BFH-OST, a new predictive screening tool for identifying osteoporosis in postmenopausal Han Chinese women

Figures & data

Table 1 Inclusion and exclusion criteria for this study

Inclusion criteria

Exclusion criteria

Han Chinese nationality Postmenopausal for ≥12 months Residency in Beijing for ≥20 years Ability to read and provide informed consent

A history or evidence of metabolic bone disease (eg, type I diabetes, hyperparathyroidism or hypoparathyroidism, Paget’s disease, osteomalacia, renal osteodystrophy, osteogenesis imperfecta) History of taking antiresorptive medications Evidence of rheumatoid arthritis History of glucocorticoid use History of organ transplantation The presence of cancer(s) with known metastasis to bone Evidence of significant renal impairment Painful hip fracture, vertebral fracture, and other osteoporotic fracture Replacement of both hips

Table 2 Regression coefficients for the final multivariate model

Variable	Regression coefficient	Standard error	Index weight
Age (10 years)	−4.730	0.00	−5
Body weight (10 kg)	3.998	0.00	4
Height (cm)	0.087	0.00	0.1
Previous fracture*	−0.798	0.05	−1
Parent fractured hip#	−0.491	0.248	−0.5
Current smoking‡	−0.327	0.680	−0.5
Body mass index (kg/m^2, mean ± SD)	1.037	0.122	1
Alcohol ≥3 drinks/day§	−1.729	0.200	−2

Notes:

* Fractures after the age of 45 years; subjects answered either yes or no.

# This item asked whether the patient’s mother or father had a history of hip fracture; subjects answered either yes or no.

‡ Subjects answered either yes or no depending on whether the patient currently smoked tobacco.

§ Subjects answered yes if the patient takes three or more drinks of alcohol daily. A drink of alcohol varies slightly in different countries from 8 to 10 g of alcohol. This is equivalent to a standard glass of beer (285 mL), a single measure of spirits (30 mL), a medium-sized glass of wine (120 mL), or 1 measure of an aperitif (60 mL).

Abbreviation: SD, standard deviation.

Figure 1 ROC and sensitivity and specificity values of BFH-OST for diagnosis of osteoporosis (T-score ≤−2.5SD).

Notes: (A) AUC and (B) sensitivity and specificity values of BFH-OST for the diagnosis of osteoporosis (T ≤–2.5) using BMD measurement. *Optimal BFH-OST index cutoff.
Abbreviations: BFH-OST, Beijing Friendship Hospital Osteoporosis Self-Assessment Tool; AUC, area under the curve; CI, confidence interval; +LR, positive likelihood ratio; –LR, negative likelihood ratio; WHO, World Health Organization; BMD, bone mineral density; ROC, receiver operating characteristic curve; SD, standard deviation.

Table 3 Summary of descriptive characteristics of the study cohort (n=1,721)

Characteristic	Mean or value	Range
Age (years), mean ± SD	60.71±8.471	40–89
Age group (years), n (%)
40–49	79 (4.61)	40–49
50–59	833 (48.57)	50–59
60–69	479 (27.93)	60–69
70–79	290 (16.91)	70–79
≥80	34 (1.98)	80–89
Height (cm), mean ± SD	159.00±5.134	140–178
Weight (kg), mean ± SD	60.94±9.142	35–94
Body mass index (kg/m^2), mean ± SD	24.09±3.35	14.38–36.72
Age at menarche	13.8±1.21	10–18
Number of pregnancies	2.64±0.85	0–11
Number of live births	1.61±0.45	0–9
Years since menopause	14.21±8.92	1–42
Age at menopause	49.4±3.65	42–60
BMD (g/cm^2), mean ± SD
L1–L4	0.85±0.15	0.136–1.534
Femoral neck	0.69±0.12	0.305–1.160
Total hip	0.80±0.13	0.347–1.308
T-score, mean ± SD
L1–L4 T-score	−1.11±1.38	−5.3–5.3
Femoral neck T-score	−1.13±1.24	−5.1–3.6
Total hip T-score	−0.61±1.20	−4.7–4.0
WHO diagnostic categories, n (%)*
Normal	516/1,721 (29.98)
Osteopenia	815/1,721 (47.36)
Osteoporosis	390/1,721 (22.66)
T-score ≤−2.5, n (%)
L1–L4	268/1,721 (15.57)
Femoral neck	215/1,721 (12.49)
Total hip	90/1,721 (5.23)

Notes:

* Lowest BMD T-score in the lumbar spine, femoral neck, or total hip was considered.

Abbreviations: SD, standard deviation; BMD, bone mineral density; WHO, World Health Organization.

Figure 2 Distribution of T-scores of different sites by BFH-OST.

Abbreviation: BFH-OST, Beijing Friendship Hospital Osteoporosis Self-Assessment Tool.

Figure 3 The comparison between OSTA and BFH-OST for the diagnosis of osteoporosis (T-score ≤−2.5).

Abbreviations: BFH-OST, Beijing Friendship Hospital Osteoporosis Self-Assessment Tool; OSTA, Osteoporosis Self-assessment Tool for Asians; AUC, area under the curve; CI, confidence interval.

Table 4 Distribution of test results for BFH-OST based on either femoral neck or total hip or lumbar spine BMD in the study cohort (n=1,721 females)

Group	BFH-OST value	Either femoral neck or total hip or L1–L4 BMD		Total	Sensitivity %	95% CI	Specificity %	95% CI	PPV %	95% CI	NPV %	95% CI
		T ≤−2.5	T >−2.5
Routinely screened, all ages	Increased risk (≤9.1)	284	365	649	73.58	68.9–77.9	72.66	70.2–75.0	43.8	39.9–47.7	90.5	88.6–92.2
	Low risk (>9.1)	102	970	1,072
	Total	386	1,335	1,721
<60 years	Increased risk (≤9.1)	30	65	95	33.66	24.6–43.8	92.02	89.9–93.8	34.3	25.0–44.6	91.8	89.7–93.6
	Low risk (>9.1)	67	750	817
	Total	97	815	912
≥60 years	Increased risk (≤9.1)	250	304	554	87.72	83.3–91.3	42.31	38.0–46.7	45.5	41.2–49.7	86.3	81.4–90.2
	Low risk (>9.1)	35	220	255
	Total	285	524	809

Abbreviations: BFH-OST, Beijing Friendship Hospital Osteoporosis Self-Assessment Tool; BMD, bone mineral density; PPV, positive predictive value; NPV, negative predictive value; CI, confidence interval.