The Investigation Of Osteoporosis Prevalence And Development Of Primary Osteoporosis Risk Screening Tool Among A Healthy Elderly Male Population

Objective: To investigate the osteoporosis prevalence and osteoporosis-related clinical risk factors in a healthy elderly male population, and to develop a simple new clinical screening tool to identify primary osteoporosis in elderly male and to compare its validity with the Osteoporosis Self-assessment Tool for Asians(OSTA) in the population.Methods: A cross-sectional study was conducted, enrolling 1485 community-dwelling healthy elderly Han Chinese male aged 50 and above. All subjects completed a structured questionnaire and had their bone mineral density(BMD) measured using dual-energy X-ray absorptiometry. Subjects were classified as the osteoporosis group(OP group) and the non-osteoporosis group(Non-OP group) according to the WHO criteria. The clinical risk factors of each subject including age, body weight, Body Mass Index(BMI), previous fragility fracture history, smoking, alcohol abuse and other capable clinical risk factors were collected and compared in OP group and Non-OP group. Using logistic regression analysis, we assessed the ability of numerous potential risk factors examined in the questionnaire to identify male osteoporosis. Based on this analysis, we build a new predictive model, named the Beijing Friendship Hospital Osteoporosis Self-assessment Tool for Elderly Male(BFH-OSTM). The validation of the new model and OSTA to identify osteoporosis was evaluated through receiver-operating characteristic(ROC) curve analysis, which plots sensitivity against(1 – specificity). Receiver operating characteristic(ROC)curve was generated to compare the validity of the new model and OSTA in identifying elderly male at increased risk of primary osteoporosis as defined according to the World Health Organization criteria.Results: In screening the 1,485 subjects with dual-energy X-ray absorptiometry, 14.1%(209/1485)had osteoporosis, and a further 51.8%(770/1485)had osteopenia. Of the items screened in the questionnaire, weight, height and previous history of fragility fracture were all predictive of osteoporosis. The logistic regression analysis and item reduction yielded a final tool(BFH-OSTM)based on body weight and fragility fracture history. The BFH-OSTM index(cutoff =-26.8), which performed better than OSTA, had a sensitivity of 70% and a specificity of 74% for identifying osteoporosis according to the WHO criteria, with an area under the ROC curve of 0.791.Conclusions: The prevalence of osteoporosis in healthy elderly male should not be ignored. Low height and weight, and previous fragility fracture history may be osteoporosis-related clinical risk factors in this population. The BFH-OSTM may be an effective new clinical risk assessment tool for identifying elderly male at increased risk for osteoporosis.