Osteoporosis Risk Score

Score algorithm

Osteoporosis risk is stratified by this method by using 6 risk factors, each of them with answer choices that are then weighted in a formula.

The risk factors and their individual weights are introduced in the following table:

The osteoporosis risk score is calculated via the following formula:

SCORE = Race + Rheumatoid Arthritis + Fracture history + Estrogen + (3 x Age / 10) - (Weight in lbs / 10)

The interpretation of the score is based on three risk categories for likelihood of osteoporosis diagnosis:

■ Low risk: scores of 6 and below;

■ Moderate risk: scores between 7 and 15;

■ High risk: scores of 16 and above.

About the study

The score was created by Dr Lydick as a stratification tool to be used in the assessment of post-menopausal women at risk of osteoporosis. Risk of osteoporosis was defined as BMD T scores <-2.

The score was developed based on data collected from subjects that have answered the questionnaire and underwent bone density measurement via dual x-ray absorptiometry.

Further validation involved a cohort of 1,279 subjects.

Although the score does not directly account for the result in bone mass tests, it helps connect individual patient characteristics with osteoporosis risk and therefore refer them for testing.

The test sensitivity was established at 91% (tested through validation study) and specificity at 40%.

Osteoporosis risk

Before the above osteoporosis risk, the only screening method was bone density test (bone densitometry) but this was often only applied in certain cases.

The risk score is a less costly alternative and allows a real mass screening before qualifiable patients are sent for further testing.

The bone density test measures the density of bones and is used to predict risk of future fractures. It is performed via a dual-energy x-ray absorptiometry scan of the hip and spine.

The result is called a T-score. The T-score statistically compares the result obtained after scan with standard measurement of a healthy thirty-year-old of same gender and race as the patient.

The interpretation is standardized as follows:

■ T-score of -1.0 or higher – indicates normal bone status;

■ T-score between -1.0 and -2.5 indicates osteopenia;

■ T-score of -2.5 and below are consistent with osteoporosis.

Early stages of osteoporosis don’t show significant symptoms therefore can go overlooked. Progressed cases experience back pain, loss of height in long term or even bone fractures (most commonly of the wrist, hip or spine).

Osteoporosis risk factors include:

■ Gender and age: women are more likely to develop it and the risk increases with age;

■ Race: osteoporosis prevalence is higher in white and Asian populations;

■ Family history of fractures: especially hip fractures;

■ Hormone levels: estrogen decrease in menopausal women;

■ Body frame: people with smaller body frames have a higher incidence;

■ Medication: such as steroids, that interfere with bone processes;

■ Lifestyle: lack of exercise and low calcium intake as risk factors.

Original source

Lydick E, Cook K, Turpin J, Melton M, Stine R, Byrnes C. Development and validation of a simple questionnaire to facilitate identification of women likely to have low bone density. J Manag Care. 1998; 4(1):37-48.

Validation

1. Geusens P, Hochberg MC, van der Voort DJ, Pols H, van der Klift M, Siris E, Melton ME, Turpin J, Byrnes C, Ross P. Performance of risk indices for identifying low bone density in postmenopausal women. Mayo Clin Proc. 2002; 77(7):629-37.

2. Cadarette SM, Jaglal SB, Murray TM. Validation of the simple calculated osteoporosis risk estimation (SCORE) for patient selection for bone densitometry. Osteoporos Int. 1999; 10(1):85-90.