亚洲骨质疏松筛查工具在健康体检中的筛查准确性评价及适宜切点研究

doi:10.19723/j.issn.1671-167X.2019.06.019

Abstract

Abstract:

Objective: To explore the screening value of osteoporosis self-assessment tool for Asians (OSTA) and the optimal cut-off value in Chinese healthy physical examination population.Methods: We selected a healthy physical examination population for bone mineral density screening at the Health Examination Center in Peking University Third Hospital from 2013 to 2016. Quantitative ultrasound (QUS) results were used as the gold standard, and T value ≤-2.5 was defined as osteoporosis patients. Diagnostic test methods were used to analyze the sensitivity, specificity, likelihood ratio and area under curve (AUC) of different cut points of OSTA. The screening accuracy of OSTA at different cut points was compared and the optimal cut-point value determined.Results: A total of 5 833 subjects were included in the study, with an average age of (48.3±17.5) years and 2 594 women (44.5%). The QUS test showed 403 patients with osteoporosis (6.9% of the total population), 343 female osteoporosis patients (13.22% of the female population). In the whole age group, AUC at the international routine cut-off value (OSTA ≤-1) screening for osteoporosis was 0.815 (95%CI: 0.804-0.825), and screening accuracy was higher in the women (AUC=0.837, 95%CI: 0.823-0.851) than that in the men (AUC=0.767, 95%CI: 0.752-0.781; P<0.05). In the whole age group, when the optimal cut-off value was 0, its AUC 0.842 (95%CI: 0.832-0.851) was significantly higher than that when the cut-off value was -1 (P<0.01), and net reclassification improvement (NRI) increased by 5.5%. In the 40 to 65-year-old group, when OSTA cut-off value ≤0, the screening accuracy was significantly higher (NRI=19.5%, P=0.003) than that when it was-1.Conclusion: The OSTA screening tool had good osteoporosis screening value in healthy people, and the screening accuracy in women is higher than that in men. Increasing the screening cut-off value of OSTA would be helpful to improve the screening accuracy in the whole and 40 to 65-year-old population. There may be different optimal cut-off values for different age group population.

Key words: Osteoporosis self-assessment tool for Asians, Bone density, Health surveys, Sensitivity and specificity

CLC Number:

R681

Peng WANG,Hua WU,Ying CHE,Dong-wei FAN,Jue LIU,Li-yuan TAO. Evaluation of screening accuracy on osteoporosis self-assessment tool for Asians and its cut-off value in healthy physical examination population[J].Journal of Peking University(Health Sciences), 2019, 51(6): 1085-1090.

Figures/Tables 4

Table 1

Characteristics of the participants"

Items	All	Non-osteoporosis	Osteoporosis	t/χ²	P value
Participants, n (%)	5 833	5 430 (93.09)	403 (6.91)
Age/years, $x ?$ ±s	48.32±17.53	46.42±16.40	74.02±10.70	33.26	<0.001
Age group, n (%)				1 111.43	<0.001
<40 years	2 398 (41.11)	2 390 (44.01)	8 (1.99)
40-65 years	2 274 (38.99)	2 216 (40.81)	58 (14.39)
≥65 years	1 161 (19.90)	824 (15.18)	337 (83.62)
Gender, n (%)				289.55	<0.001
Female	2 594 (44.47)	2 251 (41.45)	343 (85.11)
Male	3 239 (55.53)	3 179 (58.55)	60 (14.89)
Height/cm, $x ?$ ±s	166.44±8.26	167.11±7.99	157.39±6.32	23.89	<0.001
Weight/kg, $x ?$ ±s	67.34±13.20	67.86±13.23	60.26±10.40	11.28	<0.001
BMI/(kg/m²), $x ?$ ±s	24.17±3.60	24.17±3.62	24.26±3.45	0.47	0.638

Table 1

Table 2

Figure 1

Table 3

References 28

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Items	Osteoporosis,n (%)	Sensitivity/%	Specificity/%	+LR	-LR	AUC (95%CI)
All age group
All	403 (6.9)	73.95	88.99	6.71	0.29	0.815 (0.804-0.825)
Male	60 (1.9)	66.67	86.66	5.00	0.38	0.767 (0.752-0.781)
Female	343 (13.2)	75.22	92.27	9.73	0.27	0.837 (0.823-0.851)
More than 40-year-old
All	395 (11.5)	75.44	80.33	3.84	0.31	0.779 (0.753-0.805)
Male	58 (3.1)	68.96	77.12	3.01	0.40	0.730 (0.661-0.800)
Female	337 (22.11)	76.56	85.35	5.23	0.27	0.809 (0.781-0.838)

Items	AUC	SE	95%CI	Z	P₁	NRI	P₂
All age group
OSTA ≤-1	0.815	0.011	0.804-0.825	Ref.	Ref.
OSTA ≤ 0	0.842	0.010	0.832-0.851	3.692	<0.001	0.055	<0.001
OSTA ≤ 0.62	0.850	0.009	0.841-0.859	4.048	<0.001	0.071	<0.001
40 to 65-year-old
OSTA ≤-1	0.572	0.025	0.551-0.592	Ref.	Ref.
OSTA ≤ 0	0.669	0.033	0.649-0.689	3.428	<0.001	0.195	0.003
OSTA ≤ 0.62	0.724	0.033	0.706-0.743	4.693	<0.001	0.305	<0.001
More than 40-year-old
OSTA ≤-1	0.779	0.011	0.765-0.793	Ref.	Ref.
OSTA ≤ 0	0.792	0.010	0.778-0.805	1.637	0.102	0.025	0.126
OSTA ≤ 0.62	0.790	0.009	0.776-0.803	1.153	0.249	0.021	0.293

Evaluation of screening accuracy on osteoporosis self-assessment tool for Asians and its cut-off value in healthy physical examination population

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