14%~90.38%),73.33%(95%CI:58%~89.16%)and 73.53%(95%CI:59% ~88%)using the OSTA;was 100%(95%CI:100%~100%),9.09%(95%CI:0.72%~18.90%),50.82%(95%CI:38%~63.37%) and 100%(95%CI:100%~100%)using the ORAI;was 100%(95%CI:100%~100%),12.12%(95%CI:0.99%~23.26%),51.67%(95%CI:39%~64.31%)and 100%(95%CI:100%~100%)using the OSIRIS or the Self-Test.CONCLUSION: ⑴Our screening tool is handy and wieldy.It can provide aneffective and applied means for screening primary osteoporosis risk peoplein community with nicer applied value of screening , in the mean time,itmay also help physicians to identify risk people of osteoporosis. ⑵Primaryresults showed that the Simple Calculated Osteoporosis Risk Estimation(SCORE)had some screening values, popularized used it need morevalidations to confirm its cutoff. The Osteoporosis Risk AssessmentInstrument( ORAI),the Osteoporosis Self-assessment Tool for Asians(OSTA),the Osteoporosis Index of Risk(OSIRIS) and the Self-Test recommended bythe Chinese Osteoporosis Froum have limited applied values.⑶The screeningtool can sifting primary osteoporisis effectively, which could be extendedused in the second-lever prevention of primary osteoporosis and providescientific evidences for developing more primary osteoporosis communitynursing intervention.